By Nancy Manahan and Becky Bohan —

This excerpt from Living Consciously, Dying Gracefully: A Journey with Cancer and Beyond recounts the extraordinary death of Diane Manahan, R.N., M.S., a professor of nursing at Minnesota State University, Mankato. Her husband Bill Manahan, M.D., a holistic physician, had helped his wife to be in the driver’s seat for her five-year journey with breast cancer. Now he, their four sons, and their wives supported Diane to die at home, as she wished.

As part of the family’s round-the-clock vigil, Bill slept with Diane as he had for the thirty-seven years of their marriage, holding and comforting her when she would wake during the night and ask, “Why can’t I die, Bill? I’m ready to go. Dying is harder than I thought it would be.”

On the last morning of her life, Diane sat up while two of her grandchildren sang to her. Her sister-in-law, Nancy Manahan, took the next shift. No one realized it would be the last shift.

Two hours later, surrounded by her family, with Bill holding her hand, Diane Manahan slipped away, as consciously and as gracefully as she had lived her life. Nancy tells the story of Diane’s last hours.

Nancy says:

I could hardly grasp the reality: Diane, my beloved sister-in-law, was dying.

This strong, healthy marathon runner had gone from hiking, to walking, to needing a cane, to using a wheelchair. This popular college professor and gifted public speaker now whispered. She had lost almost thirty pounds, was profoundly jaundiced, had difficulty breathing, and hurt. Recently, while hugging her goodbye, I had inadvertently pressed on a tumor near her spine, and she had winced.

But the worst symptom, Diane said, was the unrelenting itching. a week and a half before she died, I offered to give her a massage, which normally she would have loved. But this time, she had asked for a body-scratch.

Diane lay on the sofa, her supple, tan legs across my lap. While I was scratching her calves and thighs, Diane said she loved the poem I had sent her, Mary Oliver’s “In Blackwater Woods.” She asked me if I would read it at her Life Celebration. I said I would be honored. (She had asked many people to actively participate in this meticulously-planned event.) We talked about it calmly, rationally, as if discussing her funeral were the most natural thing in the world.

On the 90-minute drive back home to Minneapolis, I gripped the steering wheel, sobbing, gasping, and howling as wave after wave of grief washed through me. How could I let her go?

Ten days later, on July 13, 2001, I drove to Mankato to see Diane. When I arrived, my brother told me, “Diane’s ready to die, but she doesn’t know how to do it. She’s so strong she could live for several days or even weeks.”

Bill went upstairs with me. Diane was lying in bed, looking tired but beautiful. There were no visible signs of cancer. Their daughter-in-law Kate later told me that two days earlier, after she had given Diane a bath, Diane’s stylist, had come to the house to wash and style her hair. As I leaned over to kiss her hello and hold her hand, I could smell her fresh warm scent.

“Diane, it’s Nancy. I know it’s late, but I wanted to say hello before I go over to MaryPat and Jon’s house for the night.”

She nodded and squeezed my hand. I sat on the bed and tried to be an open channel for comfort and peace, letting loving energy flow toward Diane.

Bill watched us. He knew I had to leave soon. After a few minutes, he came over to the bed. Diane put her arms around his neck and he helped her stand up and walk to the bathroom. She sat unsupported on the toilet.

“Goodnight, Sweetie,” I said from the bathroom doorway. “I’ll be back in the morning.”

“Okay,” Diane whispered, a smile barely lifting the corners of her mouth.

Diane’s sister Patt stayed until ten o’clock that evening. She told me that before she left, she leaned over the bed and said, “Good-night, Diane. I love you.” Diane whispered back, “I love you, too.” Those were the last words she ever spoke.

Topher took the midnight to four a.m. shift so Bill could get some sleep. As Topher lay next to his mother, he could hear her stop breathing for a while, gasp, and then resume breathing. This Cheyne-Stokes Respiration pattern is typical of someone in the dying process. At four o’clock, Topher’s wife Katy relieved him.

After an early breakfast at my niece’s, I drove back to Bill and Diane’s house. Riding with me was their only granddaughter, four-year-old Tessa, and their two-year-old grandson, Teliz. On the drive, the kids belted out a Northwoods canoeing song they had just learned.

“Can we sing this for Grandma Di-Di?” Tessa asked.

“Yes, of course,” I said. “Your grandma has always loved canoeing in the wildlerness. She’d like to hear your song.”

When we arrived and climbed the stairs to the bedroom, Diane was in fresh pink-flowered Capri-pajamas. Her eyes were closed. She seemed to be resting comfortably.

“Good morning, Katy,” I said. “Good morning, Diane. It’s Nancy. Tessa and Teliz are here, too.”

Diane didn’t respond.

“They’ve been practicing a song they’d like to sing for you. Would you like to hear it?”

Diane immediately pushed herself to a sitting position and swung her legs over the side of the bed. Blond-haired Tessa and Teliz stood side by side looking up at their grandmother’s face and sang softly.

Land of the silver birch

Home of the beaver

Where still the mighty moose

Wanders at will.

Although Diane kept her eyes closed, she leaned toward the children and appeared to be listening intently. Their voices grew more confident:

Blue lake and rocky shore,

I will return once more.

Boom-diddy-ah-da, Boom-diddy-ah-da, Boom-diddy-ah-da, bo-oo-oom.

After another verse, Tessa and Teliz giggled with pleasure at their performance. They scampered downstairs, calling back “Bye, Grandma Di-Di!” Diane lay back down on her side.

Katy looked tired. She had been with Diane for almost four hours. I told her that I would take the next shift.

I joined Diane on the bed, my face less than a foot away. I marveled at her clear, supple skin and generous lips.

Suddenly Diane opened her eyes and gazed directly at me. The deep blue of her irises against the bright yellow-gold of her eyes still astonished me. During the past nine weeks, I had not gotten used to what liver failure had done to her coloring.

As Diane stared at me, I started to feel uncomfortable. Did she need anything? Did she want to say something? Did she even see me? Gradually her gaze soothed my fears and answered my questions. I could see no anguish in her eyes, no suffering or sorrow. I sensed a deep, calm spaciousness. It was like looking through her eyes into eternity. I settled down inside and let myself be still with her. For long, precious minutes, we just gazed and breathed together.

Then Diane pushed herself back into a sitting position and swung her legs over the side of the bed, her bare feet on the floor. I got off the bed and faced her. She reached up and pulled my head to her shoulder. I had seen Diane do this with Bill the night before when he had helped her stand. Thinking she needed to use the bathroom again, I started to straighten up. But Diane clamped down on my neck. She was strong!

“Do you want me to stay like this for a while?” I asked.

She didn’t respond.

I was bent almost ninety degrees at the waist. After a minute, my back was aching.

“Diane, this position isn’t comfortable for me. If you want some support to stay sitting up, I could get behind you, and you could lean back against me. How would that be?”

Immediately Diane’s hands dropped to her lap. I crawled onto the bed behind her, spread my legs, and pulled her snug against me so that her legs stretched out between my legs. She leaned back against my chest, her cheek touching my cheek.

For the next two and a half hours, that’s how we stayed. It was one of the most intimate and sacred experiences of my life. It was an honor to hold her, support her, breathe with her, love her.

After a while, I heard words in my mind. I pushed them away. Diane didn’t need any words. After all, she was engaged in one of the most profound labors of her life. But the phrases kept coming, and eventually I trusted them. If Diane wanted me to be quiet, she would let me know.

“That’s right, Diane . . . Just let yourself relax . . . I’m right here with you . . . You don’t have to do anything . . . You can relax and let go . . . .”

I sensed a little release of tension in her body. I was calm and steady, as if I had been with a dying person many times. In fact, it was the first time.

I felt grateful for the three years of Living in Process training I had done with psychologist Anne Wilson Schaef. This self-directed healing work included hours of sitting on a mat beside someone who was allowing repressed feelings to surface, supporting them in their deep emotional release process. I had learned to trust my intuition about when to be a silent witness and when to say something encouraging or reassuring. Sitting with Diane felt similar.

“You know exactly how to do this, Di . . .Just like you knew how to be born.”

I wasn’t trying to think of anything to say, but from time to time, words spilled into the companionable, luminous stillness.

“Everything’s going to be fine, Diane . . . You are going to be fine . . . In fact, you’re going to be more than fine . . . You’re going to be free of any struggle, any pain, any itching!”

I could feel her relax more deeply. We were breathing together, eyes closed, comfortable.

“You’ll know when the time is right to leave . . .You can do it in your own time and in your own way . . . Just relax and follow the process on out . . . .”

I figured it would be several more days. Surely anyone strong enough to wrap her arms around my neck in a vice-like grip wasn’t close to dying.

At ten o’clock, after almost two hours, I said, “I just want to let you know that I have a half hour left to be with you. Becky is arriving at ten-thirty to drive us to Madelia for lunch with our moms. If there’s anything you need before I leave, just let me know in whatever way you can.”

Diane gave no response.

I resumed the rhythm of comfortable silences and the occasional words that seemed to come not so much from me as through me. I didn’t even know if I believed all the words, but I felt compelled to say them.

“You’re almost home, Diane . . . All those you have loved will be there to welcome you . . . your mother, your father, the baby you lost . . . They will be so happy to see you . . . Everyone is waiting for you . . . You’ll be home free, Diane . . . Home free.”

At ten-fifteen, Bill came upstairs. He kissed Diane, looked at my position supporting her, and asked, “Are you comfortable?”

“Pretty comfortable,” I replied. Actually, my back was starting to tire.

He propped pillows around me, which felt wonderful, and mentioned that Diane’s closest friends were coming between ten-thirty and eleven o’clock. He pulled a chair up to the foot of the bed, leaned forward, and tenderly took his wife’s left hand.

At ten-thirty I glanced at the clock. Since there was no sign of Becky, I stayed in place, holding Diane. Our chests rose and fell together.

“That’s it, Di, just trust the process. Mmm-hmm. Home free. Home free.” It was so effortless, I felt as if I could stay with her forever.

Katy, refreshed from a nap, came back upstairs. “How’s it going?”

“We’re doing well,” Bill said.

“I’ll be leaving as soon as Becky arrives,” I told her.

Katy went downstairs to ask Bill and Diane’s son or his wife to take my place.

Tim and Kate both came upstairs. Tim sat by the bed and, taking his mother’s right hand, put his fingers on her wrist, as he would have done with one of his patients.

“Her pulse feels thready,” he said.

Kate studied Diane’s face, left the bedroom and asked everyone to come upstairs. She started the music Diane had chosen to die to, Bach for the Bath. The first piece was full, slow, intense. After several measures, a plaintive cello entered.

“Oh, Diane,” I said. “There’s your beloved cello.”

More family members had gathered around. Everyone was quiet, listening to the soaring music. Suddenly I felt Becky behind me on the bed, one hand on the center of my back, the other on Diane’s arm.

As the Bach piece came to a slow, peaceful close, Tim touched his fingers to Diane’s wrist again, then to her neck.

“I don’t get a pulse,” he said.

Everyone looked at Diane, unable to take in Tim’s words.

“But she still seems to be breathing,” he observed.

Diane’s chest was rising and falling, slowly, steadily. After a minute, Tim touched her neck again. “I think that’s Nancy breathing. She’s gone.”

It was true. She was gone.

Bill, still holding Diane’s hand, put his head on their joined hands on the bed and sobbed, “Thank goodness, thank goodness.” After days of yearning for death, Diane had finally been released.

Although we all were crying, I felt strangely calm, full, saturated with the sacred mystery of the moment.

“You did it, Diane,” I murmured, tears running down my cheeks and wetting Diane’s still warm cheek. “You did it. You’re home free.”

Excerpted from Living Consciously, Dying Gracefully: A Journey with Cancer and Beyond by Nancy Manahan and Becky Bohan. For more information or to order their book, visit the authors’ website www.nanbec.com or amazon.com.

Tags: grief, hope