Nourishment while fasting.

Being in the hospice business does not give one a getout-of-mourning-free card. Death that is personal is so very different from death I encounter in my professional role. My father, Peter Serrell, died in November after a 10-day elective fast, 7 weeks before his 94th birthday. He had been in the hospital for a couple of days with a poorly defined problem in his gut, where ischemic colitis was highest on the differential. ‘‘It seems to be getting better’’ said the surgeon. ‘‘I’m going to put you back on some solid food and see how it goes.’’ ‘‘I have a different special diet planned,’’ said Peter. ‘‘No solid food, and no liquids either. I don’t want to wait for the next catastrophe.’’ He had talked about using this option several times in the past, but had not stuck to it. Each of the prior times, some acute event had frustrated him with another take-away from his sense of capability, dignity, and safety, but the frustration had been short lived and either the crisis had passed or he had learned to adjust to ‘‘a new normal.’’ This time he did not seem pissed with life, just ready for it to be over. I had the creeps about being ‘‘supportive’’ of his decision. It was not okay to agree with his wanting die. But it became clear to me that instead of ‘‘wanting to die’’ he saw that death was not ‘‘optional’’ but inevitable. He did not want to die BADLY, in a hospital or needing care that would burn out his caregivers. This time he stuck to his plan, day by day. He was himself and clear-headed except for the last 2 days. I had spent the first 7 of those days with him, and I knew that when I left for the airport at the end of that visit that I would not see him again. I was not sure how best to spend the final hour of my visit. In April of the prior year he had engaged in a discussionpromoting process using a set of ‘‘Go Wish’’ cards. This is a deck of cards that have things written on them that people have said might be important to them in the last days of life. There is also a wild card so that you can create other options if what you want is not already on one of the cards. He read through the cards, came up with one of his own, and sorted them into what was ‘‘most,’’ ‘‘somewhat,’’ and ‘‘not’’ important; then from the ‘‘most important’’ pile he chose and ranked his Top Ten. He did the sort with his wife of 19 months, Becky, and they talked about what he wanted and what he did not care about. Becky kept a written list of his 10 most important priorities. When the time came, we brought out the list: