Bosch: The Ascent into the Empyrean

A couple of weeks ago I had a patient, who had a lot wrong with him, including a leaking aortic aneurysm. He was compos mentis, but pretty frail. An operation was risky, but was his only chance. I discussed it with him and his family. “No” he said clearly “I’m going to see my wife again”. He was a widower, and died peacefully two days later. He was the latest in an occasional series of patients who quite clearly were almost in conversation with unseen presences as they approached death. It’s not a rare phenomenon.

When I was in training years ago, I met a 10 year old boy, in and out of hospital with serious complications of cystic fibrosis. One day he said to his mother that the next time he got pneumonia, he did not want antibiotics. He said that  he realised how much his mother was suffering, and he had seen beyond the fact of death, and was ready to go. The staff were devastated, but he stuck to it, and died within a week.

441 years ago, an English lady, Margaret Clement died in exile. 35 years earlier she had found ways to tend to nine Carthusian monks whom Henry VIII had chained upright in Newgate prison for refusing to take the Oath of Supremacy. They starved to death, one by one, over many weeks. All those years later, as she lay dying in Malines, she told her husband that the monks of the Charterhouse were about her bed calling her “to come away with them, and that therefore she could stay no longer”.

Three examples of the approach of death, where clearly the dying individual is experiencing something very real, that others in the room cannot feel. I’ve seen it quite a few times, and every time it genuinely moves me.


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