What makes people stop being afraid of death?

Shortly before the end: How people die

He: director of a hotel group. Economics studies at Lake Geneva. House on Bora-Bora. You: forwarding agent. Aborted high school. Drugs. The child removed after birth. Hardly any points of contact in two different lives, and yet they sit next to each other, on the same terrace in the afternoon sun.

What they have in common: they will die soon. Terminal cancer. Like many of the twelve patients in the Caritas Socialis hospice on Rennweg in Vienna. The length of stay per patient is just over two weeks. The last days of her life.

It's the beginning of October, still over 20 degrees outside. Schoolchildren play outdoors, with planes overhead as they approach Schwechat. The former freight forwarding agent Doris L. is 49 years old and her body looks battered. She smokes, her face furrowed, her gaze goes empty.

"I've done so much nonsense in my life," she says, and tears run down her gray cheeks. Ajoki from Hamburg, one of the nurses, is there when it comes to comforting and listening. Holds hands or sometimes just the ashtray. "We have our eyes, our hands," she says when it comes to how she treats patients.

Make everyday life easier

You hear a lot of questions here: Is it right? Can she bring anything else? Chilled the juice or do you prefer room temperature? There are also high-tech medical devices. Pain pumps that inject morphine, connected directly to the body via a vein flow. The patients push them beside them or place them on the table in front of them, a plastic box the size of a book. Flow rate 0.5, pulse of 1.20. What sounds technical makes everyday life easier.

The human is the center of attention. "I really like to bathe" is written on a yellow post-it that someone stuck in the patient folder of Herbert S., the hotel manager. Others stay one night on the terrace with their bed. Sleep again in the open air. Or you can go on a trip with the care team to see the Danube.

Amazingly, it is often open stories, in relationships and in the family, that preoccupy the dying in the last days of their lives. One last attempt to put things right. With Doris L. it is her mother. Mentally ill, neglected, the daughter is embarrassed for her. And yet she gives herself a jerk, for the first time in decades, and asks for a discussion.

What is the most important thing in life?

Herbert S. thinks about it. He lived on each of the five continents. A hotel opened in the port of Auckland, dived in the South Pacific. Speaks English, French, Italian, Japanese. "Don't always run after the money," he sums up after a short break.

Ajoki. At the age of 27, she jokes and laughs, encourages people, touches hands whose skin is thin as paper, and adjusts the volume of a television set. Barbara Karlich chats in the silence. Ajoki announces what she does when she turns her body in bed, connects catheters, changes diapers, full of respect for the dignity of the people. "Dying is always a very special encounter," she says. Humility, she says, is her basic attitude.

The gratitude of the patients and their relatives is palpable. The hospice - a deeply human place. Fear gives way to a feeling of security, it smells of lavender from fragrance lamps. There seems to be more stress outside, in front of the windows in Oberzellergasse, where life goes on, the church bells ring, people come home from work.

The last breath

"The last breath is always special. People choose carefully who is allowed to be there," says Cornelia, a native of the Waldviertel, a devout Buddhist and a nurse for 14 years. On this first Friday of the new year, she visits two patients at home in her little red company car, equipped with a lot of compassion and a bag full of morphine ampoules.

"I always feel like a dealer," she says and smiles. She has accompanied hundreds of people as they die. Doctors know: hearing is the last of our senses, which remains active until shortly before the end. Cornelia confirms that.

Just the day before, one of her patients died in the presence of his two grown daughters at home. They played him his favorite melody: "Insieme" by Toto Cutugno. With the last note he stopped breathing. There are many such stories: of the woman who was dying and could hardly breathe, but could only let go when her son made it to her by plane from Sydney two days later.

Another died in the three minutes when her husband, who had been at the bedside around the clock for a week, quickly changed the parking ticket in the car. Some die in hospitals or hospices because they cannot calm down at home with their families.

To die young

It is different with David, Cornelia's second visit that day. He doesn't want to die in the hospital or in the hospice. He likes the view from the window of his apartment, of the tram shed with the discarded wagons. The balcony, which he occasionally takes his wheelchair out onto to have a smoke.

David has bright blue eyes and a long scar on his head. Eight years ago he fell from the third floor in an accident onto the asphalt: since then he has lived in a wheelchair with a titanium plate in his head. As if that weren't enough of a stroke of fate, a kidney carcinoma was added. He has undergone seven chemotherapies. During the last one last June, he says, he almost gave up on himself. He is 34. His back is a gaping wound above his buttocks from sitting in a wheelchair for hours.

Cornelia, hardly older than her patient, carefully turns him to one side, changes the bandage and attaches the vacuum pump that sucks out the wound secretion. He patiently lets him handle his body. He left shame behind him a long time ago. It is like it is. Lies in bed in a hoodie, his head buried in the yellow upholstery.

He says he doesn't mind that David is likely to die earlier than his parents, who live around the corner. He would love to go on another trip, maybe with a friend. Tenerife or Amsterdam, he's never been there. A barrier-free bed and see the sea again. That would be a very nice ending, thinks David.

Shadow of the past

How will it actually be? Nobody knows until that happens. Some withdraw into an inner, invisible reality that no longer has anything in common with the outside world. Have dialogues, grapple with shadows from their past. Breathing changes about twelve hours before death. It becomes flatter, sometimes irregular. In technical jargon "terminal phase". There are dropouts that can last up to a minute.

Cornelia says that you can shorten the dying phase with a conversation about being able to go now. Even if the patient has stopped answering for a long time. The last moment is the leap into the unknown. Sometimes it is more like a back-and-forth pendulum between the worlds, the faces suddenly brighten, incredulous amazement. Then the final letting go.

In Haus Trazerberg in Vienna-Hietzing, nine pensioners stand around the coffee buffet, eight of them have a walker. The scene is somewhat reminiscent of a Monty Python film: it is eleven o'clock. "Meal," greets a lady, the others watch in silence. On the pin board a course announcement for April 2nd: focus on tombstone care. There is lighter fare in the afternoon. A film screening. "Pay over" with Hans Moser. Before that, it's into the dining room: 50 tables with green tablecloths and artificial flowers.

Once a retirement home - and never going back

Two neat ladies sit at the next table, white hair, with pearl necklaces and an emergency button on the bracelet, spooning vegetable cream soup, their movements slowly, withdrawn. Life here consists mainly of memory. Tired and sometimes wise eyes. A few meters further on, in the ward, those who are even worse off are eating.

Instead of walkers, now wheelchairs. Absent faces. Folk music is playing on the radio. "You are so close to me and always there for me." Right in the middle: Christine S., former secondary school teacher, without a wheelchair, in a good mood. She taught English, now she is demented and is eating her compote. "Would you like to have one too?" Smiling good-naturedly, she holds out her cup to me. She has lived in the house for six years and likes it very much.

Right next to her, an elderly man is always scolding to himself. Often the last phase of life shows our character unfiltered, it reveals how one lived. I thank Ms. S. "Enjoy your day", I say goodbye. She shines. "Enjoy your life!" She replies.

Sweet, but also bitter

Ms. Elfriede W, 99 years old, lies one more corridor, alone in the room, full of spirit, and waits for "that I will be redeemed". But death doesn't want to come. Not yet. Clock ticking. Black and white photos of her parents and brother on the wall. She talks to them again and again, with her "Mamschi" and the "Papschi", tells them how she is doing. Next to the bed is a thermos with tea. "I should drink it up." Cookies. Ms. W. once learned to be a seamstress, as a young woman she was sporty: a good swimmer, she loved climbing poles in gymnastics lessons.

Now her legs are failing. "You just sink in, I never would have thought that." She doesn't feel lonely. Deported, alone, dying anonymously in the home? Not here. The nurses make an effort, the board of trustees of Viennese retirement homes has given them extra training on palliative medicine. Ms. W's daughter-in-law and the four grandchildren keep coming to visit. Ms. W.'s résumé at the end of a long life? "Life is sweet, but also bitter." Smile. 100 years of life experience in one sentence.

Like a spaceship

Change of scene. Intensive care unit, State Hospital Wiener Neustadt. Those who die here do not choose that. 21 beds, there are patients with skull injuries, brain tumors. Victims of traffic accidents. Reanimated. Cerebral hemorrhage. As in room 5. Thomas R., mid 60s, gray hair, a bald head on the back of the head. He's freshly shaved. He went for a walk on January 1st, but it was a bad start to the new year.

Hours later he was found lifeless in the park with a cerebral hemorrhage. Since then he has been lying unconscious in his bed, his legs bent, his mouth half open. He is fed through a probe in his nose, artificially beamed through a tube that leads directly into the windpipe.

He does not see the gray winter sky in front of his window, nor the rocks of the high wall on the horizon. Although he opens his eyes sometimes. When Sandra, the nurse, touches him. Or suck the mucus out of the bronchi. Then it looks like he's coughing, he wrinkles his eyebrows, furrows his forehead, but no sound can be heard. Only the rustling of the oxygen and the pressure of his leg compresses building up and releasing again.

To the left of the bed: motor pumps that are remotely controlled and very slowly send medication into the bloodstream. A monitor shows blood pressure, EKG, oxygen saturation, intracranial pressure and tidal volume. If one of the values ​​exceeds a critical limit, the device triggers an alarm.

"The intensive care unit is like a spaceship, relatives are almost always overwhelmed," says Sandra. And what about the patients? They lie there as if in an in-between world, their former life hovers somewhere in space. It is as if they cannot find their way back. Open your eyes and yet you are far away.

Plug out

One in ten doesn't make it out of here alive, say the statistics. And here, too, the following applies: Not everything that is technically possible enables dignified dying. "In the past it was often a wild fight for life, by all means. Today, palliative treatment in intensive care is also possible," says Helmut Trimmel, the medical director here in Wiener Neustadt.

Again and again the question arises: "Pull the plug" or not? This question is decided in the team, in close consultation with relatives. And only when it is really clear that no improvement can be expected will it be done. The remote-controlled motor pumps then stop and the medication is discontinued. Heartbeat and blood pressure drop. The end comes with the breakdown of the circulatory system, sometimes it happens after a few minutes, but sometimes it lasts for hours.

You can see how the body decays, it is an optical dying process. But at some point it becomes quiet, the oxygen no longer rustles, a shell remains. Thomas R. has a good chance of surviving. But it will remain a nursing case.

In death, it is said, one sees how someone has lived. For Doris L. in the hospice he comes 16 days after our meeting on the terrace, in his sleep. Before that, after a long time, she was able to speak to her mother. Her supervisor explains that she was impressed that someone from a newspaper was interested in her life. She didn't think she was interesting.

Herbert S., the hotel manager, receives death a month later, quite a gentleman. Freshly shaved with his Dior aftershave on his cheeks. He thanked the nurse for shaving with a kiss on the hand. (Michael Marchetti, CURE, June 10, 2019)