Back at home, August is birthday month. There are something like six birthdays in my family in August, mine and my twin brother’s included. So while I am used to celebrating a birthday almost every week, I didn’t expect the trend to follow me here. First it was my host mom’s niece, then my host mom’s sister. Next it was my birthday, then the birthdays of two of the hospice’s psychologists. Finally, we celebrated the birthdays of two of our patients.
How do you celebrate someone’s last birthday? This was the question running through my mind as Estefany and I set up the hospice lounge for Doña Elena’s 79th birthday party. We were celebrating her birthday a couple of days early to accommodate some family conflicts, and we wanted everything to be as nice as possible. There was, however, one inescapable problem. We were in a hospice. Doña Elena had been relatively healthy when she first entered Hospice San Camilo; every day, she would get out of bed and seat herself in a more comfortable arm chair, where she would enjoy her breakfast before taking a small walk around the hospice grounds accompanied by her caregiver.
Doña Elena began to decline about a week before her birthday celebration, although the changes were subtle. She talked slower, used her wheelchair to get around the hospice garden, and seemed generally more tired. The day of her party, however, Doña Elena was full of energy. She bathed in the morning even though she had just showered the day before. With the help of her caregiver and some of the nursing staff, she had her hair and makeup done by 11 a.m. The party was to start promptly at noon. Her family members began to arrive around 11:30, and each one seemed to bring another treat to add to our spread.
Once Estefany and I had everything set up, we invited the family and hospice staff into the lounge. Doña Elena’s daughters brought at least two dozen roses with them. They passed them around the room so that everyone had at least one rose. Estefany set up a rendition of Happy Birthday on her laptop, began to play it aloud, and then entered Doña Elena, accompanied by her older sister and Dra. Gaby.
One of Doña Elena’s daughters began to tear up immediately. We sang Happy Birthday three different times, once in Spanish, once in English, and then again in Spanish. After we were finished singing, everyone began an impromptu line to hand Doña Elena their rose, and to personally wish her well. As each friend, family member, or medical worker greeted Doña Elena with a rose, a hug, and a blessing, the emotion in the room became tangible. More of Doña Elena’s children were visibly tearing up as the procession continued. After Dra. Gaby gave Doña Elena the last rose, she proposed a toast to Doña Elena and her family. Her toast was met with cheers, “¡Que viva la cumpleañera!“
Doña Elena died a week after her birthday celebration. Her decline was swift, and relatively painless. The day before she died, I was helping one of the nurses get her ready for her shower. Doña Elena and I were chatting a little while we waited for the shower to warm up.
“I celebrated my birthday last week.”
“Yes, I was there! It was beautiful, and all of your family came, right?”
“Yes, they came to celebrate my birthday.”
“How lovely. And, did you like the cake? I thought it was delicious.”
Doña Elena and I had the same conversation the day before, and the day before that. She nodded and smiled before shutting her eyes and muttering something else about her birthday that I couldn’t understand. The nurses then took Doña Elena to the shower and that was the last time I spoke with her.
The next day Dra. Gaby, with tears in her eyes, informed me that Doña Elena had passed away.
“I guess she had been waiting for her birthday. That was it. ”
As I reflected on Doña Elena’s birthday and death, I began to think even more about my own birthday. I have never really celebrated my own birthday. I had always blamed my lack of celebration on soccer…I always had a game or a practice or something on my birthday that seemed more important than the fact it was my birthday. Even when I wasn’t busy with soccer, my birthday just didn’t really matter to me. In the light of Doña Elena’s death, however, it became clear to me what a birthday really is. At its core, celebrating a birthday is acknowledging our mortality. I was left wondering if perhaps I would care about my birthday more if I wasn’t so complacent about my own mortality.
We celebrated Doña Daniela’s birthday much like we celebrated Doña Elena’s. Doña Daniela had been a patient at the hospice when I arrived, and her condition remained relatively stable during the two months leading up to her birthday. Some of her daughters visited often, but just as with Doña Elena’s family, those who lived farther away made an extra effort to be present for Daniela’s birthday celebration. We celebrated Doña Daniela’s birthday two weeks early before her youngest daughter had to leave Quito. Doña Daniela tended to spend a large part of the day in her bed, and was a little weaker than Doña Elena had been, so we decided to host the party in her hospice room, where everyone gathered for cake and to sing happy birthday. Although Doña Daniela fell asleep in her chair while we were singing happy birthday, everyone seemed to enjoy the celebration. The room seemed to be filled with less emotion than Doña Elena’s party had been, maybe because she had been stable for so long.
Nonetheless, Doña Elena died one week after her birthday party. Dra. Gaby and I were doing home visits in the south of Quito when she got the call. We were both stunned–neither one of us had expected her death to come so soon.
How do you celebrate someone’s last birthday? Maybe I should be asking, how do you know if it’s someone’s last birthday? In a hospice it’s certainly easier to predict. But I guess you never really know. I think next year I will celebrate my birthday a little more.