Beyond Knowing: Mysteries and Messages of Death and Life from a Forensic Pathologist 
by Dr. Janis Amatuzio

Dad died in August this year; my own father…a physician and internist, the one who inspired me to be a doctor.  It is hard to believe that he is gone; from my sight, from our holiday meals, from our daily lives.  What will the Holidays hold for my family and me?  This year will be different. 

But it was always Dad who said not to worry, that he would be fine. I remember when I was in 9^th grade and called 911 after I found my father collapsed in his chair, slumped over his desk in the library where he read each night.  He was in the hospital for 2 weeks; when he came home he was very weak.  The only thing good that happened was my mother let me drive his car to school and back every day. I felt quite proud of myself, even somewhat “grown-up”.  

When Dad was out of the hospital, I reported to him each day after school.  We talked about my high school classes, exams and grades of course, and now we discussed “our Oldsmobile”. I often found him resting on the bed upstairs when I got home from school. It was autumn, and the door to the deck was open to let in the fresh leafy fall air.  

The day I filled up the gas tank for the first time on my own, I proudly handed him the receipt. “Now, I would like to learn how to check the oil, Dad.”  My father looked at me with surprise, “The oil!! Why would you want to check the oil!” he said.  

“To be sure it keeps on running, Dad. You know, it’s ‘our Oldsmobile’ now”. 

“Not so fast, Janis, not so fast”, he said with a smile. “You remind me of myself when I was young. My Uncle Johnny had an Edsel, that’s when I learned to check the oil; actually Uncle Johnny taught me how to drive. We had so much fun with that old car, cruising around the old neighborhood, giving rides to our friends.” 

I remembered my great Uncle Johnny only slightly. I remembered that he always had a joke to tell my father, and that they would laugh so hard when they saw one another. John Chiovotte had died a long time ago. 

“When was the last time you saw Uncle Johnny, Dad?” I asked. Dad smiled slowly, and he paused.  

“I saw him when I had my heart attack in the library”, Dad said. “He put his arm around my shoulder and smiled at me. He was so gentle, and so happy.” 

I listened intently; my father seemed lost in thought. 

“Did he say anything to you?” 

“Not in so many word, Janis. I was so happy to see him, I felt like he was telling me not to worry. Then he started to leave, and I called after him. He looked back and I heard, ‘Don’t worry, Don, I’ll be here’. That was the last time I saw my Uncle Johnny.”  

The story seemed real to me, and I was not surprised. My father had told me of other similar experiences; I never questioned their validity. 

However, now it is my turn. 

Dad died at home in August, with the help of hospice care. He had managed his chronic renal failure with all his medical skill and will power; eating no protein and following a diet low in sodium and potassium. Finally the symptoms of kidney failure caught up with him; nausea and weakness, and profound bone pain. My mother called me in tears late one evening, and I rushed down to their home to be there, and help with their decisions. 

The next morning he got up early, apparently unable to sleep. I found him sitting on the patio in the backyard. He was starring down at the cement; his hands were hanging motionless from the arms of the chair. It was cool out, and the chirping birds were the only sound. Dad was almost blind; his vision had deteriorated due to macular degeneration. I pulled up a chair and sat there with him. I am glad I didn’t know that it would be just 10 days till he died. 

“I’m in trouble, Jan”, he finally said. “I can’t win this one; the nausea and pain is getting the best of me. He put his head in his hands, “I don’t know what to do.” My heart went out to him. “I’d have to go on dialysis to feel better, and at 88, I know how that could end…in disaster.” 

I had listened to my father all my life, I had always been the student and the daughter; he the physician, father, and teacher.  He had always been the one to comfort and reassure me. Now, on a morning in early August, I realized the roles had gently reversed.   

Then, I used everything I knew about medicine, dialysis, dignity, and about my dad to help guide his decision. I had the strange sense I had known this moment would come all along. 

“Dad, you can’t think clearly when you feel so bad. Let me remind you of what you have always said.” 

His weary eyes looked up at me. “You have always told me you wanted to die at home, not in the hospital. You said you wanted to live in your own home, and plant your tomato plants and green beans. You said you wanted to die with dignity, and to be able to make your own decisions.  I know things have been tough for you these past few months, you’ve told me more than once that ‘time is short’”. 

And you have lived at home, you planted your garden, and you have been here with Mom. Dad, I don’t know how you could have done it better…You’ve handled this chronic disease, with such dignity and grace. You never complain.  

I could see he was listening. He clasped his hands in front and sat a little easier in the chair. Is there anything else you want to do, Dad?  Is there anything left unfinished?  He shook his head, no. Then he waited. 

“Well, Dad, I think you might want to consider hospice care; you can stay here, there will be no dialysis, and there is medication that will keep you comfortable. It can relieve the nausea and the bone pain. You can stay home with Mom, and be here where you are comfortable, in your own bed.” 

“Thank you Jan, that’s what I needed to hear; thank you for reminding me. I will go on hospice; will you call my doctor and make the arrangements?

“Sure Dad, I will.”  

Then tears filled my eyes and spilled down on my cheeks. It seemed that time stood still, it didn’t seem real, but it was. “I’ll miss you”, I choked out.  I couldn’t say another word.  

“I’m a free man now” he said with a smile. He looked visibly relieved and calmer. “Take good care of your mom, I am leaving you in charge. And Janis, don’t worry, I’ll be here.” 

I looked up quickly. “You know what I mean.” 

“Yes, Dad, I know”, I answered. “Just like Uncle Johnny.” Dad nodded and smiled. 

My father did die in his own bed sometime after 3 in the morning, when all of us who were staying at the house had gone to sleep. He died holding my mother’s hand. It was just the way he had wanted it. 

Later that evening, after all the arrangements had been made, I was driving home. I was finally alone, tired, and dazed. I drove in silence, reflecting on the life changing events of the day; tears frequently filling my eyes. After 45 minutes I was nearing my home, and suddenly I felt I had had enough silence.  I punched on the radio to my favorite country station. What happened next amazed me. 

A song by Martina McBride was playing; “In my daughter’s eyes”. I listened to the words as the last verse was sung,

“In my daughter’s eyes, I can see the future

A reflection of who I am and what will be

When I’m gone I hope you’ll see

How happy she made me

For I’ll be here,

In my daughter’s eyes. 

As a forensic pathologist, I have listened to these amazing experiences for years and have written two books about them, Beyond Knowing and Forever Ours. Those who have told me of their own synchronicities, dreams, and visions after the death of a loved one have been comforted by the reconnection, once again.   

I have kept this experience close to my heart, and have written the words of the last verse on a piece of paper I keep in my purse.  When the waves of sorrow come, often when I least expect it, I take out the paper and reread them again.  

And then I remember the beautiful words that Richard Back wrote, “What the caterpillar calls the end of the world, the master calls a butterfly.” These brief, beautiful connections, these mysteriously soothing gifts of love and reassurance…  Perhaps they really are true. And, of course, that would change everything! 

The holidays will be different this year, but then again, so am I. 

_______________________ 

Janis Amatuzio, MD, author of Beyond Knowing and Forever Ours, is known as the “compassionate coroner.”  She is the founder of Midwest Forensic Pathology, P.A., serving as coroner and a regional resource for several counties in Minnesota and Wisconsin.