“I'm not going anywhere!” she exclaimed, as she settled down for the night in her comfortable new bedroom. The nurses were perplexed; this lady knew the hospice was a short-stay unit. She had been referred to us for pain control prior to moving into a nursing home. “I like it here, I'm staying,” she insisted. The pain from her cancer was crippling and she was no longer mobile. She lived alone, and sadly, home was not a safe option. I felt like the “bad guy” trying to raise the topic of discharge planning. Reluctantly, she agreed to let us explore some nursing home options. She was quickly accepted by her top choice and they came to meet her. “She says she's still smoking. We don't take smokers.” Another home was contacted. “No beds, you'll have to look elsewhere.”

As the days ticked on and her pain improved, I got to know this lady quite well. She talked about her past, her family, her hopes and dreams. She was one of those patients you couldn't get away from, but at the same time you didn't want to. She was too young for this, life had been cruel, but humour was her coping mechanism and she always seemed to be smiling. Friends and family came to visit, and there seemed to be a growing sense of peace about her, a new contentment. One day, we were praising the efforts of the hospice gardeners when she turned to me and whispered, “There's a single tulip growing right outside the smoking-room window. I look out at it every day. I'm not going until the tulip goes.” I felt another grip of guilt; we'd just heard another nursing home bed had become available.

A few days later, I arrived at work to find she had deteriorated overnight following an acute and unexpected event. During discussions with the on-call doctor, she had stated clearly that she did not want to attend hospital. I stepped into her room and was saddened to find her just about conscious, her breathing laboured. She opened her eyes when I called her name. “I told you I wasn't going anywhere,” she rasped. I'm sure I caught a wink as the corners of her mouth lifted weakly into a smile.

I couldn't help it. I had to go and look. I snuck out to the smoking room, and there right in front of the window was a shriveled tulip, one petal loosely holding on. I'm not in any way superstitious, but I felt a slight chill run down my spine.

The next morning I peered into the smoking room before arriving onto the ward. The last petal had dropped, leaving behind the naked stem. I didn't need to be told. “She was very peaceful at the end,” they said.

As doctors, our lives are very scientific. We are taught about the clinical signs that indicate a patient is approaching the end of life. Yet there's something about death that is purely spiritual. We often hear about patients who “held on” for that important anniversary, wedding, or birthday before they finally “let go.” As if there was an element of control. We will never truly understand this, but in the busy whirlwind of medicine, it's a refreshing thought when I look out the window and remember my patient, as the last petal drops.