My friend’s mother was coming to the end of her grueling fight with breast cancer. As a palliative care physician in a local hospital, I had used my network to help arrange home hospice services for her in her final days. By then she had become so sick from the relentless chemotherapy that she was spending most of her time either vomiting or sleeping. But finally, in hospice she was able to rest. The hospital bed was pulled into the center of the living room and she held court with her family.
She became increasingly sleepy and unresponsive. When I was visiting the house a few days before her death, my friend pulled me aside. “My mother made me promise to make sure she never had any hairs growing on her chin. But now I’m seeing one growing. What should I do?”
When she had still been healthy, before the cancer, before all of this, the older woman had made her daughter promise to immediately pluck any hairs on her chin when she was on her death- bed. Even if she was in a coma. They laughed about it at various times over the years, the good, and then the bad-- but she had meant it.
We ushered everyone from the room and shut the door. My friend shone a flashlight on her mother’s chin to illuminate the culprit hair, then plucked it. Then she brushed her mother’s hair and fastened it in a clip. She murmured into her mother’s ear that she was on the job. The woman died a few days later, impeccably groomed, as she had wanted.
This request, made in an intimate exchange between mother and daughter, is an example of what my team and I refer to as “goals of hair.” One might think that in these final days, a dying person wouldn’t notice or even care about how she looked. That by the time she has become so weak she can no longer brush her hair, or comb down an unruly cowlick, it won’t matter to her. But these little details, which may feel vain, or trivial, or a distraction from the real work of fighting disease, are a part of who we are. Losing the ability or strength to groom oneself can add a film of self-consciousness, sadness, or even despair to the suffering already present. And so I believe it is important to discuss with our loved ones these intimate, maybe embarrassing personal preferences for how we wish to live, right up until the end. These conversations may someday enable someone to receive the gift of a bit of autonomy at a time when everything else may feel out of control.