In all my career, I never met a patient who taught me as much as Staci. Staci, a 25-year-old business owner who presented with headache. MRI showed a tumor. It had the classic appearance of the last thing you want to hear. After a workup, biopsy, and surgery, she awoke on Oct. 14, 2009, in the recovery room very cheerful and told everyone around her how much she appreciated the care she received.

A month later CT showed post-op changes and mass effect. I explained that some people don’t survive this. I asked her if she had been told this before. She said never. I was horrified. What had I done? She said that no one told her, but she knew she had a glioblastoma. She knew she would take a trip soon. See, Staci would [not] say she was dying; she insisted she was taking a trip to Milan.

Staci’s [second] surgery went well medically, but the tumor had grown. She would not leave the hospital. She was going to be admitted to inpatient hospice. Well, that’s what the surgeons and oncologist said.

December 11, Staci painted her nails stiletto red and signed out of the hospital AMA. Over the next 14 days, she put her life in order. She told me she was going to make it to Christmas but not to New Year’s. On the 23rd she wrote the 22 things you must do before you die. … Late on the evening of the 25th she told me it was the best Christmas ever. She was ready for her trip, she said. She asked me to share her list of the 22 things to do before you die. She died in her sleep that night.

22 Things to Do Before You Die

1. Tell people you love that you love them.
2. Plan your flight (will, burial, monies, belongings).
3. Keep pushing what’s the worst that can happen?
4. Don’t worry about things you never had a chance to do. Cherish the things you did.
5. Find a way to laugh.
6. Give hope to those still in the fight.
7. Run up your credit cards (banks are the last to know).
8. Acknowledge [that] the people who are close to you will be sad and think it’s not fair; comforting them for some reason comforts you.
9. Make peace with friend and foe.
10. Cover your mirrors don’t dwell on how you look now. What you see in the mirror is cancer, not you.
11. It’s OK to cry even if you tell others not to.
12. Take care of your pets. They love you unconditionally. Leave plenty of food and water out for them because friends and family will forget to feed them.
13. [For] children or loved ones, write a letter in words they can understand.
14. Record an audio message; videos show death, but your voice doesn’t have to
15. Keep in mind that no parent or spouse wants to watch you die; comfort them. Let them know it’s not their fault. They will never forget that conversation.
16. Live your life and live your death like a Dr. Seuss book: “I will never say I wish I would have could have!”
17. Keep pushing; drink Red Bull. You have plenty of time to sleep when you are dead.
18. Support groups are fine – BUT having one true friend listening is like [the] Mastercard commercials: priceless.
19. Die at home if possible. Have as little medical equipment as possible.
20. Believe in things that are out of sight – Santa Claus, flying reindeer, virgins have babies, and me!
21. Don’t let a scared family member call 911.
22. Know when to give up your car keys.

On Jan 7, St. Joseph’s started an ED-based palliative medicine program and Palliative Care Emergency Center. We have treated and cared for more than 300 EOL patients in the first 18 months.