‘Today you will be with me in paradise’: A reflection from a palliative care physician

[The criminal] said, “Jesus, remember me when you come into your kingdom.” He replied to him, “Amen, I say to you, today you will be with me in Paradise.” Luke 23:42-43

She had been under my care for nearly two weeks. Her body was shutting down from a combination of ailments, generally the consequences of poor life choices. Years of heavy alcohol use had caused her liver to stop functioning, which set off a cascade of terminal organ dysfunction.  

Her family was estranged, but her brother would appear at bedside on occasion and give her medical team glimpses into her life. She had been abused in her younger years and found comfort in drugs and alcohol. She had a couple of children, but was unfit to raise them and hadn’t seen them in years.  

Now she was dying. She had been essentially unresponsive since I took over her care. Her blood pressure was often so low that our blood pressure cuffs couldn’t measure it. Her hands and feet were cold and dusky, physical signs usually seen in the few hours prior to death. It appeared as though she would die any minute. But she didn’t.  

Her brother suspected that she had not only been estranged from her family, but had also been estranged from God. He didn’t come out and say it, but it was obvious that he worried about her salvation. She continued to hold on, day after day, for nearly three weeks. I have no medical explanation for how her body lingered without food or water, on the brink of death for so long. Then one morning I came to work and she was gone. She had died overnight with only her nurse at her bedside.  

As a Palliative Care physician, I witness death on a regular basis. I am constantly humbled by the opportunity to be at the bedside of patients as they take their final breaths. I have been a spectator, observing the collision of heaven and earth, of this life and the afterlife on numerous occasions. I have watched as patients slip away gently and I have watched as others cling to this life with every shred of their being, not ready to die.  

In Luke 23:42, the thief on the cross next to Jesus asks to be remembered when Jesus comes into His kingdom. In the following verse, Jesus says to the thief, “Truly I tell you, today you will be with me in paradise.”

Ask any hospice provider and they will tell you stories of patients who have seen angels, spoken with loved ones who have already passed, even spent time with Jesus, in the days and hours before they died. These stories are not unusual and the themes no longer surprise me.  

While many patients and families take a great deal of comfort in the promise of Heaven and the stories of loved ones and angels coming to carry them off to eternity, there are others who face death with less certainty, perhaps no certainty at all. Much like the thief on the cross, they have come to a spiritual crossroads. Perhaps they have spent their life running from God. Maybe they have lived a life of sin and destruction and are now full of regret. With trepidation and fear, they are staring death in the face.  

I have seen people like my patient lie unresponsive for days, sometimes weeks, in the throes of a spiritual crisis, refusing to let go without resolution. The body holding on only at the insistence of the soul.  

As I care for these patients and reflect on the story of Jesus and the thief on the cross, I remember Romans 8:38-39, “For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord.”  

Even when the mind has become unconscious to the things of earth, Jesus speaks into the soul. When the body is no longer able to respond to earthly stimulus, Jesus stirs the spirit.  

Like the thief on the cross, Jesus loves us and continues to pursue us until the end. He is not barred from the heart by the condition of the body. He pursues the thief and the liar and the alcoholic, just as He pursues the priest and the giver. He seeks us, undeterred, asking only that we believe in Him. Even for those who have spent all of their lives running from Him, He doesn’t give up. Even when the body has all but ceased to function, and the mind is seemingly asleep, I believe that Jesus persists, offering the promise of the cross and the assurance of paradise. As He was for the thief on the cross in his final moments, Jesus is there, ready to take us home, whispering, “Today, you will be with me in paradise.” I hope that in my patient’s final moments, she took Him up on His offer and was finally able to slip away into eternity.  

[Identifying details have been withheld to protect patient’s privacy.]

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Read all 7 reflections on each of the last words here.