Mark E. Williams, MD


June 09, 2021

Mark E. Williams, MD

Birthday parties are a special celebration in long-term care. They tend to be light and festive and a counterpoint to the seemingly more common memorial services.

On this particular day, Anyika* was celebrating her birthday, and she had made a special request to see me. Anyika was a woman from the Gullah Geechee diaspora of South Carolina. Her room was always spotless and spartan, with a rocking chair, a freshly made bed, and a small table. On the table were just three items: a thin red book with "De Nyew Testament" written on it in gold letters; a small, round, ornate sweetgrass basket with a golden patina; and an old photograph of a tall, thin young woman ("dat's me").

Anyika told me those three items were her most treasured possessions. The basket was one she had woven as a young girl, living on a barrier island, and the New Testament was a recent gift from a dear friend.

"My mother was a basket weaver, and she wanted me to learn how to weave but I was too restless and only made this one basket," she once said.

Anyika had supported herself as a beautician and enjoyed being in the center of local gossip. "When you fix a woman's hair, she will tell you everything — and I mean everything."

The Birthday 'Girl' Has a Special Request

"Happy birthday, Anyika!" I announced as I entered her room. "You made it to 99. Congratulations!"

"Thank you, doctor, but we need to have a serious talk. I want you to promise me you will do everything you can to make sure I reach 100. "

"Anyika, I really do not have any way to guarantee that you will make it to 100, but you made it to 99 in reasonably good health," I said.

"Ninety-nine is not good enough. I want you to change my advance directive from DNR to full code. Please change it right now."

"Are you sure?" I asked. "You have lived a long and full life, and most people are not fortunate enough to make it to 99. In the Chinese culture, 99 can mean true love and is considered lucky."

"I don't care about other people," she said. "One hundred is the milestone, and I have to make it to 100, come hell or high water. When was the last time you saw a birthday card for someone who turned 99? My friend down the hall got a nice card when she turned 100. For me, 99 is an unlucky number and I have to bide my time until I get to 100. I want to be full code, and I want everything done to save my life. Do you understand my wishes?"

"Yes, I do," I said. "I would never go against your wishes, but I will ask you about it periodically in case you ever reconsider. If you have a cardiac arrest, you should know that you almost certainly would not survive it."

"No need to bother yourself about that," she said. "My mind is made up."

A (Nearly) Uneventful Year

The year was a good one for Anyika. The only real test was when she had a high fever due to a urinary tract infection. Fortunately, the infection responded promptly to antibiotics. She was undeterred and resolute in remaining full code.

Eventually the big day arrived: It was Anyika's 100th birthday! I went to a card store and bought her a big birthday card to celebrate. She was right. I did not see any cards to celebrate a 99th birthday. (And I doubt they were all sold out.)

"Doctor, thank you so much for the beautiful card and for fulfilling your promise to get me to 100. I feel so much better. Please change my advance directive to DNR, and do not send me to the hospital for any reason. I have finished the race and made the milestone."

I followed her request and rewrote her advance directive for DNR and do not hospitalize.

Anyika lived another 3 years. She died peacefully in her sleep at age 103.

Upon Reflection…

Anyika showed me that having a goal and an effective life philosophy can be advantageous in old age. Her goal was to make it to 100. Her life philosophy was to "love everyone, serve everyone, and remember God."

*The patient's name was changed to protect her identity. "Anyika" is, however, an authentic Gullah name.


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