This story was originally published in MAiD in Canada.

I have supported many families through the final hours of a loved one’s life. I’ve watched as they said goodbye—sometimes with laughter, sometimes through tears, and often with both. As a medical assistance in dying (MAID) support nurse, I’ve held hands, offered hugs and quiet reassurance, placed IVs, and stayed long after the last breath to make sure no one felt alone in their grief. Being present for individuals and their loved ones during this deeply personal process is both humbling and profound.

But nothing fully prepared me for the moment I found myself not just at the bedside—but in the family photo. This time, it wasn’t a patient, it was my grandma. And suddenly, everything I thought I knew about being the calm in the room, the steady one, the support…shifted.

This is the story of how I moved from MAID nurse to MAID granddaughter—and what it taught me about love, loss, and the quiet strength it takes to say goodbye.

From the nurse’s side of the bed

I am a registered nurse with 14 years of experience in palliative care, having worked in a variety of roles from bedside nurse to nurse clinician to patient care coordinator (affectionately referred to as the “chaos coordinator”). Working on an acute palliative care unit means I have cared for people experiencing some of the most complex and difficult-to-manage symptoms. As a result, I have witnessed some of the most profound and intolerable physical and psychological suffering. So when the Supreme Court released its decision about Carter v. Canada in February 2015, I knew that some of the patients in my team’s care would seek an assisted death. Despite the abundance of support we offer and the extensive arsenal of medical interventions available to us, not all suffering can be alleviated to a level the person experiencing it considers tolerable. And that is where MAID sometimes comes into their story.

Since its legalization in 2016 I have supported MAID, but in truth, I have supported the right to choice at the end of life long before I became a registered nurse. Now, nine years into MAID legislation, I have been involved in many facets of the process—from witnessing requests, coordinating assessments and provisions, to supporting provisions. Using the knowledge and experience I’ve gleaned through the years, I also have the privilege of mentoring both nurses and volunteers on what compassionate, informed support looks like throughout the MAID journey.

It is in these moments that I am most reminded of the beauty of human connection, compassion, and the importance of accepting each other’s decisions.

Despite my involvement in so many aspects of MAID, what remains most humbling and meaningful for me is supporting my patients and their loved ones through the provision itself. It is an extraordinary privilege to bear witness to the deeply human, and often beautiful, interactions that unfold as families share their final days and moments together. I have also had the profound honor of being present with patients whose families could not—or chose not—to be there for the provision. In those moments, I find myself sitting, holding the hand of the individual—a position at the bedside traditionally reserved for loved ones—as they slip into a deep sleep and take their final breaths. It is in these moments that I am most reminded of the beauty of human connection, compassion, and the importance of accepting each other’s decisions.

As the years have gone by and I have supported more and more MAID provisions, with or without loved ones present, I often found myself wondering: What is it like for the family and friends, knowing these were their loved one’s final days, hours, or moments? What did that last day feel like for them? Was it surreal to realize this was the end? And what did they want their last words to be?

When it becomes personal

Well, in 2021, I personally learned what it felt like to be the loved one. My grandma’s health had been declining over a couple of years, but the most significant change came after her 90th birthday in March 2021. To be honest, reaching that milestone was something she had hoped for—and it was truly a fantastic day. Her birthday was filled with love from family, friends, and neighbors. And, at her request, we even ate cake for lunch. My grandma was a fun lady, even in her advancing years.

My early childhood was filled with games of tile rummy, my grandparents mock-cursing me for using their own tricks to beat them, and evening swims with my grandma after the tide rolled in over sun-warmed rocks. As I grew into adulthood, not much changed, although the West Coast waters eventually became too cold for my grandma to take a dip. Our evenings shifted to Wheel of Fortune and Jeopardy, glasses of wine in hand, laughter and stories echoing through the house. My grandma loved to laugh and tell stories—often taking the most detoured, scenic route before finally reaching the conclusion. It used to drive my family crazy, but we laugh about it now. And you know what? She always made it to the end point of the story and it all made sense when she got there!

The lady with the cookies

Among her many talents, my grandma could cook some damn fine dinners, and her baking was absolutely delicious. Even in her final years, visits to her home were often greeted with the aroma of freshly baked cookies or cheese biscuits. Her cookbook still bears her beautiful cursive inscription: “Kim’s favorite” written beside the cheese biscuit recipe, which brings a smile to my face everytime I see it. Her longtime doctor (and MAID provider) recently shared with me that her now adult son remembers my grandma as “the lady with the cookies,” from the home visits he made to my grandparents’ house as a child. It’s amazing to think that such a simple act—sharing cookies—could leave a lasting memory years later. But this was my Grandma, she loved to take care of people, share food, and tell stories.

Born in 1931 during the Great Depression, and having spent part of her childhood in logging camps, my grandma was incredibly resilient. She seemed to hold no resentment for what they lacked growing up, but instead lovingly shared memories about how they made the most of what they had. She spoke of how they grew, canned, and preserved much of their own food. Even in my own childhood, fresh vegetables were always abundant, straight from their garden. Applesauce and apple pies came from the apples picked in their yard, and blackberry jam—affectionately known as “Grandpa’s jam”—was the result of hours spent by my grandparents picking blackberries together along old logging roads. Even as the world evolved around them, they maintained a calm, simple approach to life. They travelled often in their camper, exploring Vancouver Island, venturing up to Alaska, and driving across Canada and the U.S. My grandparents both absolutely adored golden retrievers, having four over the years plus a litter of puppies from their first one. They managed all their own affairs, and even as my grandpa’s health declined, they resisted help from family, only accepting support in his final months.

After my grandpa’s death, my grandma carried the mantle of fierce independence for as long as she could. Even as a widow at 82, she was determined to live out her life in her own home—and on her own terms. Her unyielding self reliance could sometimes turn into fierce stubbornness, a trait Paul will definitely confirm I’ve inherited! She regularly reminded us “I’m never going into a home!” and even though we would’ve loved to have her closer to all of us on the mainland, Vancouver Island, specifically the Comox Valley, was her home. We all knew she would live and die in Comox.

She called it her ‘bus ticket.’

So in early May 2021, when her health took a turn for the worse, we all gathered at her home in Comox and took turns visiting her in the hospital. Thankfully, a short stay in hospital helped her regain a bit of strength and mental clarity—enough to express her wish to request MAID. She had told me several times in her final months that “the days were getting long”, so her request for MAID didn’t come as a surprise. She didn’t choose a specific date at the time, but she felt a sense of relief knowing the option was available. She called it her “bus ticket,” something she could cash in when the time came.

The day she chose

About a week after she was discharged from the hospital, I received a text from her longtime doctor—who was also her MAID provider—letting me know that she wanted to proceed the following day. She had been struggling with pain and profound weakness over the past few days and felt that the time had come to say goodbye. I was at work when I received the message, and I had to take a moment to process what I had just read. I had always supported her decision, but suddenly as I found myself telling my coworkers, “My grandma is having MAiD tomorrow” it felt real in a way it hadn’t before.

I called her from work, and she said, “tomorrow’s the day.” I told her the doctor had messaged me and that I’d be on the ferry the next morning. Looking back, I wonder if I should have gone to Comox that night—would it have given me more time with her? My aunt and uncle were already at her place, having arrived for a planned visit, only to hear her share her plan as soon as they got there. I can’t help but wonder if I could have supported them more if I had been there sooner. In the end, I decided to leave early the next morning, knowing she wasn’t alone and recognizing that maybe I needed the evening to emotionally prepare myself. I actually felt surprisingly calm, but my frantic cleaning told a different story. When there’s uncertainty in my life and things feel out of my control, cleaning becomes my outlet—so when Paul came home and found me vacuuming, he wasn’t surprised at all!

This would be the last time I’d go to the island to see Grandma.

I don’t remember much else from that night, but I do remember the ferry ride the next morning. It was a gloomy, rainy day, and I sat in my car on the top deck, watching the ocean. I had made this crossing hundreds of times throughout my life. As I grew into adulthood, the ferry ride from Horseshoe Bay to Nanaimo became a space where I could relax, leave the city bustle behind, and find comfort in the slower pace of island life, “just kicking stones”.

This trip felt the same, yet it was completely different. I couldn’t help but think this would be the last time I’d go to the island to see Grandma. Eventually, her house would be sold and we’d no longer have “a home on the island.” It’s strange, the certainty of knowing something so significant and the exact moment everything would change.

I drove up the island in a quiet sort of calm, music playing softly as the coastal scenery passed by. On the way, I stopped at the liquor store we always visited—Cascadia, a local gem in the Comox Valley, known for its craft beer wall. It was an ordinary stop on an ordinary drive, one I had made countless times before. The woman at the counter smiled and said, “Have a good day,” and I smiled back, thinking, if only you knew what was happening in my world today.

That was the first moment I truly understood what it meant to be the loved one on the day of a MAID provision.

It struck me at that moment how the world outside keeps moving, unchanged, while inside your world, everything is shifting. The surreal weight of it hit me: I had entered this day as a nurse who had supported many patients and their loved ones through MAID, but now I was walking it as a granddaughter. The ordinary rhythms of daily life—the ferry ride, the liquor store, a polite exchange at the store—were unfolding beside one of the most profound experiences of my life. Monumental and mundane, side by side. That was the first moment I truly understood what it meant to be the loved one on the day of a MAID provision.

I arrived at the house to find my grandma peacefully asleep in her favorite chair. My uncle updated me on how she had been overnight and that morning. Although I felt guilty for not being there overnight to support him and my aunt, it was reassuring to hear that they had done such a great job keeping her comfortable. About 30 minutes after I arrived, she woke up, and we were able to have a brief but meaningful chat. She was still drowsy but managed to show me the coffee she had spilled on her shirt and that she hadn’t combed her hair. “Don’t worry, I’ll fix you up,” I told her softly. I helped her change into her favorite pink sweater, gently combed her hair, and carefully tended to the dressings on her legs. She smiled and said, “You’re good at this.” I grinned and teased, “I may have done this once or twice before.” That little exchange brought a chuckle to my uncle as well.

Finding moments of lightness, and even humor, in such an emotional and foreign situation often created a peaceful space before the MAID provisions I had previously supported. It didn’t surprise me that I instinctively brought humor into my own experience—it was exactly what my grandma would have wanted for her family. When my grandma was in hospital with a broken hip years before, I helped her wash up. With her sense of humor shining through even at her worst, she jokingly said, “I guess once you’ve seen one pair of boobs, you’ve seen them all.” That was my grandma—always able to crack a joke, no matter the situation.

Once she was all fixed up, my uncle and I settled into the sitting room with her, old western films playing quietly on the TV as she drifted in and out of sleep. The last time I had watched an old western in that room, I was sitting next to my grandpa — and it was the last time I saw him as well.

Around 5 p.m., her MAID provider and the support nurse arrived. They checked in with her, making sure she was comfortable and wanting to still proceed with MAID and then placed her IVs for administration of the medications—things I would normally be doing as the support nurse. Her provider took time to walk through the provision process with my uncle and aunt, ensuring they understood everything and felt supported.

Saying goodbye

Once everything was ready, it was our time to say our goodbyes. We chose to do it one at a time—her close neighbor went first, followed by my aunt, then my uncle, and finally me. I had thought this would be the hardest part of the day, but in truth, the most difficult moment was helping my grandma say goodbye to my mom.

My mom couldn’t be there in person, so she said her goodbye over the phone before the doctor arrived. I held the phone gently to my grandma’s ear, overhearing the tender words of love and gratitude they shared. My grandma was my mom’s best friend—no one could ever replace what they had. In the absence of a present father, my grandma had been there for my birth, supported my mom and me through my childhood, and helped shape the person I am today. They spoke often, their bond only deepening after my grandpa passed. Though my mom doesn’t talk about it much, I know the void must have felt enormous. Yet she always seemed to find comfort in remembering my grandma, often sharing entertaining stories about her senior moments and the stubborn ways that made her so uniquely herself.

Eventually, it was my turn to say goodbye. I can still hear her voice, and I carry her final words with me like a keepsake tucked deep in my heart. She told me, “I couldn’t have asked for a better granddaughter,” and that she was “so proud of me.” She knew everything about my life—my adventures and misadventures, the life-altering and difficult decisions, and all the moments in between. Knowing she was proud of who I had become was the most meaningful gift she could have left me.

I still think about those words of admiration and wonder what she’d say if she knew the work we’re doing now. She always told me how much she loved that Paul and I worked in the same field, knowing it meant we could understand each other’s experiences in a way others might not. I think she would be even prouder today.

With all of us gathered around her chair, waiting for her signal to proceed, she looked up and said with a little twinkle in her eye, “Do I get a glass of wine to toast?” We all laughed and my aunt quickly grabbed her a glass of white wine. She raised it and toasted each of us—her family, her neighbor who felt like family, and her amazing doctor, who had compassionately guided both her and my grandpa through the final chapters of their lives. When she finished her last sip, I curled up at the foot of her chair, our hands resting together, one over the other.

You can let go now.

We turned on the music she had chosen—The Blue Danube Waltz by Strauss—and her doctor began to administer the medications. Just like so many MAID provisions I had witnessed before, she drifted off to sleep within seconds. It wasn’t long before her breathing slowed and then stopped, and she peacefully slipped away. After she confirmed my grandma’s heart had stopped beating, her doctor pulled me into a hug and softly whispered, “You can let go now.” At that moment she acknowledged that I had been channeling a quiet emotional strength, harnessed to ensure I supported my entire family. Her words lifted a weight I hadn’t even realized had grown so heavy. It felt like permission to finally set it down. There were very few tears in the room, and it took only moments before laughter filled the house, as we began sharing stories about my grandparents—a true testament to the legacy of joy and humor my grandma had instilled in all of us.

Before my grandma’s doctor and support nurse left, her doctor gave me one last loving hug and said, “so much of her lives on in you.”

I knew she truly meant it—after all, my grandma spent more time sharing stories about our family with her doctor than actually talking about her health! I hope she is forever commemorated as the fiercely independent, narrative enthusiast, afghan knitting and cookie-baking patient – that would be a wonderful patient legacy.

The grief that followed

My uncle, aunt and I all stayed in my grandma’s house and I left Comox the following morning. Before heading out, I stopped at the beach across the street to say goodbye to the spot where so many memories were made. With their original house being waterfront, I had spent every childhood and early adulthood visit to Comox just steps from the ocean. As a child, I played with our golden retrievers in the now-shrunken tidal pools, learning much about West Coast sea life. As an adult, I glided the calm sea on my paddleboard, drifting over beautiful kelp forests far offshore and soaking in magical sunsets from the water. I think my heart will forever be drawn back to my grandparent’s street in Comox.

As I drove out of Comox that morning, a beautiful rainbow appeared behind me and stayed there as I merged onto the highway. I’m not a spiritual person—if anything, nature is my spirituality—but the timing of that rainbow couldn’t have been more perfect. It brought a smile to my face, like everything was okay in the world for just that moment. Then, as if on cue, a song called Missing Home by Flora Cash came on. It has since become the song that takes me back to Comox every time I hear it.

The days that followed my grandma’s death were odd—that’s really the only way to describe it. I didn’t think I was distracted by the loss but then I would drive across the city and arrive without remembering the actual drive. It was quite bizarre. I went back to work right away for a couple of shifts. The distraction helped, but I was profoundly exhausted and eventually had to take a few days off. I didn’t cry a lot, but when I did, it was always in the most inconvenient places, such as the grocery store. That’s the thing about grief, it doesn’t wait for permission. It shows up when it wants, where it wants, and you’re just along for the ride. Grief doesn’t wait for the right time—it just arrives unannounced. So yes, I had a quiet little cry in the produce aisle at Safeway one day.

Tears are simply all the love you had for someone, looking for a place to go.

Something I’ve been blessed to learn as a palliative care nurse is that the only way through grief is straight through it. So I took the same advice I often give to families and let my emotions unfold however—and whenever—they needed to, even in awkward, unexpected places like Safeway. Because the truth is, grief needs a way out. Tears are just all the love you had for someone, looking for a place to go. You have to let them fall—because on the other side of those tears, there’s relief. And the more you let those emotions move through you, the less they’ll catch you off guard. In time, the sharpness softens. And in place of the tears, there’s warmth, and laughter, and the gentle comfort of remembering someone you loved.

Some people ask whether grief feels different after a medically assisted death compared to an unexpected or unaided one. My answer is: yes and no. The pain of losing someone you love is universal—they are gone and you are left to navigate a world without them, regardless of how they died. That said, there’s a surreal quality to a MAID death: one moment you are talking with your loved one, the next, they are gone.

Very little in life is certain, and there’s something uniquely strange about knowing the exact day and time someone you love will take their final breaths. While MAID can offer space for intentional goodbyes, loving final words, and a peaceful death—it can still feel a bit abrupt. That suddenness, even when the moment feels prepared, may shape the grieving process differently for some. One of the most difficult challenges in grieving after MAID is that not everyone will agree with their choice. This can leave loved ones feeling the need to hide the truth about how someone died, which can lead to guilt, isolation, and moral distress. Grieving is hard enough—grieving in silence or secrecy is even harder.

What I still carry

It’s been four years now since my grandma’s death, but that day remains as clear in my mind as if it were yesterday. I can tell you what I was wearing, the wine I drank that night, and the conversations my family shared after she passed. I returned to Comox on the one-year anniversary of her death, sat quietly at the beach, and listened to The Blue Danube Waltz by Strauss. It was, without a doubt, the most healing moment I experienced that first year. In that stillness, I felt both free and deeply connected to her—and to that special place I still think of as my second home. Despite all the open and healthy grieving I had done, this was the moment I truly stepped through to the other side of my grief.

As the years go by I continue to speak openly about my grandma and my experience as a loved one of someone who chose MAID. That said, there are still a few people very close to me who don’t know how she died—they only know she died peacefully at home with our family by her side. Despite my openness about my grandma’s choice, I have withheld this information from these few individuals because I fear their response. We do not see eye to eye on MAID, and the last thing I want is for my grandma’s decision to be judged by someone close to me. I want to honour my grandma and the peaceful ending she chose, one our family was grateful to be part of, but I don’t want to find myself having to defend that choice to people I care about. This has been, and continues to be, a moral dilemma for me.

One day, her story may come out, and I hope these individuals close to me will understand that my grandma made a decision about her life and death. This decision honored both her relentless determination to live on her own terms and her right to determine how much suffering she was willing to endure. And just as I’ve witnessed with my patients and their loved ones over the years, my grandma’s final day was filled with love and laughter—exactly how we all wanted it to be for her.

My grandma was very clear with us that we were not to write an obituary…but we respectfully ignored that request! I can imagine what she might say about me writing and sharing this so publicly. But alas, her legacy is now woven into mine. Just as I carry her final words with me, I carry her story too, proudly and always with love.