When Elmer Smith left his body behind this December, he went out with the same gumption and grace that enlivened his 97 years.
"Dad wanted to be at home," said Lloyd Smith of Longview, one of Elmer's 70-year-old twin sons.
"He'd say, ‘Don't take me to a meat locker.' "
Elmer spent his dying days in a bed at his son's house surrounded by kin, including a granddaughter who's a nurse, great-grandkids who held his hands and relatives who joined him as he took a last communion in a paper cup.
Death is not a matter of choice, but those who die of illness or old age can make decisions about how they will die. And if they prefer to die at home, without medical intervention, they don't have to go it alone.
Elmer and his family got help with his personal care and pain management from Community Hospice in Longview, which coordinates end-of-life services with Kaiser Permanente and the newly established Palliative Care Program at St. John Medical Center.
Hospice care is for those who do not want extreme measures to prolong their lives — no emergency ambulance, no paddles, no feeding tubes or ventilators. Whether at home or in the Hospice facility, patients are bathed and their linens are changed. Medications control their pain. When their digestive systems slow to a halt, meals do too.
And when the time comes, they're allowed to go.
Elmer was referred to Hospice by his doctor, said his son Larry Smith of Jacksonville, Ore., who is Lloyd's twin.
"Hospice provided respite care," Larry added, referring to support and time off for family caregivers. "They sent a social worker and a nurse. They brought us the equipment we needed and the medications."
Amber Shields, Elmer's 38-year-old granddaughter, is a nurse in Southern Oregon. She came up to Longview and slept on the floor next to Elmer's bed in the last days of his life, Larry said.
"If Amber needed something, Hospice said ‘Sure.' No questions asked."
"Hospice is about the quality of life, not the quantity of it," said Linda Beattie, the chaplain at Community Hospice in Longview who visited Elmer Smith during his last days.
An ordained Lutheran minister with a doctorate in psychology, Beattie serves Hospice patients in three counties. She has interacted with about a thousand dying patients, she said, and was present when more than 50 of them died.
"We try to figure out what's the best way for them to have the quality they want," she said.
For some, it's "the bucket list idea. Do they have the energy to go to the beach one more time?"
Others want to make decisions about how to share their belongings after they go. "They have gifts they want to give to their family."
Others need to "make the phone call to say ‘I'm sorry,' or to reconnect and say goodbye. You can't do that if you're hooked up to a whole bunch of tubes," Beattie said.
She hopes that Skype can soon be added to Hospice services, so out-of-town relatives and those in the military might visit with dying patients on two-way video computer program.
In her ministry, Beattie honors all denominations — or none. "When I was in training, a man did not want the chaplain in his room. I said, ‘Will you talk to me?' He said, ‘Sure!' He was a chef. For two days, we talked recipes. ... Cooking was his praying.
"I find out if there are church connections. If there are, I let the church know. I fill in if needed," especially to listen to the stories, the confidences, the losses that dying people may need to share.
"Every single death is different," she said. "Whatever journey they are on, it's my privilege to walk with them."
'That roof is still there'
Some hospice patients shy away from a minister, but that wasn't the case with Elmer Smith.
Faith framed his life, beginning in the 1930s when he fell in love with Ruby Rasmussen walking home from church in Kalispell, Mont.
"Dad and mom met when he was 19 and she was 15," Larry said. "Part of loving him was because we saw the love between Mom and Dad.
Throughout childhood, he said, he and his twin "worked right alongside of him."
Elmer earned near-mythical respect from his sons, who choke up talking about him a month after his death.
"Dad had a hard-scrabble life," Larry said. He was one of 12 children whose father abandoned the family; they lived in three box cars in Colorado, on the outskirts of Glacier National Park, with no electricity or running water.
"He invented things to play with; he raised rabbits and built a club house," Larry said.
Lloyd remembered that "Dad couldn't sleep without a light on. He'd say, ‘Once I got electricity, I could never shut the lights off.'"
Elmer was so good at math in high school, Lloyd said, "his teacher told him he should go to MIT. But he didn't have any money."
During the Depression, Larry said, their dad "picked apples, he sawed logs for firewood, he mined for gold. All his money went to his mother."
When Elmer struck out on his own, he became a machinist. "He worked 16 to 18 hours a day," Larry said. "He'd come home from that job and milk the cows, put up the hay and work on his garden for another eight hours."
"I never say my father sit and watch TV," said Lloyd. "Never."
In 1946, when the twins were 6, Elmer and Ruby purchased 20 acres of timbered land in Phoenix, Ore.
"He cut his own timber and built three houses," Lloyd said. "He sawed his own lumber, and did all his own plumbing and electrical. We asked him how he learned to do all that. "He said, ‘I helped a guy build a house once.' He was so smart."
Their parents never bought anything on credit, Lloyd and Larry said, and taught the boys to save.
When they earned money at their chores or worked for the National Park Service, "10 percent went into the tithe jar, and that went to church," Lloyd said. "Ninety percent went into the savings jar." She used that jar to purchase savings bonds. This went on for years, Lloyd said. "It became college tuition. When we both got married in 1966, they handed each of us our down payment on a house."
Elmer's discipline reached into every corner of life. He tipped the scales at 150 his whole life, and for his short, muscular build earned the nickname of "Stub."
"He was a gymnast," said Lloyd, and exercised every day well into his 90s.
"He invented health food," Larry said. "One of his teachers, in the 1920s, mentioned healthy eating. He never drank pop, he didn't eat sugar."
Lloyd picks it up: "We'd have dessert, but very little. He never told us we couldn't; it was by example."
Of all the things Larry and Lloyd admire about their father, character wins out.
"He never stole, cheated, lied," said Lloyd. "He had ethics. He never spent money on himself. He'd give $100 to somebody, or do work for them. The day his mother died, he was putting on a roof for a guy. He talked about his mother for 10 or 15 minutes and went back to work."
"That roof is still there," said Larry, his voice clouding over.
'Seeing things you can't see'
The Smith twins both became teachers. Lloyd retired 10 years ago, moved to Longview and got into the crematory business, and Larry is still teaching.
After Ruby died, Elmer was nearly blind, and Larry and his wife, Linda, watched out for him down in Jacksonville. In typical fashion, Elmer invented ways to take care of himself and operate his phone and appliances.
His whole life, he would massage his head every day (his one vanity was his luxurious head of hair) while doing heel-toe exercises.
After a serious fall, Lloyd and Helen talked Elmer into coming to Longview. He settled in, insisting on paying rent and managing his personal needs. Then he fell and broke his hip, and on Halloween, suffered a heart attack.
"He just started getting weaker," Larry said.
At St. John, a physician referred Elmer to Community Hospice.
"The doctor told him, ‘Well Elmer, you have several choices, none of them good. We can send you home, and you'll have weeks, maybe months.'
"Dad looked at me and said, ‘Where's my comb?' He wanted to comb his hair."
Family members were called. Amber came north to provide nursing care for her grandpa.
As his sons did all those years ago, Elmer's great-grandchildren stayed by his side. "The kids all held his hand and he told them how to be a good person, how to love the Lord," Larry said. "He went from one to the other, asking, ‘Will I meet you in heaven? Will I meet you in heaven?' "
As each one committed to getting there, Elmer said, "Thank you, Jesus!' "
His dying happened in stages.
"He was in and out of reality," Lloyd said. He told Larry "I'm seeing things you can't see."
Lloyd describes the moment when his father called out, " ‘God, I'm coming home!'
"We were playing Christian music, and it was a really neat spiritual moment.
"He didn't die though."
The end came later, with family crowding the room.
Elmer looked up at Lloyd and said, "Where should I put it?"
"I said, ‘Put what?'"
"When I throw up, where should I put it?"
At that inglorious moment, he died.
"We were sobbing," Lloyd said. "We're saying, ‘He's gone. He's gone!'
Then DeeDee, she's 9, she turned to me and said, ‘Uncle Lloyd, are you going to burn him?' "
"We all just all broke down laughing."
There were two services for Elmer, both of them planned and prepaid, right down to the singers, his sons said.
In his job, Lloyd said he regularly sees "people who have been really sick for a year, and I say, ‘Have you talked to a funeral director?'
"They say, ‘Oh, I'm not going to worry about that. Let my kids take care of it.'"
He shakes his head. "Mom and Dad planned ahead. Everything was in place."
Coming Feb. 13: From pyres to picnics, grass caskets to ocean ashes — how to plan your own service.