A remarkable woman who died as she lived. I had been treating her for four years for stage four widely metastatic nonsmall cell lung cancer. When I first saw her she had brain involvement, liver involvement etc. She went throught the gamut of treatments, radiation, chemotherapies, experimental treatments etc. Heck, she outlived the four month life expectancy someone with her stage of disease would have had when I first saw her! On top of all of that, she had spent the past thirty years of her life ravaged with Rheumatoid Arthritis, her hands having been crippled into fists long ago. She never complained once and was always bright and cheerful. Time finally ran out on her today, we had exhuasted all options and I had placed her into Hospice care about three months ago. Her pain had gotten worse recently and so i had admitted her to the hospital for a morphine drip to keep her comfortable. This morning, I noticed that she had lost conciousness over night, and her breathing was in what we call a "Cheyne-Stokes" pattern- rapid breathes alternating with slow laboring breathes. That is a sign that the bain stem is taking over control of the breathing process, that the reflex to breathe was becoming more primative, more terminal (edit:not painful-sorry for the typo earlier). Worse still, she had the "death rattle" which is a haunting sound of fluid buildup in the back of the throat as the muscles start to relax- a sign that death is imminent. I called her husband and daughter to come to the hospital and informed them of what was about to transpire. By the time they arrived, the nurse called me back to the room and asked me for more sedatives because the patient was becoming restless. She was still completely unresponsive to painful stimulus or voice command, but was rhythmically lifting her arms up and down from her waist to above her head. We tried to restrain her but, in the end, I was more afraid of hurting her with the restraints and so just let her do it. The husband and duaghter came in and saw that, and stood together quietly looking at each other until, finally, my patient crossed her arms across her chest and breathed her last breath. When I turned around, I was astonished to see her husband and daughter smiling in the back of the room. Her husband turned to me and explained "She had promised us she wouldn't die until she could grow her angel wings and fly away to be our guardian angel".