LOS ANGELES (AP) — Everywhere Jay Westbrook turns, behind the wheel of his black pickup, a memory flashes.
In Van Nuys, it is the lifeless little girl he held at Valley Presbyterian Hospital after she was found in the bottom of a hot tub. Near Beverly Hills, it is the old woman in a seven-figure condo whose misery he tried to soothe. On Skid Row, it is the 29-year-old crack addict he brought morphine to numb the pain of cancer, as she died in a box on the street.
There have been thousands of them, thousands of souls he journeyed with to the intersection of living and dying, who helped establish him as one of the foremost experts on care in a patient's final days. Thousands of deaths that collectively formed his life.
It might have gone on this way forever. Then came one death too many.
The first time was a cluster of machines and tubes, and breaths shallow and panting. Westbrook was a student nurse, the patient a big man, swollen from cirrhosis. Westbrook had cared for the man for several weeks and when the time finally came, a profound sadness drove him to tears.
He felt powerless and mortal; and for the first time, this son of atheist parents felt something more.
"I had that experience of the place where life and death meet being filled with God," he said.
In the two decades that followed, Westbrook experienced more deaths than he could count — as a cancer nurse, in pain management and, most of all, in hospice.
He heard a little boy confess to his dying mother he once stole from her wallet, and a married Orthodox Jew acknowledge a long affair with a man. He saw athletes and movie stars, deaths surrounded by dozens and deaths all alone.
Each one was both singular and similar. Those who survived a brush with death reported traveling down a tunnel toward a bright light. Those whose age or disease brought a more gradual exit often experienced visions of a loved one who went before, as well as a day of seemingly stunning turnaround, where lucidity returned and pain subsided and all, for a short time, seemed well. It could be a cruel tease to those praying for a miracle, as it was generally followed by clues the end was near: mottled skin, cold extremities, and breathing that sounds like a locomotive leaving the station.
Through it all, he was sustained by love.
They met on June 7, 1968, at a party bidding Westbrook farewell before he was to leave California to teach reading in Appalachia. Two young women arrived dragging an unenthusiastic third.
"Nancy, this is Jay," the host said. "Jay, this is Nancy."
She wanted to take a walk on the beach, and Westbrook accompanied her. They took the footbridge over the Pacific Coast Highway, walking and talking for hours and coming to rest on the sand.
"Six hours later, the sun came up and we were in love," Westbrook said.
He never went to Appalachia. He was smitten. Before long, Nancy Morgan was Nancy Westbrook. They lived modestly but joyfully.
They couldn't have come from more different upbringings. She grew up in an Ozzie-and-Harriet family, surrounded by love and support, in Wichita, Kansas.
As Westbrook tells it, his own mother left when he was an infant, and when his father remarried two years later, he was placed in the care of family friends who abused him. His parents eventually reclaimed him, but he says he was still subjected to his stepmother's explosive anger and incest by his grandfather. He ultimately dropped out of high school and ran away. Later, addicted to drugs and alcohol, he spent time in prison, sinking so low he hatched a suicide plan.
He is 67 now, but the scars of childhood remain so deep he still sleeps with a nightlight to ward off a lasting fear of the dark. They helped stir in Westbrook a strain of empathy so strong he became irreplaceable at the worst moment in others' lives.
"My suffering," he said, "became my vehicle for awakening compassion in me."
He first put his soothing power to work as a veterinary technician, offering solace to owners when a pet was euthanized or a tough prognosis was delivered.
He then became a clinical gerontologist; in that role he constantly glimpsed death, and felt a nagging need to get closer.
A nursing degree brought him where he wanted to be. He became a luminary of the end-of-life world, not just because of his skill, but because he told the stories of his work with such eloquence it enthralled audiences, from medical students in a Harvard lecture hall to hospice workers filling a conference room.
Colleagues were in awe of his ability to say the right thing, manage patients' pain and forecast their remaining time with striking precision.
"All heart," said Mary Jo Leste, a nurse who once hired him. "He has a gift," said Carmen Febo, a hospice worker he mentored. "A pioneer," said Chris Downey, a doctor who attended a palliative program with him.
It was deeply fulfilling, but draining work. Nancy not only helped her husband deal with the depths of his past, but also the daily trials of death. Sometimes, when he arrived home from a tough day, he'd put his head on her chest and listen to her heart beat. They'd play with the dogs, talk about their days, discuss lessons learned from the dying.
Time and again, he saw a deathbed full of regrets. It taught him and Nancy to never part without an embrace and an expression of love. Tomorrow, he knew, was not guaranteed.
It was a Monday — Dec. 12, 2011 — when Nancy first awoke in pain. On Wednesday, she saw the doctor. On Thursday, she had a CT scan. On Monday, she had surgery. And on Tuesday, the diagnosis came: pancreatic cancer.
The doctors said she likely had four months to live with no intervention, up to a year with aggressive chemotherapy. Westbrook had had hundreds of pancreatic cancer patients before and expected she had seven months. Four days shy of that, she awoke feeling great, free from pain and full of energy — the cruel pre-death rally he'd seen so many times before. In the yard, she asked him to lift her up, and she put her head on his chest.
"I love you," she said, emphatically.
Before long, her skin became mottled, her extremities cold, her breathing strained. He knew the end was near and, though they didn't speak of it, he suspects she did, too. She wanted to stay outside in her beloved garden. And late into the night, they sat. She kept resisting going in to bed, but when they finally did, Nancy mustered her last words.
"I love you," she said again. "Goodnight."
By morning, she had lost consciousness. He took her in his arms.
"Sweetheart, I love you so much, I will miss you so much when you're gone, but I'll be OK," he said. "And if and when you're ready, you have my permission to go."
Ninety seconds later, it was over.
And now, Westbrook knew, his career was too.
Westbrook is behind the wheel of his Dodge, zooming south to the Hollywood Hills.
It has been nearly two years since he buried Nancy. He hasn't attended to another patient since.
He speaks of her in the present tense. He speaks of his career in the past.
"I've lost my life and I've lost my work," he said.
So many of his patients died with such certainty on where they were going next, but all these years of death brought him no closer to knowing whether he'll ever see Nancy again. He dreams of a blissful reunion. Even if it never happens and he carries this pain forever, he's grateful for what he once had.
"Small price to pay," he said, "for a lifetime love affair."
He has begun to counsel couples and advises on grief and pain relief. But he will not go to a dying patient's bedside.
He worries he would be more guarded, no longer giving his whole self to patients because he is immersed in grief. He wonders what it would be like to return home from a day filled with death and no longer have Nancy to turn to. He always saw his vulnerability as an asset; now he thinks it is a liability.
He drives and the memories surround him. He thinks of the young mother whose children watched in horror as she struggled with her final breaths. He thinks of an elderly man who, even as he died, could not forget the stillborn daughter his wife delivered 60 years before.
And he thinks of Nancy, the last ghost in a life filled with them. He smiles as he drives away.