When my younger sister, Jane, hit adolescence, she became a full-fledged rebel, getting into every kind of trouble teenagers can find: smoking, drinking, driving fast, doing drugs, insulting her teachers, and playing hooky from our staid New England high school. After graduation and a futile six-month attempt to buckle down at college, she joined the entourage of a popular blues band and headed for the bright lights of the big cities where the action was. She rarely made the effort to be in touch with our parents, which was probably just as well. Her lifestyle would have worried them sick, saturated as it was with shady and hazardous behaviors.

Eventually, Jane’s love of living close to the edge led her to heroin, and as happens frequently to those who are tempted to flirt with that seductive drug, thinking themselves strong enough to avoid getting caught in the spider-web of its allure, Jane quickly found she couldn’t live without it. For it takes more will power than most people have to wrestle themselves free from heroin’s soul-devouring grip, and many of those who engage in frequent use become junkies, irrevocably addicted and trapped in wrecked lives. Finally, she made the mistake that’s all too easy for drug users to make: she overdosed.

When the paramedics found her, she was unconscious and barely breathing. Her resuscitation was a difficult one, and she remained in a coma for a week before regaining consciousness. When she did, she related an unusual experience. She had found herself floating up near the ceiling of her hospital room, looking down at her body lying in a bed with the side rails up. She saw how beaten and depleted the poor thing looked, and she felt a sense of sadness for it. Then she noticed a window in her room, with sunshine outside and green growing things and blue sky above. The vibrancy of this scene beckoned to her, and she drifted toward the window, feeling an immense peacefulness waiting for her just outside.

Yet as she neared the window, something tugged on her attention, drawing it back to the scene below, where her body lay pale and still. Several people were bending over her body, tending to it, trying to help it recover, and their concern touched her deeply.

Suddenly, Jane understood that she had a choice. She could continue toward the window and float out into the peace that waited for her there, or she could return to her body that was being kept alive by these caring attendants and pick up the thread of her life again. The outcome had not been decided yet. It was up to her, with one caveat: if she chose to stay, she had to change her ways fully, or she would fail.

Without hesitation, Jane made her decision. She said yes to living and starting over.

Instantly, she found herself waking up inside a cold, pain-riddled body that was as stiff and uncomfortable as a suit of armor. It was an immensely unpleasant sensation, but with it was the awareness of being alive, and the sweetness of that awareness made the discomfort bearable— just.

Within a few days, Jane was weaned off the respirator, and, to the surprise of her doctors, she had no neurological or cognitive deficits whatsoever. Though extremely weak, she expected to recover fully. But there was one final hurdle that she had yet to overcome, and it came in the depth of the night: an ink-black figure that appeared at the foot of her bed. The featureless shadow-figure stood and gazed at her silently, filling the air with ill will. Looking back at it was like looking into a bottomless pit of darkness, devoid of any hope.

As the figure stared at Jane with its icy-cold presence, to her horror she felt herself starting to slide, ever so slowly, down the bed toward it, as if the thing possessed an irresistible malevolent power. Fear seized her, and she gripped the sheets, trying to keep herself out of its reach, but she continued to slide. With enormous effort, she reached for the nurse’s call bell and pressed it frantically.

After what seemed an interminable amount of time, the night nurse stalked into the room, shined her flashlight into Jane’s face, and asked impatiently what she wanted. When Jane tried to explain, the nurse scoffed.

“What a whacked-out druggie you are,” she grumbled. With a derogatory wave of her hand, she walked briskly out of the room, leaving Jane realizing that she would be on her own when and if the sinister presence came back for her.

And it did, the next night. It stood as before, full of menace at the foot of her bed. And again, Jane had to strain with all her might to resist its insistent pull. She fought hard, pitting her will against its strength, fighting with gritted teeth to keep from sliding – until the figure eventually faded away, leaving her heart pounding wildly against her rib cage.

The third night was the worst by far. The dark presence exuded scorn for her success in resisting twice and made her strength seem a pitiful illusion. Tonight, the presence seemed to promise, she would not get away.

That night the sheets were more slippery than ever. She couldn’t seem to get a good grip on them, and as hard as she tried to hang on, she felt herself losing ground.

Still, she refused give up. She had gone far enough into darkness in her life. She wanted to return to the light. So, as there was no one to help her, she called on the only resource she had: herself. She called on every cell and every fiber and every ounce of energy in her being, and she called upon them fiercely. She summoned every dream and every drop of hope and happiness she had ever possessed, and she hung on to them and would not let go. And—slowly, slowly—she felt the presence losing its grip on her, until finally it began to fade. And then, like a puff of smoke, it was gone.

On the fourth night, Jane waited with dread for the dark figure’s return, but it didn’t come. Whatever that experience had been – whether a trial to prepare her for the huge task she was undertaking of starting her life completely over, or a test to see if she had the strength she would need to resist the temptation to turn back—it didn’t matter. Her ordeal was over, and she had endured.

By the time I learned about Jane’s overdose and flew across the country to be with her, she had made good progress in regaining her physical health and recovering from the acute stages of heroin withdrawal. She was able to get out of bed into a wheelchair, and she seemed to be basking in a state of wonderment. When I took her for short strolls by wheelchair around the grounds of the hospital, she would reach down to stroke the grass, or finger the leaves of the bushes we were passing, or peer up through the branches of the trees and let her gaze linger on the clouds in the blue sky above, as if she were seeing it all for the very first time.

Over the next several years, Jane fought mightily to rebuild her life. She bent her rebellious spirit to her will and entered a residential drug treatment program where she lived a strictly regulated life for three years before she was pronounced “clean.” After her graduation, she married the man who had been her counselor and greatest support in the rehab program – a man who had also freed himself from heroin addiction and thus knew her as no one else ever could—and, together, Jane and her husband Leonard set about building new lives.

While Leonard created a construction business, Jane worked days and studied nights, eventually earning herself a college degree with honors. Propelled by a strong desire to do something for others in gratitude for the help she had received, she then set her sights on becoming a nurse. Having, as she did, a father who was chief of surgery, a mother who was director of a corps of hospital volunteers, and two siblings who had recently obtained their MD’s, it wasn’t surprising that she would choose to pursue a career in the health care profession—but the health care profession was far from welcoming. Of the twenty nursing schools to which she applied, not a single one would accept her because of her history as a narcotics addict.

Yet Jane refused to give up. Determined to prove that she was free of the pull of drugs, she persuaded a pharmacist to let her work for him and thereby show she could be trusted. After a year of work, the impressed pharmacist wrote her a glowing letter of recommendation. With his letter in hand, Jane applied to nursing school again and, to her great joy, was accepted. Once having earned her nurse’s cap and RN degree, she went on to work as a visiting nurse, tending to home-bound elderly patients: “my children,” as she affectionately called them.

With the freedom she had gained, Jane created a home for herself and Leonard and made good friends until life tested her courage again. Leonard became ill. An infection with so-called “flesh-eating bacteria” started as an innocuous red spot on his skin and grew with lightning speed into a conflagration that sent his body into shock. As a team of specialists worked round the clock, trying to save his life, Jane sat unflinchingly beside the bed where he lay unconscious in the ICU, whispering, “Fight, Leonard, fight!”

But the hope of Leonard’s surviving steadily faded, and, by the end of the week, Jane conceded defeat. Bending close to Leonard one last time, she whispered in his ear, “It’s all right, my love. You don’t need to fight any more. You can go.” By the time she had driven home from the hospital, the phone was ringing with a call from the ICU to give her the news that her husband was gone.

The weight of Jane’s grief was huge, and the ache of it reverberated painfully through my own heart. Without her long-time partner by her side, I feared she would finally go down. And indeed, she did later confess that she had considered the idea of ending her life then and there. But after a time of wrestling with it, she had rejected the idea. The reason, she said, was because the prize she had fought so hard to win—having a life that was hers to live—was not something she was ready to throw away, even after suffering a wound that terribly deep. And so, with the undefeatable determination of which the human spirit is capable, my brave-hearted sister picked herself up and went on, selling Leonard’s construction business and focusing on tending her small but flourishing garden. It was a choice she never regretted.

Many years later, when Jane was diagnosed with terminal cancer, she called and asked me if I would be interested in spending time with her and helping with her care. Since I could think of nothing I wanted more than to accompany my one and only sister on her last adventure, I took a leave of absence from my work as a doctor and went to be with her. And thus, it was that I came to witness the finale of Jane’s life, including her curious release from her oldest wounds.

Understanding that she had a prognosis of only a few months to live, Jane declared she was not about to let the medical profession take control of her life and fill up her remaining time with futile treatment protocols. Besides, she said, she was ready for death to come. She had lived as much life as she needed to and was satisfied with all she had done. She had faced her greatest fears and stayed the course, and there was not a thing that she would change. No, there really wasn’t any reason she could see to hang around, especially with Leonard gone and the emphysema she had developed from years of cigarette smoking slowly beginning to suffocate her. She was clear about the matter: she was not afraid to die.

So, with Jane’s agreement, I helped her enroll in hospice, and she soon found herself being cared for at home by a steady stream of attendants who carefully bathed her, massaged her, coaxed her to eat meager amounts, and kept her house neat and clean. This helpful arrangement allowed the two of us plenty of time in which to set her affairs in order, reminisce about our past adventures, and mull over the mystery of living a human life.

Of all the valuable things that hospice did for Jane, the most significant – and the most paradoxical, as it turned out – was the relief they provided her from the gnawing pain of her cancer. The paradox lay in the fact that the medication they prescribed in order to give her such needed relief was a close relative of the drug that had nearly stolen Jane’s life away. Morphine, a sister drug to the heroin that Jane had had to fight with all her might to free herself from, came in those last three months to ease her discomfort and smooth the path of her dying. The hospice team instructed her to use as much of the drug as she needed in order to remain comfortable. They assured her that the benefit of the drug’s powerful ability to relieve pain far outweighed concerns about addiction for someone who was dying and wished to meet the end of their life without undue suffering.

So, with a weary smile, Jane accepted the offering and used it with a moderation upon which she herself decided, living through those final months with both her hardwon sense of dignity and her persnickety sense of humor intact. Right into her last few days, she was clear-eyed and conscious, commenting on the curious course of her life. The peace she had fought so hard to find shone through her more and more clearly, until, on the day my darling sister died, lying in a hospital bed that we had set up in her living room, it seemed to suffuse her entire being. Not a trace of effort or illness remained to be seen. Only a look of absolute serenity lingered on her face, and a hint of amusement at the upturned corners of her mouth. Perhaps, I thought, she was enjoying the satisfaction of having made a radical adjustment on the balance sheet of her existence. She had certainly come out well ahead in the end.

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