Running Out of Time

Later that afternoon, Mr. Christensen, her cousin, called with an update. Ms. Keochareon had asked for an intravenous sedative that would make her sleep, delivering her from the mounting pain. That morning’s visit, it turned out, had been the last.

Ms. Elliot, who had planned to visit Ms. Keochareon after her shift that day, regretted not having asked more about how she felt about death.

“She already seemed to be at that spot where she had that inner peace about it,” Ms. Elliot said that evening. “You want to ask them the questions: So what does it feel like to be dying? Do you know something we don’t know?”

Ms. Keochareon died nine days later, in the evening on Dec. 29. Mr. Christensen had asked her to wait for snow; nearly six inches fell that night, the first of the season. Only her husband was there for her death — a consequence of the weather, but perhaps also part of her plan, Mr. Christensen said.

At the funeral, Ms. Keochareon’s sister Ruth Woodard spoke in her eulogy about “just what prompted Martha to offer her situation up as a teaching tool.” Ms. Keochareon deeply wanted nurses to understand her illness from the patient’s perspective, she said. But that was not all.

“I notice that every time that Martha gave of herself she received far more,” Ms. Woodard said. “In fact, she received a few moments of less pain and I suspect that she received life itself — a few more hours, even days, with purpose.”

When the new semester starts this month, Ms. Santiago and Ms. Elliot will return to more conventional coursework: a pharmacology class, for example, and rotations in maternity and acute care. But they will also present to their classmates what they learned in the little house in South Hadley. Ms. Santiago said she would remember Ms. Keochareon “until the day that I die” — especially her resolve.

“Who in her situation, to be like that, would call up and say, ‘Hey, I want to teach a student about my cancer?'” she said.