Jimmy Carter's long farewell

Let's be honest: hardly anyone ever thought he would even be elected president. Or that he would forge a landmark treaty in the Middle East. Or that he would win the Nobel Peace Prize. Or that he would beat cancer.

But Jimmy Carter has confounded expectations over a lifetime that lasted nearly a century. And so he is now almost at the end.

Mr. Carter entered hospice care a year ago Sunday, choosing to forego further life-sustaining treatment with the intention of returning to his humble home in Plains, Georgia, to spend his final days in comfort and peace. It turns out there have been more last days than he or anyone around him expected.

The former president's long farewell has defied expectations and absorbed many around the world who have spent the past 12 months honoring his memory even as he has refused to follow anyone else's timetable. Hospice care is intended to ease the end for both the patient and the family, and is prescribed for people who have less than six months to live. About half of those who enter hospice care do not last longer than 17 days. A small proportion are still alive a year later. Mr. Carter, the only president ever to live to 99 years old, seems destined to continue pushing the boundaries.

“He's been a record breaker for decades — the oldest living president, the longest married president,” said Jill Stuckey, a longtime friend from Plains who visits him regularly. “It's always been on President Carter's terms. This is how he lives and this is how he will die.”

His endurance at the end can serve as a rejoinder to those who never recognized his tenacity. “Carter once told me that he thought the biggest misconception about him was that he was weak,” says Jonathan Alter, author of “His Very Best,” a biography of Mr. Carter. “He wasn't, as a person or as president. In reality, this slight man – who was called 'Peewee' as a boy – is a person of extraordinary toughness and perseverance.”

Mr. Alter recalled that when Mr. Carter announced he had cancer in 2015, the former president said he was at peace with what God chose for him before ultimately overcoming the disease. But even as he accepted his fate, Mr. Alter said, “he has also always been very ambitious — and that ambition extends to wanting to stick around and see what happens in the world.”

Mr. Carter spends his days in the one-story Plains rambler he has owned for more than 60 years, watched over by caretakers and visited by relatives who take turns making the pilgrimage. The last time he was seen in public was in November, when he gathered to attend funeral services for his wife of 77 years, Rosalynn Carter, who died at the age of 96.

He looked so weak in a wheelchair, his legs covered by a blanket and his mouth open, that friends at church and admirers watching on television were shocked. But he was determined to be there no matter what, according to family members, who believe he stuck it out for so long partly to ensure Mrs. Carter was never left alone.

“He was really honored and happy that he made it to the end with my grandmother, and that was a real treasure for him,” said Jason Carter, a grandson and chairman of the Carter Center board. “And I think for whatever reason he approaches this with tremendous faith. And so he just believes that, for whatever reason, God is not done with him yet.”

Mr. Carter said one of the remarkable things about the past few months is that his grandfather is not much different today than he was at the beginning of hospice care. He doesn't eat or drink much – he did ask for coffee after Mrs. Carter's service, a rarity these days – and he isn't mobile or particularly talkative. But he is still lucid enough to express his thoughts and absorb and appreciate information.

When Jason Carter told him that tributes and well wishes came from more than 100 countries for his 99th birthday last fall, the former president was deeply moved. “It brought tears to his eyes,” Jason Carter said. “It was a very traumatic event for him.”

Ms. Stuckey, the superintendent of Jimmy Carter National Historic Park, said he still made his wishes known. “I came in the other day and he was smiling, and we were talking to him about a meal in the future, and he told us exactly what he wanted to eat the next night,” she said.

She was not surprised that many friends were impressed by his appearance at Mrs. Carter's service. “I think a lot of people were shocked that he went and was able to go, and that people hadn't seen him in a while,” she said. “If you don't see someone for a while, it's usually a little surprise to see him or her again. He may look weak, but he still has that spark in his eye and he is still out to help as many people as he can.”

Mr. Carter, a peanut farmer with a toothy grin who rose from obscurity to become the 39th president of the United States, has made a splash after leaving office after decades of philanthropic activities in the fight against disease, negotiating conflicts, monitoring elections and building houses for the underprivileged. Even as he faded away, he regularly asked for the latest figures on the Guinea worm, a disease that affected 3.5 million people a year in 21 countries in Africa and Asia when he started combating it in 1986, but which is almost exterminated. with only 13 cases worldwide last year.

“Carter's entire life was defined by his ruthlessness,” said Kai Bird, author of “The Outlier,” another biography of Mr. Carter. “And so I'm not really surprised that he has persevered in hospice care. He is a silent force of nature – a ruthless man in life, but also in approaching the end of life.”

Although Mr. Carter does not have an underlying fatal condition, such as cancer or heart disease, he decided last February to forgo further life-prolonging medical treatments in favor of hospice care, the first president known to employ it. His decision has raised awareness of the availability and benefits of hospice care, which aims to relieve pain and discomfort in the end stages of life.

“The way he and his family have approached this makes this a national conversation,” said Ben Marcantonio, interim director of the National Hospice and Palliative Care Organization. “Early in his care we talked about it one way, but now we talk about it in a different way. It opens up new dimensions of the conversation.”

The one-year anniversary of his entry into hospice care is not being marked as if it were a holiday, but for Mr. Carter it happens to be the day before Presidents' Day, so a discussion about his life will take place in Ms. Stuckey's park.

For his family, however, there are mysteries that no panel or biography can solve. “One of the things that has become clear to me is that there are things in life and the mind that you just can't understand,” Jason Carter said. “I don't know what it's like for him now. I don't know what it's like to face this moment the way he's faced it over the past year. But it was liberating for me to know that I just don't know. And that's okay.”