Practically no one ever thought he would be elected president in the first place. 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 been confounding expectations throughout a life that has lasted nearly a century. And so he is again now near the end.
Mr. Carter entered hospice care one year ago Sunday, choosing to forgo further life-prolonging treatment with the intent to return to his simple home in Plains, Ga., to pass his final days in comfort and peace. As it turns out, there have been more final days than he or anyone around him anticipated.
The former president’s long goodbye has defied the odds and absorbed many around the world who have spent the last 12 months honoring his memory even as he has refused to follow anyone else’s timetable. Hospice care is meant to ease the end for both patient and family, prescribed for those with less than six months to live. About half of those who enter hospice care last no more than 17 days. Just 6 percent are still alive a year later. Mr. Carter, the only president ever to live to age 99, seems destined to keep pushing the limits.
“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. That’s how he’s living, and that’s how he’s going to die.”
His endurance at the end may 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 is weak,” said Jonathan Alter, author of “His Very Best,” a biography of Mr. Carter. “He wasn’t, as either a person or a president. In truth, this slight man — called ‘Peewee’ as a boy — is a person of extraordinary toughness and grit.”
Mr. Alter recalled that when Mr. Carter disclosed in 2015 that he had cancer, the former president said he was at peace with whatever God chose for him before eventually overcoming the disease. But even if accepting of 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 at the one-story rambler in Plains that he has owned for more than six decades, watched over by caregivers and visited by relatives who take turns making the pilgrimage. The last time he was seen in public was in November, when he rallied to attend funeral services for his wife of 77 years, Rosalynn Carter, who died at 96.
He looked so frail in a wheelchair, his legs covered by a blanket and his mouth agape, that it shocked friends in the church and admirers watching on television. But he was determined to be there no matter what, according to family members, who believe he has hung on so long in part to ensure Mrs. Carter was never left alone.
“He was really honored and glad 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 that for whatever reason, the way he approaches this is from a place of enormous faith. And so he just believes that for whatever reason, God’s not done with him yet.”
Mr. Carter said that one of the remarkable things about these last few months is that his grandfather is not much different today than at the beginning of hospice care. He does not eat or drink much — he did ask for coffee after Mrs. Carter’s service, a rarity these days — and he is not mobile or particularly talkative. But he is still clear enough to make his thoughts known and to absorb and appreciate information.
When Jason Carter told him that tributes and good wishes came in for his 99th birthday last fall from more than 100 countries, the former president was deeply moved. “He teared up,” Jason Carter said. “It was a really affecting thing for him.”
Ms. Stuckey, the superintendent of the Jimmy Carter National Historic Park, said he still made his wishes known. “I walked in the other day and he smiled, and we were talking to him about a meal in the future, and he told us exactly what he wanted to have for dinner the following night,” she said.
She was not surprised that many friends were struck 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 people hadn’t seen him in a while,” she said. “When you don’t see somebody for a while, it’s usually a little bit of a surprise to see them. He may look weak, but he still has that spark in his eye and he still is out to help as many people as he possibly can.”
Mr. Carter, a toothy-grinned peanut farmer who rose from obscurity to become the 39th president of the United States, made a mark after leaving office through decades of philanthropic activity fighting disease, negotiating conflicts, monitoring elections and building houses for the disadvantaged. Even as he faded, he asked regularly for the latest figures on Guinea worm, an affliction that affected 3.5 million a year in 21 countries in Africa and Asia when he began combating it in 1986 but that has been nearly eradicated, with just 13 cases worldwide last year.
“Carter’s entire life has been defined by his relentlessness,” said Kai Bird, author of “The Outlier,” another biography of Mr. Carter. “And so I am not really surprised that he has persevered in hospice care. He’s a quiet force of nature — a relentless man in life but also in approaching the end of life.”
While Mr. Carter does not have an underlying fatal condition like cancer or heart disease, he decided last February to decline further life-extending medical treatment in favor of hospice care, the first president known to use it. His decision has expanded awareness of the availability and benefits of hospice care, which is focused on relieving pain and discomfort in the last stage of life.
“The way that he and his family have approached this is making this a national conversation,” said Ben Marcantonio, the interim chief executive of the National Hospice and Palliative Care Organization. “We talked about it one way at the beginning of his care, but now we’re talking about it in a different way. It opens up new dimensions of the conversation.”
The one-year anniversary of entering hospice care is not marked as if it were a holiday, but by chance for Mr. Carter it will fall the day before Presidents’ Day, so Ms. Stuckey’s park will host a discussion of his life.
For his family, though, there are mysteries that no panel or biography will resolve. “One of the things that has driven home to me is there are things about life and the spirit that you just can’t understand,” Jason Carter said. “I don’t know what it’s like for him right now. I don’t know what it’s like to face this moment in the way that he has been facing it for the last year. But that’s been liberating for me to know that I just don’t know. And that’s OK.”
