On Life and Death

Our terminal patient who was going to die on extubation Sunday: things changed. A cousing flew in and changed the wife's mind. When I went in Monday he was still alive, and alarmingly, fitting the ventilator pretty hard (did NOT look comfortable). They were going to prepare him for surgery, etc they said.

We were sad - he had expressed that he did not want to live like this, yet not everyone was prepared, so on he lived.

When we came back Tuesday they had changed their minds again - he would be extubated and let die. Everyone was now ready.

Finally, today we returned to see him, and they had extubated him. He was gasping and gurgling, arms flailing. To our alarm the family had STOPPED his pain medicine drip that morning. I almost lost it. It was one of the saddest thing youve ever seen, and I'm not sure they even realized it. Doing what they did was purely selfish.

We immediately ordered the pain drip back on. I was disgusted. Here was a man who clearly said he did not want to live with tubes, etc and now they had stopped his pain meds because they seemed to think he had some chance of living that way. It was sad - he was drowning in his own secretions - choking on his spit and flailing his arms, unable to get air. I listened to his chest and could not even hear his heart through the "rales" of fluid in his lungs.

His eyes bulged out his head. He strained.

When I left he was still alive, if you can call it this. Hoepfully he was not in any more pain.

Lesson? Listen to your doctors as your loved ones approach death. There is one thing we ALL have in common - we all die. But we should be able to choose to die in comfort, not choking and gasping for hours on end. Sadly, most people only realize how this goes once they have already been through it.

In these times, think of your loved one that is dying,not yourself. Think of what you would want and what they would want. If you are unsure, ask them, get them to put it in writing, AND ask them to assign a health care proxy in writing as well. This is person that makes the health care decisions in difficult times like these.

What a tragic day, BUT it confirmed further my desire to work with terminal patients.

On another note, my residents all wrote extremely nice evaluation notes about me and my work on the team.