My patient Mr. G passed away, alone in his room, with me watching the monitor as his heart slowed down and finally, it stopped. A flat line.
Mr. G is not the first death that I have witnessed, nor will it be the last one. I have seen patients pass away in front of me, while I was gone. I have seen patients pass from the incurable and from the lack of resources. Some hit me harder than others.
Mr. G's death was different in its own light. Mr. G had cancer, very bad cancer. He was scared and afraid of death. The night before he passed, he said: "I am scared. I know this is it, but I am scared." Mr. G, in many ways reminded me of my own aunt. I was 16 when I was told of her diagnosis. I remember being confused, not understanding what cancer really meant. I remember visiting her in the summer, six month before she passed away, worried, but not knowing what I could do. There was the rest of the family, each silent and at lack of words. When I sat with my aunt, I didn't know what to say, how to comfort her. I spent at two weeks at her place, but somehow I don't remember talking to her at all.
And then, six month later, on a dreary winter day, the news came. She passed in her home, with her husband at her side, and my grandparents there too. That's when it hit me. She was gone. I cried and cried and cried. I couldn't even cry in front of any one because we were so deep in our grief that to share in anyone else's would be too much to bear. And in some ways, I felt guilty, that I didn't spend enough time with her, that I couldn't do anything for her.
I will never forget that winter day in Iowa. The sun shining on the mountains of deep snow that never melts, the endless stretch of the cold, snowy land. My grandmother's tears, my mother's sorrow, and my uncle's broken heart. Her death forever changed our lives. She lived far away from us, so I didn't see her very much, but I will always remember the fun memories of her laughing, her kindness and motherly attitude to me, and how much in love she was with her husband. That was why I didn't want to see her after she passed, because I wanted to remember her for who she really was.
Taking care of Mr. G was hard because of how similarity there was. His unwillingness to give up, his family's distant but sorrowful faces, and even the young age that he was. Was my aunt scared in her last moments? My grandmother always said that she was hopeful, goig through the rounds of chemo and radiation, until her doctor told her that there really was no options left. She said that that's when she changed, and not saying much for her last couple days, for she passed not too long after that. I don't know if she ever received any palliative care or hospice, but I understood Mr. G's family's request to not inform him that there is no choice left. Let him be hopeful until the end. But I also understood what my attending had wanted him to come to terms with dying peacefully. For certainly, there would have been no dignity with dying after rounds and rounds of endless CPR.
I remember stating in my ps that I wanted to help my patients not only live happily, but die with dignity. Our medical advancements can prolong life to a certain extent, but where is the dignity of dying on a machine without even the basic joys of life such as eating and talking? And would one really want to pass with blood spluttered everywhere, body almost cracked open from being pounded on? We will all die someday, and would one rather go in peace with dignity, or to go after endless torture of medical machinery?
A family member once asked me, "so is this it?" and sometimes, that question is hard to answer with certainty. There are always exceptions to the rule, but would an extra month on a machine with a hole in your throat in a nursing home be better than passing peacefully? The hard part of the job is making the predication of will the patient be the lucky 1% who makes it out of the hospital or the rest of the 99%? But I know that we will all die some day, and I think that it is part of the job to help the family see and understand how the future will likely unfold.
Mr. G actually lived well beyond what his physician had predicted for him (by about a year), but at what cost? I do not blame him for being scared, but I wonder, is undergoing the extra pain and living in fear worth it? I would have chosen differently, as I understood what the future would have evolved. But if this was my mother, could I have counseled her to make that choice? I can only imagine how scared he must have been, and I can see how much pressure the family must have been in the past year, to keep trying, to continuously face his fears and live with their own fear. But to give up on someone, to have to face grief early, it takes a tremendous amount of courage.
I know how I want to die. I want to pass away in peace, as if forever entering into one of my action packed, crazy dreams. And I want to look pretty as my body turns to ash and be sent into outer space, where I cannot travel to in life. But there are many more people who haven't witnessed death as much, and they probably never gave dying a thought. It is a unbearable burden to be the family member that makes the decision to let the person die in peace, to not undergo the likely useless interventions. There is such an amount of guilt that is carried with that decision. The what-if's combined with the grief, these are such hard decisions. And it is an equally hard conversation to have with a loved one, to make them face the possibility of losing you one day. But it should be a mandatory conversation, as how we live is just as important as how we die. And do we not want to die in dignity?
Mr. G is not the first death that I have witnessed, nor will it be the last one. I have seen patients pass away in front of me, while I was gone. I have seen patients pass from the incurable and from the lack of resources. Some hit me harder than others.
Mr. G's death was different in its own light. Mr. G had cancer, very bad cancer. He was scared and afraid of death. The night before he passed, he said: "I am scared. I know this is it, but I am scared." Mr. G, in many ways reminded me of my own aunt. I was 16 when I was told of her diagnosis. I remember being confused, not understanding what cancer really meant. I remember visiting her in the summer, six month before she passed away, worried, but not knowing what I could do. There was the rest of the family, each silent and at lack of words. When I sat with my aunt, I didn't know what to say, how to comfort her. I spent at two weeks at her place, but somehow I don't remember talking to her at all.
And then, six month later, on a dreary winter day, the news came. She passed in her home, with her husband at her side, and my grandparents there too. That's when it hit me. She was gone. I cried and cried and cried. I couldn't even cry in front of any one because we were so deep in our grief that to share in anyone else's would be too much to bear. And in some ways, I felt guilty, that I didn't spend enough time with her, that I couldn't do anything for her.
I will never forget that winter day in Iowa. The sun shining on the mountains of deep snow that never melts, the endless stretch of the cold, snowy land. My grandmother's tears, my mother's sorrow, and my uncle's broken heart. Her death forever changed our lives. She lived far away from us, so I didn't see her very much, but I will always remember the fun memories of her laughing, her kindness and motherly attitude to me, and how much in love she was with her husband. That was why I didn't want to see her after she passed, because I wanted to remember her for who she really was.
Taking care of Mr. G was hard because of how similarity there was. His unwillingness to give up, his family's distant but sorrowful faces, and even the young age that he was. Was my aunt scared in her last moments? My grandmother always said that she was hopeful, goig through the rounds of chemo and radiation, until her doctor told her that there really was no options left. She said that that's when she changed, and not saying much for her last couple days, for she passed not too long after that. I don't know if she ever received any palliative care or hospice, but I understood Mr. G's family's request to not inform him that there is no choice left. Let him be hopeful until the end. But I also understood what my attending had wanted him to come to terms with dying peacefully. For certainly, there would have been no dignity with dying after rounds and rounds of endless CPR.
I remember stating in my ps that I wanted to help my patients not only live happily, but die with dignity. Our medical advancements can prolong life to a certain extent, but where is the dignity of dying on a machine without even the basic joys of life such as eating and talking? And would one really want to pass with blood spluttered everywhere, body almost cracked open from being pounded on? We will all die someday, and would one rather go in peace with dignity, or to go after endless torture of medical machinery?
A family member once asked me, "so is this it?" and sometimes, that question is hard to answer with certainty. There are always exceptions to the rule, but would an extra month on a machine with a hole in your throat in a nursing home be better than passing peacefully? The hard part of the job is making the predication of will the patient be the lucky 1% who makes it out of the hospital or the rest of the 99%? But I know that we will all die some day, and I think that it is part of the job to help the family see and understand how the future will likely unfold.
Mr. G actually lived well beyond what his physician had predicted for him (by about a year), but at what cost? I do not blame him for being scared, but I wonder, is undergoing the extra pain and living in fear worth it? I would have chosen differently, as I understood what the future would have evolved. But if this was my mother, could I have counseled her to make that choice? I can only imagine how scared he must have been, and I can see how much pressure the family must have been in the past year, to keep trying, to continuously face his fears and live with their own fear. But to give up on someone, to have to face grief early, it takes a tremendous amount of courage.
I know how I want to die. I want to pass away in peace, as if forever entering into one of my action packed, crazy dreams. And I want to look pretty as my body turns to ash and be sent into outer space, where I cannot travel to in life. But there are many more people who haven't witnessed death as much, and they probably never gave dying a thought. It is a unbearable burden to be the family member that makes the decision to let the person die in peace, to not undergo the likely useless interventions. There is such an amount of guilt that is carried with that decision. The what-if's combined with the grief, these are such hard decisions. And it is an equally hard conversation to have with a loved one, to make them face the possibility of losing you one day. But it should be a mandatory conversation, as how we live is just as important as how we die. And do we not want to die in dignity?
