A Good Death

We simply don't talk about it.  We become uncomfortable and change the subject, avoiding the inevitable.


As a society, we often box any discussion of our certain demise and tuck it away, out of sight, and we hope, out of mind.  We tend not to think about or discuss our wishes with the ones we love, and when a diagnosis looms, we desperately search for a cure, a surgery, a magic pill --- little of which bring solace or fruitful resolve.


In my own family, regrettably, I've born witness to unhealthy deaths, not so much the death itself but all that follows.  Misunderstanding over the past and confusion over the present with regards to particular family proceedings have left me sad and hollow, all so very unnecessary.


And, so when a good death comes along, I am somewhat stunned and appreciative for the opportunity to take part.


As a medical student, I volunteered briefly for Hospice, sitting with patients at odd hours wherever they were in their final days and hours, visiting with them and their families.  I became comfortable with the physiologic changes at the end of life --- increased need for pain relief, air hunger, and spiraling vital signs.  But I never was faced with being the one to tell a patient's family that their loved one was dying and that medical intervention is futile, at best.  Recently, however, one of my favorite patients gave me that opportunity, teaching me immensely in his final hours.


As a medical team, we had known for a while he was sick, and we were frustrated because we didn't have a solid explanation as to why he was so sick.  We all loved him and his stories, his photos, and his jokes.  He never wanted to be a burden.


On the morning he began to decline rapidly, I called his son and asked for him to come.  I don't know when he will die, I said, but I suspect it will be soon.  After I finished caring for my other patients, I took over for my attending physician to wait until his sons could arrive.  Both she and I did not want him to be alone.


Thankfully, my pager was silent for those forty-five minutes as I sat with him and held his hand.  One of the nurses brought me an e-mail message from a family member that his eldest son from several states away was on his way and asked me to relay the news.  I started to and broke down.  After about ten minutes, I regained enough composure to tell him what it said.  Although he could no longer respond, I told him how much I enjoyed his jokes and that his younger sons were on their way.  But mostly I sat quietly at his side.  It was the best doctoring I've done to date.


That afternoon, after his sons arrived, the palliative care team, my attending physician, and I visited at length about what was happening --- his disease, his death process, his wishes.  A remarkably frank and refreshing conversation, we were all on the same page in terms of making sure their father was comfortable and free from pain.  We encouraged them to say what they needed and wanted to say and to do the best they could to take care of themselves through this.  But mostly, we shared stories.  We learned from his boys about his upbringing, the morals he passed along to his sons, and their family traditions and forgiveness.  As one of his doctors, I had come to know my patient through his labs, tests, and symptoms, but that afternoon, I gained a much greater understanding of the incredible person he was, both before and while he was sick.  I gave his sons my number in case they had questions and gave each of them a hug before I left.


That night, before I left the hospital, I stopped by his room to say good night and goodbye.  His sons had gone to stay with family.  I squeezed his hand and told him how much I enjoyed taking care of him, how great a job he did raising his sons, and that he could go, whenever he was ready.  He died early the following morning, comfortable and at peace.


A few days later, the attending physician, medical student who had cared for him, and I attended our patient's memorial services at a small city park.  Over fried chicken, macaroni salad, and Hawaiian punch, we laughed, looked at pictures, and celebrated.  I stood up to share a few words and thanked his family and friends for allowing us to attend.  I marveled at the healing around me --- his sons from two marriages who had never previously met were getting to know another, and the ex-wives hugged and welcomed family.  Out of pain and loss came almost palpable rejuvenation and mending.  And being able to witness it all was beautiful, to say the least.


I am grateful to him, my funny patient who was always ready with a compliment, a smile, a story, a man who had the conversations he needed to have as his life drew to a close and made certain his boys knew how much he loved them.  One of those patients I will remember for the duration of my career, he taught me what it means to live a good life ... and how to live a good death.