I watched a man die today
[cross-posted]
I watched a man die today. It was peaceful and entrancing.
Then the room swelled with an organized effort to force him back into his body. There were 20+ people present from all over the hospital. They worked on my patient for half an hour before they got a pulse coursing through his flesh--then they lost it again. When a steady pulse was established again, off they wheeled the man's body to ICU, intubated, utterly dependent for this least beat and breath, absent with his eyes open. (I guess his eyes would not stay closed--they placed damp gauze over them to keep them moist.)
I'd never witnessed death before. It is something i'd looked forward to. I have wondered what it looks and feels like. What about it cannot but be experienced. I have sensed that this much-maligned thing is secretly almost recklessly glorious.
My patient was not old, but he was very, very sick. His belly was swollen like a toad's throat croaking. We knew that his condition was highly unlikely to improve and that he was apt to lose his breath or his heartbeat anytime now. He was delusional, and he knew it, at least for as long as we were able to call him to attention. But he was increasingly losing his ability to respond or interact at all. I had listened to this sweet man's soft moans all day long. Then he became restless.
We placed an oxygen mask over his face and muscled him into bed from his chair. The best aide a nurse could wish for assisted me with a minor procedure, then we dressed our man in a clean gown. Within minutes, he began thrashing and rolling, tugging away his gown, knocking the mask off his face. The aide and i struggled to keep him from falling to the floor, ripping out his urinary catheter, or inadvertently hitting us. He managed to yank his IV line. He didn't seem to see us, but he begged us to stop, let go. My incredibly competent aide told me that she was scared. Other nurses rushed after physicians' orders and gentle restraints.
Then, quite suddenly, the man became still. He lay back in bed with his eyes open and began breathing in a strange, gurgling way that surprised me. Beyond my comprehension, i knew that he was dying before my very eyes. His eyes followed something I could not see. And then he just stopped. Stopped seeing, stopped breathing. The man had checked out. At no point in this paragraph did it even occur to me to do my job, which was to call a code and initiate CPR.
The shout of another nurse snapped me back into our world of odd customs. I dialed a number and said, "Code blue, room ###." Goodbye, mister. Here we come.
Not for heroics on the parts of doctors and nurses do we perform most codes. In America today, an order called Do Not Resuscitate must be signed in order to allow someone to die, should the occasion arise, for we have the power to delay and parcel out the inevitable. Understandably enough, families are often unwilling to sign these papers, even when a suffering loved one has virtually no prospect of an improved quality of life, a return to consciousness, the ability to survive without massive technological support, etc. They may not appreciate the odds that are frequently already at play by the time this question arises, nor the gruesome, protracted nature of the physical demise they are in effect often signing for. Death comes whether we formally approve it or not.
This gentleman's family had declined to sign the forms offered today; he would not go down without a fight. Our fight. Death is a release, and the living hold on. The only time i got choked up this evening was when i imagined telling the family, "I am so sorry." But the rest of the time, as i stood watching nurses taking turns on the chest compressions, i whispered to the man in my mind, "Go! Go!" I dreamt i saw his crinkly-eyed goofy-sweet smile super-magnified in the ether above the crowd.
My patient might indeed have held a pulse for a minute or two after i watched him leave. Never had the difference between body and soul seemed so clear to me. I am not generalizing about the potentials and outcomes of all resuscitative efforts. In this case, however--the only one i'd ever witnessed--i knew that our team was merely going through the motions, performing a legal duty. There was no hope of fulfilling the purported purpose of this operation. We didn't save anybody's life today. I might as well stick my hand through the back of the guy's neck and give a puppet show. He has not returned.
Mercifully, in this particular case i feel hopeful that no further suffering is likely to be had. Our man will not be present for our well-meaning tortures and his piecemeal decay.
By the way, maybe it's tacky to mention this, but your annual taxes probably wouldn't cover even a fraction of the cost of maintaining this enterprise for one week, and there's no telling how long it will go on. No whiny comments on this last remark, please. I have no interest in commiserating about taxes nor about any other damnable thing--such is life, get over it--but only in offering some information i think worth bearing in mind. The consideration applies to funds from all sources, but taxes seem to hit home.
But back to my sappy shit. I don't think i can really express what a blessing i felt, watching that soul buck his ride. Some might expect that the death itself would be unnerving while our activities around it would feel purposeful. Instead, i felt awe, a kind of beauty, in that one quiet moment between a man's battle against what was happening to him and our elaborate endeavour to reanimate his body.
In hindsight, i'm glad he had someone simply present with him as he passed. In fact, as i look upon it now, i recognize my unacknowledged but important role in this universal human scenario. Death's midwife: isn't this a role i've long envisioned fulfilling? I was the only one really watching him in his final moments. It felt almost like being inside a bubble, with everything outside of us going momentarily mute and invisible.
My patient's family had been excused from the room soon into the chaos surrounding his passing. I think that someday they could be relieved to know that someone was attentive to him as he died. It's such a basic need that it was nearly neglected.
It seems significant now that i'd impulsively chosen to carry my red medicine pouch around my neck today, beneath my scrubs. I hadn't worn it in months. Something behind and beyond me knows wonderful things that i can only discover through a sort of hide-and-seek i barely realise it's playing with me. It works out most marvelously where i don't think a whole lot.
Thank you for incarnating, good sir. I liked that smile and your gentleness and your frank self-awareness even as you were losing it. It was an honor to spend this day with you, and to see you out the door. Enjoy your freedom. Fare well!
I watched a man die today. It was peaceful and entrancing.
Then the room swelled with an organized effort to force him back into his body. There were 20+ people present from all over the hospital. They worked on my patient for half an hour before they got a pulse coursing through his flesh--then they lost it again. When a steady pulse was established again, off they wheeled the man's body to ICU, intubated, utterly dependent for this least beat and breath, absent with his eyes open. (I guess his eyes would not stay closed--they placed damp gauze over them to keep them moist.)
I'd never witnessed death before. It is something i'd looked forward to. I have wondered what it looks and feels like. What about it cannot but be experienced. I have sensed that this much-maligned thing is secretly almost recklessly glorious.
My patient was not old, but he was very, very sick. His belly was swollen like a toad's throat croaking. We knew that his condition was highly unlikely to improve and that he was apt to lose his breath or his heartbeat anytime now. He was delusional, and he knew it, at least for as long as we were able to call him to attention. But he was increasingly losing his ability to respond or interact at all. I had listened to this sweet man's soft moans all day long. Then he became restless.
We placed an oxygen mask over his face and muscled him into bed from his chair. The best aide a nurse could wish for assisted me with a minor procedure, then we dressed our man in a clean gown. Within minutes, he began thrashing and rolling, tugging away his gown, knocking the mask off his face. The aide and i struggled to keep him from falling to the floor, ripping out his urinary catheter, or inadvertently hitting us. He managed to yank his IV line. He didn't seem to see us, but he begged us to stop, let go. My incredibly competent aide told me that she was scared. Other nurses rushed after physicians' orders and gentle restraints.
Then, quite suddenly, the man became still. He lay back in bed with his eyes open and began breathing in a strange, gurgling way that surprised me. Beyond my comprehension, i knew that he was dying before my very eyes. His eyes followed something I could not see. And then he just stopped. Stopped seeing, stopped breathing. The man had checked out. At no point in this paragraph did it even occur to me to do my job, which was to call a code and initiate CPR.
The shout of another nurse snapped me back into our world of odd customs. I dialed a number and said, "Code blue, room ###." Goodbye, mister. Here we come.
Not for heroics on the parts of doctors and nurses do we perform most codes. In America today, an order called Do Not Resuscitate must be signed in order to allow someone to die, should the occasion arise, for we have the power to delay and parcel out the inevitable. Understandably enough, families are often unwilling to sign these papers, even when a suffering loved one has virtually no prospect of an improved quality of life, a return to consciousness, the ability to survive without massive technological support, etc. They may not appreciate the odds that are frequently already at play by the time this question arises, nor the gruesome, protracted nature of the physical demise they are in effect often signing for. Death comes whether we formally approve it or not.
This gentleman's family had declined to sign the forms offered today; he would not go down without a fight. Our fight. Death is a release, and the living hold on. The only time i got choked up this evening was when i imagined telling the family, "I am so sorry." But the rest of the time, as i stood watching nurses taking turns on the chest compressions, i whispered to the man in my mind, "Go! Go!" I dreamt i saw his crinkly-eyed goofy-sweet smile super-magnified in the ether above the crowd.
My patient might indeed have held a pulse for a minute or two after i watched him leave. Never had the difference between body and soul seemed so clear to me. I am not generalizing about the potentials and outcomes of all resuscitative efforts. In this case, however--the only one i'd ever witnessed--i knew that our team was merely going through the motions, performing a legal duty. There was no hope of fulfilling the purported purpose of this operation. We didn't save anybody's life today. I might as well stick my hand through the back of the guy's neck and give a puppet show. He has not returned.
Mercifully, in this particular case i feel hopeful that no further suffering is likely to be had. Our man will not be present for our well-meaning tortures and his piecemeal decay.
By the way, maybe it's tacky to mention this, but your annual taxes probably wouldn't cover even a fraction of the cost of maintaining this enterprise for one week, and there's no telling how long it will go on. No whiny comments on this last remark, please. I have no interest in commiserating about taxes nor about any other damnable thing--such is life, get over it--but only in offering some information i think worth bearing in mind. The consideration applies to funds from all sources, but taxes seem to hit home.
But back to my sappy shit. I don't think i can really express what a blessing i felt, watching that soul buck his ride. Some might expect that the death itself would be unnerving while our activities around it would feel purposeful. Instead, i felt awe, a kind of beauty, in that one quiet moment between a man's battle against what was happening to him and our elaborate endeavour to reanimate his body.
In hindsight, i'm glad he had someone simply present with him as he passed. In fact, as i look upon it now, i recognize my unacknowledged but important role in this universal human scenario. Death's midwife: isn't this a role i've long envisioned fulfilling? I was the only one really watching him in his final moments. It felt almost like being inside a bubble, with everything outside of us going momentarily mute and invisible.
My patient's family had been excused from the room soon into the chaos surrounding his passing. I think that someday they could be relieved to know that someone was attentive to him as he died. It's such a basic need that it was nearly neglected.
It seems significant now that i'd impulsively chosen to carry my red medicine pouch around my neck today, beneath my scrubs. I hadn't worn it in months. Something behind and beyond me knows wonderful things that i can only discover through a sort of hide-and-seek i barely realise it's playing with me. It works out most marvelously where i don't think a whole lot.
Thank you for incarnating, good sir. I liked that smile and your gentleness and your frank self-awareness even as you were losing it. It was an honor to spend this day with you, and to see you out the door. Enjoy your freedom. Fare well!