Comfort Care

I want to say that I killed someone yesterday, but of course that's not strictly true. In the cliche of the business, I pulled the plug. I let him die with dignity. In the tactful layman's terms, I withdrew support. In the clinical jargon, I discontinued pressors, including dopamine.

Mr. R passed gently into that good night surrounded by his family members, feeling no pain. I would venture to say that I would want to die that way. Better that than in a car crash, or because of a sudden unexpected heart attack.

The lingering sucks, no doubt about it, but as excruciating as the wait for death can be, it gives you time - allowing you (and your family members) to dip your toes into the pool of extinction and acclimate to eternity if even just a little bit.

Mr. R's family decided just after midnight to turn everything off, an hour after his last daughter had arrived from San Jose airport. We stopped the dopamine at 2:30 and for the next few minutes they stood around uncomfortably, waiting for him to die. Only he didn't. I gave them my chair, and got four more from the waiting room. And though they were silent at first, they ended up reminiscing and joking in the way of close family members, as their father's breaths became more and more agonal. He had had his last lucid thought at around 6pm, when he made the decision not to pursue surgery.

My chief resident had told me that families tend to fixate on the cardiac monitor showing his heartbeat and blood pessure, so I turned the monitor away, but could not resist its heartless pull. Mr. R's blood pressure dropped about one unit every few minutes, but his heart remained strong. It took him an hour to die. His heartbeat did not go into the paroxysms that I had expected, but simply slowed, and flatlined. I pronounced him dead at 3:30, and his strong, laughing sons started to cry.

Death, like all things in hospitals, requires a lot of paperwork. I had to write the death note, request an autopsy, and call the California Organ Donor Network, even though Mr. R was 71 and had heart disease and two previous cancers.

The mourge collected his body swiftly and janitors were mopping his room within half an hour.