Doctors die with grace and dignity

Most non-medical people develop a false belief that modern medicine can prolong the quantity of days a person will live, and that "doing everything" to prolong life will result in a high likelihood of a good quality of life thereafter.

For this reason, I think that every person should spend a minimum of six weeks shadowing a respiratory therapist, nurse, or doctor. Doing so would cause people to learn three things:

1. Everybody dies
2. Death does not always come easy
3. Bad things happen to good people
4. You cannot take the risk out of life

Everybody dies.  As recently as the turn of the 20th century most people dealt with death on a regular basis, as the life expectancy was not that great.  Today, however, thanks to better medicine, people are living longer. This has made it so people don't see death often, and so they develop this false perception that people don't die, or that they will live forever.  

Death does not always come easy.  So they develop this false perception that modern medicine can keep them alive longer.  Sure we can do that. We can intubate you and put you on a ventilator.  We can put a pacemaker to keep your heart beating. We can artificially feed you.  We can clean your bottom. But you may not like the quality of your life once we start doing all of this. 

Bad things happen to good people.  You can be the best Christian in the world and still get sick and die young.  Yes, there is truth to the song, "Only the good die young."  It happens.  

You cannot take the risk out of life.  There's a serious effort in this nation to get people to eat healthy, exercise, get in shape, and lose weight.  Surely there are people who don't take care of themselves and end up as regular patients in hospitals and nursing homes.  Still, there are many people live unhealthy lives who live long lives, and there are people who live perfectly healthy lives who still die young.  So, no matter how much we can try, you cannot take the risk out of life.  You will have 41 year old otherwise healthy men get lung cancer.  It happens. 

Believers tend to be better patients

He was dying and he knew it.  Yet still he continued to read his history book.  I entered his room, and he smiled at me.  He told me stories of his past.  He enlightened me about what he was reading about.  He was a very smart man.  He was a good man.

I got to know him quite well over the course of a few days.  Then one day I sat down in a chair, and he said, "You know that I'm dying and it doesn't bother me. You want to know why?"

I nodded and watched as he picked up his Bible.  "This is the reason I don't worry about death.  I know that death is not the end but the beginning."  He smiled.

I truly believe that people who believe in God die better than those who don't believe.  Believers are happy all the way to the end because they know death is not the end.  They know that what they learn in this life can be used in the next, and so they continue to produce and to show joy.

I used to wonder why it was that someone who knew he was going to die would be reading a book.  What's the point? But the more I learn, the more I realize that most folks who know, and are reading, have a Bible on their side table.

I'm not saying that all people who know they are dying and don't believe are bad patients, nor that all believers are pleasant.  Yet I am saying that, based on my own observations, that believers tend to be more pleasant.

Prayer

So I'm standing with a nurse in the hallway, and we are watching as a group of our coworkers attempt to save a young man's life.  She turns to me and says, "I think this is a good time to start praying."

I said, "I already began."

She said, "I knew when I saw you standing out here that this man was going to be prayed for."

It's kind of a neat feeling when someone tells me that seeing me reminded them of God.  It says a lot about the image I portray, and shows the importance of a good Christian upbringing.

It wasn't obvious that I was praying, as I was not on my knees or anything like that. She knew it because I told her one night that I pray in such situations. As a Christian I know that death is not the end but the beginning.

The many faces of death

I have been doing this long enough to know what death looks like.  I have seen death more often than the average person, and I have seen every kind of death.  I know how people die.  I am, shall I say, a default expert on dying.

How many different ways are there to die?  I cannot say.  I had one elderly man die while I was talking to him.  He said, "I don't feel good."  He became suddenly anxious and walked to the recliner, where he simply stopped breathing.  I had been having a nice discussion with him just prior to this.

There was this other elderly man with a heart function of less than 10 percent.  He was a happy man, and he said to me, "I'm not afraid of dying at all.  I am ready.  I have said good bye to my family and friends.  Whenever God wants to take me, I'm ready."

He was one of the neatest old men I ever met.  A nurse and I were sitting at the nurses station watching the telemetry units, when we saw his rhythm change.  We both got up to look at him, and saw that he was sleeping sound with what appeared to be a smile on his face.

We saw his heart stop.  The way he went out, in his sleep that way was therapy for us in a way, because, by the line of our work, we too often see people die among a burst of pain and agony, and then we call a code and make un-Godly attempts to reverse God's call.

It is never pretty when this happens, and we never succeed.  And then we feel bad because things usually do not go as planned.  Sometimes we feel guilty, thinking we could have done more.  Yet after seeing a few of these events, a healthcare worker generally grows numb to death.

I don't think growing numb to death is such an odd thing, though.  I think in today's day and age where medicine keep people alive so long, we tend to see death seldom.  This was not the case prior to the 20th century, when death was a common occurrence.

How many people died just because they got appendicitis, something that is now treated with a simple surgery?  How many people died due to their their throat swelling up because they contacted a disease that is not exterminated by modern science?

There was a time when 50 percent of infants died in birth, and many died in childhood due to one disease or another.  Most kids never got to see their grandparents because most people did not live past 40.

Death is not common anymore, so we fear it.  Yet this is not the case if you work in healthcare, particularly as a physician, nurse, or respiratory therapist.  You will see death for what it really is.  You will accept death as just another part of life.

But this is good, I think.  As the Bible says, we never know when our time will come.  We never know when God will call for us.  And for this reason we should heed the words of Mark 13:33:  Beware, keep alert; for you do not know when the time will come."

I think that people who believe in God tend to go out with grace and dignity.  And healthcare givers who believe in God do a better job of dealing with it.  For we know that death is not the end but the beginning.

How do people die?

Your question:  Have you ever watched people die. What is it like?

My answer:   I have seen death, and I know how people die.  I have seen many different types of death.

1.  Peaceful:  The patient who falls to sleep and just stops breathing.  I witnessed this during a breathing treatment once. Unfortunately, people who work in the medical field tend to get a skewered view of death because they rarely see this type of death.  The good news is, this type of death is the most common.  Most often, people simply die peacefully in their sleep, or so one would hope.

2.  Long agonizing:  Here you have a patient who is dyspneic and suffocates to death. This is what we see in the hospital setting, and it's kind of a sad ending.  In the hospital setting we watch as people end their lives gasping for air.  They become dyspneic, and, perhaps due to hypoxia, the end eventually comes. Yet it comes with a struggle for air.

3.  Sudden death:  The most common cause of sudden death is cardiac arrest.  A less common way is a ruptured aneurysm in either the head or aorta.  Prior to the 1930s the most common cause of sudden death was drowning or some other such accident.  Back in the 19th century cardiac arrest was rare, mainly because people didn't live long enough to get heart failure.  So while the cause of sudden death may have changed over the years, the effect is the same.  It was actually attempts to save drowning victims that gave rise to efforts at artificial resuscitation.  We generally get these victims in the hospital, and by the time we see them they are being worked on by emergency response teams, and it gets pretty graphic at times.  Most of these victims die, although sometimes we bring a person back to life.  However, when we do succeed, rarely does the person just walk out of the hospital and live a normal life.

I saw a person die peacefully in his sleep when I was slow one night in the critical care.  I had a nice conversation with this man who was a DNR.  He was a police officer during his life, and he was telling me neat stories.  Then I was visiting with the monitor tech when I saw his heart go into v-tac.  I went into his room and he had a pleasant looking (peaceful) on his face.  He was sound asleep.  This was good therapy for me, especially after many cases of observing the other two types of death.

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Is death the enemy?

There's a neat article over at nursetogether.com by Richard Wagner called "Is death the enemy?" He writes that "for many nursing and healing professionals death is the enemy.  Then he lists four points to consider "if encountering mortality is our goal." 

I will paraphrase thes points here:

1.  Death is a normal part of life.  Well, it is. 

2.  Many of us have trouble accepting that we will die.  Why me?  Why do I have to die so young? I have so much more to do. 

3.  Living a good death begins the moment we accept our mortality.  If we live our lives every day as though any moment may be our last, the end comes better for us.  He explains, " Facing our mortality allows us to achieve a greater sense of balance and purpose in our life as well."
The final point I'm going to quote directly:

4.  Dying can be a time of extraordinary alertness, concentration, and emotional intensity. It’s possible to use the natural intensity and emotion of this final season of life to make it the culminating stage of our personal growth. Imagine if we could help our sick, elder, and dying clients and patients tap into this intensity. Imagine if we had this kind of confidence about our own mortality.

I think there is another that should be added here, and this is as follows:

5.  Those who believe in god die better.  It's true.  I have observed those who believe reading moments before they die, and I ask them about it, and they say, "God needs wise people."  Those who don't believe are the ones who go out grumpy and irritable.  They are tough to care for.

6.  It is better to die with grace and dignity, than to try to punish yourself with every remedy just so you can live another week.  Do you really want to be intubated if you have end stage cancer? Do you really want to have CPR done on you if you're going to die anyway?  Do you want to die with a mask on your face and a tube in every orriface, or do you want to die on morphine in the comfort of your own bed? 

So I guess what I think about this is death is not the enemy at all, but, as noted above, a part of life.  We're going to die some day.  It's not whether or not this will happen, but how you deal with it.  As I've stated before, I think it's best to go out with grace and dignity. 

What do you think?

The day the dead don't die

I thought that would be a neat name for a book.  I thought of that after spending an hours of performing advanced life support on an elderly man.  We could barely keep his heart going with our medicine and artificial breathing, so when the family said it was time to quit, the man continued to live. His heart rate increased, and his blood pressure increased, and he continued to breathe. Instead of dying, he did not die. He was evidentlyl brain dead, but his body did not die. He lived this way for another 13 hours, dying at precisely the tone of the church bell at midnight.

He died peacefully in his sleep

I have seen people die. I have seen many people die.  I know how people die.  I know the truth of how people die.  To be honest with you, for a while any way, I had a picture of death that was the antithesis of what they tell you when you get the phone call: "...and he died peacefully in his sleep."

I have never seen anyone die in their sleep.  For me, I have seen people die other ways.  I have seen people die while sitting in a chair in the middle of a conversation, and it was sudden dyspnea and chest pain.  I have seen a person standing, clutch his head, saying, "The pain!  The pain!" and drop to his knees, fall to the floor, and drop down to the ground, and stop breathing.

So we pound on his chest and breathe for him, and he dies three days later with a tube in every orifice To me, this is the least dignifying way to die.  His last memory was of pain.  His last memory was of being with strangers in a hospital.

I had one lady die while taking a breathing treatment.  But she had been dying for days, her kidney's failing, and her body slowly giving in.  Yes she did die in her sleep, but it was only after a long coma, gasping breaths, increased oral secretions, and finally nothing (coincidentally during the treatment).

So you can see, my vision of death was not the pretty scene diagrammed by the phone call.  Until last night.  Last night I was talking to Mr. Jenkins.  I was talking to him about where he was going to go when he was discharged.  He wasn't happy about going to a nursing home, "but it's what my kids think is best."

He was one of the nicest guys I've ever met.  He fell asleep.  An hour later his monitor showed ventricular fibrillation.  I entered his room.  He had a peaceful look of sleep upon his face.  His eyes were shut and his mouth agape.  He had the big O expression.

I said a prayer. The nurse said what I was thinking, "this was the nicest guy. He's now up there.  Don't be afraid to look up.  He's looking down on us now."

The nurse called the family.  He said, "...and he died peacefully in his sleep."

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What's the most interesting to happen as an RT?

 Your question:  What's the most interesting thing to happen to you as a respiratory therapist?  What's the most interesting thing you've seen?

My answer:  It's probably the witnessing of a person die.  Once I put a breathing treatment on a patient who was awake and alert.  She appeared to fall asleep, and I went to take a respiratory rate: there was no rate.  I closed her eyes and said a prayer. 

Another time I was talking to a 95 year old man, and he said he new my grandparents.  He wanted to tell me a story about my grandparents, but I was in a rush and never heard his story.  An hour later I was called to his room because he was having chest pain.  He said, "I'm glad you came back."  He closed his eyes and died. 

Lesson learned: "Take the time to listen now, because there may not be a tomorrow. 

Our experience with Gift of Life

My wife and I had our own experience with gift of life recently. After her mother passed away unexpectedly from a brain aneurism, my wife and her three siblings decided her mother would want to do this.

They decided that even though her mother stated she would not want to donate her organs. She came to that conclusion because when she was a student she watched the gift of life take organs from a patient, and for some unknown reason the organs ended up being wasted. So that gave my wife's mother a sour taste about the idea of donating.

However, when the occasion came up, my wife said, "You know, an irony about this is that while this is our time of grieving, seven or eight people could be celebrating right now."

So the "reasonable" decision was made to trump their mother's decision. I remember watching over this discussion. Here four siblings in their 20s were standing around the lifeless body of their mother who was still on a ventilator making decisions people in their 20s normally don't have to make these days.

Back in the 18th century every family had death experiences. It was common for people in their 20s to have their parents die. It was common for infants to be born dead. In fact, at the time of Jesus 50% of children didn't make it to adulthood. Yet, thanks to modern wisdom and medicine, we just don't see death as often anymore.

So here my wife and her siblings were facing death for the first time. And a few days later the nurse came to my wife and said, "You know, I've seen many people die in the past year, and you are only one of four who decided to do the gift of life without consulting the gift of life first. I'm very impressed."

I recently talked to the gift of life representative here at Shoreline, and he said the law has it that a nurse or doctor is not allowed to approach a family about gift of life. However, if a person is close to dying, or even if the doctor thinks a person might die, the gift of life has to be called. Then it's up to the gift of life representative to approach the family. They are trained to do it.

Plus I imagine there might be a conflict of interest for the nurses and doctors trying to save a life to be coaching on Gift of Life.

So he said there are many people who decide to give to the gift of life, only a few do it without first being consulted. However, my wife is a nurse. She's also quite smart and reasonable.

My dad had a similar experience when his brother passed away after he hit his head as a result of a car accident. He was on his way to our house, and he lived only a mile away. All he had to do was cross the highway. He was teaching his 15 year old daughter to drive a stick shift. It was Memorial weekend. He was taking apples to our house to feed the deer.

The Jeep stalled at the intersection. Uncle Ted, who always wore a seatbelt, just unhooked the seatbelt because he was going to switch seats with his daughter. Yet just then the jeep was hit on the driver's side by an 88 year old driver.

The other driver wasn't going fast, and the hit wasn't hard, but just enough to knock uncle Ted out of the side of the Jeep where he hit his head on the curb. Dad was a member of the fire department, and ironically he was the first on the scene. He said Tad was talking to him, or screaming, "It hurts, Bob. Help me!"

This was back in 1989. This was back when the emergency helecopters were new. The Big Hospital up north just got one. My uncle was going to be the first passenger. He needed to have his head tapped to relieve pressure, but he had to be transported to the Big Hospital -- and fast.

Well, dad said the bed he was on didn't fit in the helecopter, so they had to wheel Ted back into the emergency room. It wasn't for another hour before they got him in the helecopter. By the time Ted arrived at the Big City Hospital it was too late to tap. Two days later he was pronounced brain dead.

Tad's wife asked dad what to do about organ donation. Dad said to her that Ted loved people and he would love to do this. Tae would be very happy with that decision. Yet his wife was scared and said, "But I can't do that."

So my uncle took his organs with him. That's fine. Yet back then the wisdom wasn't what it is today. Today we know that organ donation works. It saves lives. Grandkids and kids will be able to spend some more years with the 57 year old grandma who received the lungs of my mother in law (she was only 50).

Before this experience I personally was leary about donating my organs. However, when I was filling out the paperwork to get my new Michigan drivers license, and the lady asked me if I'd like to be a donor, I found myself saying, "yes!"

Now I know that little red "donor" next to a red heart over my picture (a much better picture than my last one I must add) has no legal significance, yet it might help someone make the decision later down the road. If something happens to me, I certainly don't want my organs to be buried with me. I won't need them in Heaven.

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The leading causes of death are fun and money

I was reading a blog recently (I wish I could find it so I can give credit to the author) whose writer made an interesting point regarding the leading causes of death in 1900 as compared to 2009.

He noted that while most deaths in 1900 were caused by diseases that people no longer kill people due to antibiotic therapy, rehydration therapy and improved medical practice, most of the deaths today are due to our own behavior.

Consider the following:

Top diseases in 1900(stats provided by public agenda.org):

1. Pneumonia (27% of all deaths). cause is infection with bacteria or virus.
2. Tuberculosis (11% of all deaths); cause is cause Micobacterium Tuburculosis.
3. Diarrhea (8% of all deaths); cause is dehydration.
4. Heart Disease (8% of all deaths); cause poor diet
5. Stroke (6% of all deaths); cause is poor diet

Top diseases in 2009:

1. Heart Disease: (6% of all deaths); Causes are smoking, poor diet
2. Cancer: (23% of all deaths); Causes are smoking, alcohol, poor diet, environmental exposure to hazardous chemicals
3. Stroke (6% of all deaths). Leading causes are smoking and poor diet.
4. Chronic Lung Disease: (5% of all deaths); 80% of cases caused by smoking
5. Accidents: (5% of all deaths); Unintentional injuries, falls, poisonings, vehicle accidents

You should also note here that COPD is the fastest rising cause of death on this list, and is actually expected to reach the top as baby boomers are aging. It is noted that deaths from this disease have increased 165% between 1965 and 1998.

The author noted that with an improved diet, quitting smoking, eliminating exposure to hazardous chemicals, and quitting drinking, we might be able to eliminate the top four leading causes of death in 2009.

Or, stated another way, antibiotic therapy and improved medical care has made "US" the leading cause of death. Or, stated another way, improved medicine since the last turn of the century has made "FUN" the leading cause of death.

He wrote that the way to solve this problem is for all of us to talk to our doctors about how to improve our diets.

My criticism of this solution is that it isn't that easy, as I would state the leading causes of death today are the following:

1. Stress
2. Peer pressure
3. Fun
4. Anxiety
5. Accidents

I don't think there is any way accidents will ever be eliminated from this list, as accidents will always happen. However, even in this category, there has been improvements. The new saying, per se, is: safety first.

Yet, even while there are laws requiring people to wear seat belts and drive safely, progress can still be made, particularly in educating people how to do these things correctly.

Yet, due to stress, peer pressure, fun or anxiety we are all prone to put a little peddle to the medal. I mean, just today I drove three blocks with three wailing kids in the back seat, and some teenage drove with his buddies for the first time. I'm not sure it wasn't really my kids who stressed me, but the fact I was fatigued from working too much.

So, really, the only way to get rid of the top killers of 2009 will be to get rid of angry and grumpy bosses and our peers who urge us to go out and have a little fun due to the stress and anxiety the boss causes.

Or, perhaps you can say the leading cause of death today is the need for money.

So, minus the creation of a world where we don't have to quest for money, I don't see the leading causes of death changing any time soon.

What's it like to die?

When you work in a hospital you see death more than the average person. It's almost impossible not to think about it. And even though you've seen it, you still have no idea what it is like to die.

Yet, still, I have been asked on more than one occasion the one question no RT, RN or Dr. ever wants to be asked: "What is it like to die."

The patient who asks this is usually one who knows he is dying, yet still feels so alive. If you've worked in a hospital long enough, you know exactly what I'm talking about. One time I had a young patient with terminal cancer, and he'd sleep most of the day only to wake up and say, "Oh, I'm still alive."

That would be a sad way to go.

Once I had a middle-aged lady with end state Pulmonary Fibrosis and her lungs simply had no compliance, or had become too stiff to oxygenate her body. She would smile through choppy sentences and ask, "What's it like to die?"

Perhaps you know already," I would think. Yet I'd say, "I don't know. I wish I could answer that."

So, what is it like to die? I have no idea. But most of the time I imagine that people lose consciousness before they die. Usually your organs start to fail, your kidney shuts down, and you simply lose mental awareness. Then you die.

But what about if you have the big one while awake. Would you not feel agony a moment before you lost consciousness, just before you died?

What about the terminally ill, or those in chronic pain, or those who have no lungs left. There are ways to make the transfer easy, and it often involves comfort measures only and some morphine.

After I finished my round of midnight treatments I sat in the patient waiting room and watched Red Eye on Fox News. I really didn't plan on watching this show, it just happened to be on when I clicked on the old boob tube.

I have no idea the name of the host nor the guest, but the conversation essentially revolved around the death penalty.

The host asked what the worse way to die was. The guest said probably stoning. It was very common in the old world, and is now only common in some far out countries. He said the electric chair has been banned in many states because it's so gory.

The shooting squad might result in instant death if the shooter hits the heart with the first shot. But I simply couldn't imagine the anxiety. I'd probably die of a heart attack before I made it that far.

Perhaps the worst way to die was the Pilgrim way. They used to place people they didn't like in water. If they sunk to the bottom they were innocent, if they came to the top they were guilty and they chopped off their heads.

Nobody accuses anyone else of being witches anymore, but I suppose it's possible that we could execute innocent people from time to time. However DNA testing makes this more and more unlikely.

Now the most common method of execution is by lethal injection. But the saying goes that this may not even be a humane way to go.

Penethol is used to put the person to sleep. Actually, the dose given here is enough to be lethal in itself. Pavulon is then used to paralyze the person so the executors don't have to watch the person squirm. Also, since the person is paralyzed, he won't breath. Then, to top it off, potassium is used to stop the heart.

So how do we really know the person went peacefully or not? Seems convincing to me, but how do we really know?

Is there a humane way to kill someone? How about if we hang them. When we used to hang people, according to the guest on Red Eye, they would have a bowel movement,urinate and ejaculate all at the same time because the muscles all relax. But that happens in all people who die, he said.

Anyway, just something to look forward to.

Still, what is it like to die? Does any living person really know? Well, we watch people die. We can say, "Usually people die peacefully in their sleep." But do they really die peacefully?

A conversation on Red Eye went something like this:

"What's the best way to die?" the host asked.

"In your sleep," the guest said.

"So if someone is sleeping, you don't know if they really felt pain before they went out."

"No."

"I mean, it's not like a person ever woke up after dying saying 'It sucked."

Whenever someone in my family has died, this question was always asked by someone: "How did he go. Did he suffer?"

"Nope," someone will say, "He went peacefully in his sleep."

Oh yeah. How do you know?

But when you are the RT or RN or Dr. and you have to talk with the family, and make your humble effort to ease their pain and suffering, you will find yourself saying those same words:

"He died peacefully in his sleep."

Depressed spouses make themselves sick?

One of the most frustrating things I see in the hospital is when we have an older patient whose spouse just died and the couple had been happily married for over 40 years. We had one man recently who was a very successful member of the community even up until recently.

However his wife died a couple weeks ago, and then he became so depressed he ended up a permanent fixture in the hospital. He got pneumonia, he refused to eat, his medical condition deteriorated, he ended up on a ventilator, and he eventually made it back to the floors and continued to be a depressed mess.

I tell you I have the utmost sympathy for people in this situation. However (and I'm no expert in this area other than by mere observation as an RT), I wonder if they have their priorities straight. I know lots of people who were happily married, only to live on for many glorious years after their spouse passed on.

I consider myself happily married, but I sure would hope that if I passed on that my wife would go on with her life after the initial mourning process. I mean, I know their is nothing more difficult than losing a loved one (especially a child), but I can't imagine the one who passed on would want his best friend to spend the rest of her life mourning.

Being old and being fed up with going to the doctor, about being blind and deaf and having to tackle a million prescriptions every day is one thing. I know when my uncle Donald died recently, I was told he had simply decided he had enough, and then he got his wish a few days later. He was 92.

I understand that. But to be of good health, sound mind and body, and to simply give up living, to me, is a foolish thing to do. And, I might wonder, if that person didn't have his or her priorities in life mixed up. I rarely do this in real life, but I would like to ask these people some questions like:

1. Do you believe in God?
2. Do you place God ahead of your wife?
3. Do you have children?
4. If so, do you prioritize your yourself over your children?
5. Do you have hobbies that you like to enjoy that you can still do?
6. Were you so attached to your wife that her love was the only quality thing in your life?
7. Do you have quality friends?
8. If so, do you place your grief ahead of your quality friends?
9. Do you not care that you are setting a bad example for the ones who still love you?
10. Do you not think you are letting your freinds and family members down by giving up?
11. Do you not care what other people think?
12. Do you realize people feel sorry for you?

Sometimes, when I have time, which often I do here on nights (but not lately), I talk to these patients. I ask them, in an appropriate way (and only when they bring up the topic), the above questions, and sometimes I get them to participate in an intelligent discussion during the treatment. I get them talking about how wonderful his wife was, or career, or something.

And, more often than not, I get a smile. The reason, I think, is that, even while he is depressed, he doesn't want to be a stick in the mud; he doesn't want to share his depression; he understands that there are other people (like me) who still have several quality years of life left.

So they smile. And, I bet more often than not, they eventually recuperate. I bet most of them do. But, unfortunately, some never do. These people become permanent fixtures around the hospital and nursing home arenas. They are the ones who demand attention, ring their call bells every 15 minutes chanting to whomever answers the call with: "Get me this," or "get me that."

Those are the lucky ones. Those are the ones who are still willing to talk, because some of these individuals are so depressed they just lie there and sulk. I feel bad for them at first, but then after a while I wish they would just quit feeling sorry for themselves. I wish they had other priorities in their lives other than the one they lost.

I wonder if they do believe in God. I wonder if they do believe in heaven. Because, as I wrote before, I believe that people that have their priorities together are the best patients. In fact, I bet most of these people don't get sick and avoid the hospital altogether.

I'm no expert in this area, yet here I am just wondering.

The saddest part of the job

There are a lot of tough parts about working in the medical field, but by far the worst is when you have to face the death of a boy or girl.

So the story goes, his mom thought he was watching TV with his brother. But, what he was really up to was riding his quad. It was snowing out, so he probably thought it would be fun to ride in the snow. But the fun turned on him, as the quad landed over his little 9-year-old body.

He was rushed to the hospital by ambulance, but he was probably already gone. Nonetheless, our staff worked on him for over 45 minutes hoping to defy the odds. Our general surgeon rushed in to help at the code, and we are thankful for his efforts, but in the end there was really nothing any of us could do.

I was told he didn't have any cuts or scrapes on his body, so whatever got to him must have been internal. Perhaps the pressure of the quad on his chest didn't allow him to breath and he suffocated. Perhaps he broke his neck. We're praying he broke his neck, because that would be the quick way to go.

While most of us are bagging, or inserting IV lines, or deciding what recommendations we could give to the doctor, the Doctor has the job of telling the child's mom that her son is not going to make it, and the rest have the job of consoling her. That, I think, would be the saddest job in the world. I'm glad I don't have to do it.

I've been in too many situations like this, and I can tell you the worst part is when you are still bagging and the family comes in to say their final good-byes. A rare person will walk from that room without a tear in his eye as the doctor says, "Okay, time of death 12:05."

The silence as everyone slowly sets down what they were doing and stares at the lifeless child, all saying their silent prayers. They stare at the child, sweet and innocent up to the end, even in his last daredevel act.

He was in the prime of his childhood. He will never to go on a date. He will never explore the world on his own. He will never again sit on his mom's back porch and feel the cool, fresh breeze upon his face. He will never hug his mom again. He will never play with his brother again. He will never play catch with his dad again.

But that's not the worse of it. The worst part is thinking how his mom is going to cope. Because I can't imagine anything that would be more difficult in this life than losing a child.

In an older person's death we find some solace in knowing they had a full life. In a middle-aged person we have solace knowing they died in their prime. There is no solace when a boy dies, only anger and regret.

Knowing the child is now with Jesus does little to make a mom feel solace, I'd imagine. Yet, that's where solace will come from in time.

I can't imagine anything worse than losing a child.

Good patients go to be with the Angels

Patients who believe in God are often far better patients than those who don't. This is a theory that my friend Sin over in the CCU Cave and I discuss once in a while. And more often than not our patients prove us right.

Last night was a perfect example. I walked into a patient's room to give him a breathing treatment and he said, "I don't want that damn thing." He flailed his arms and tried to hit me.

I was blunt with him: "I have kids that behave far better than you do."

I left and charted a refusal. I don't care if he was short-of-breath or not. Fortunately for him he wasn't SOB, but he did have a harsh, audible, prolonged and forced expiratory throat wheeze when he was all worked up, which he was at that time. And for that reason the patent's nurse, Wren, called me to the room.

"I think he really needs his treatment," Wren insisted.

I studied the patient again. "What he needs is s spanking."

"You shouldn't talk like that in front of the patients."

"This guy isn't having anything close to bronchospasm. He sounds bad and that's about it. Even his doctor told me he's like this at the nursing home. As soon as he calms down he'll fall asleep and he'll be just fine, just wait and see. And if you guys just leave him alone he will calm down."

"Why don't you just give him a treatment?"

"Because I have patient's who want my services and I'd like to live to give them. I'm not going to stand there and risk my life and force a treatment down someones throat when he doesn't want it or need it." My voice trailed with that last part.

"All you have to do is put a mask on."

"And he keeps ripping it off. The day RTs gave him a blowby all day, and he won't even tolerate that now. Besides, like I said, he keeps trying to hit me."

I paused a minute while she tried to insert her syringe into the IV port, and the patient jerked his arm away. "GO AWAY!" The patient ordered. I grabbed his arm forcefully and held it down while she did her job.

"See what I mean. I'm not trying to be mean, it's him. I know this guy, he's been here all weekend. I've studied him. Trust me when I say he's not short-of-breath, he's simply anxious."

Wren smiled. "I see."

Later on we had time to discuss the patient, and laughed. I told her about my God theory and she agreed with me.

Later in the night I visited Sin who took care of the patient a few days earlier, and Sin told me he had a tryst with the patient, who shouted, "I don't have no use for your f#$%ing God! Get the F#%^ out of my room!

Sin said, "He has no reason to be good. He didn't believe if he was good he'd go some place good, like Heaven. There's no incentive for someone like that to be happy at the end, so they take it out on everyone around them."

"So you're saying he's scared."

"Yes. And people who believe they are going to Heaven do not get scared. I mean, they get scared, but you know what I mean."

"Yep, I agree with you."

"Whether you believe in God or not, it's a proven fact that people that believe in God, for the most part, are good as Angels. And I think most patients fall into this category."

I told him my favorite end-of-life stories are when people go out still doing something they love. I remember this one lady who loved doing Genealogy, but her computer broke down just prior to her coming to the hospital."

"Do you know how to fix computers?" she kept asking me. She was in CCU and I know she knew she was going to die. Doctors told her her heart was going to give out any time. She was cheerful and happy as ever. And she simply continued to work on her little projects.

I know they say it's not good to get close to your patients, but I'm telling you that's not always possible, especially when they are so sweet and innocent.

My grandpa, I was told, checked out while he was making a to-do list.

Many ladies whittle to the end. I'll never forget this one long-time patient of whom I participated in many interesting conversations. A couple days after she was discharged I was called to the front desk. Her husband was there holding an afaghan.

"She wanted you to have this," he said. I smiled and waved to her out in the car. I didn't have time to visit at that time.

A few days later I read her obituary. I think of her every time I use the afaghan.

I see many terminal patients reading books. I think, "What more could there be for you to learn? What good would this knowledge be?"

I know the answer now. God can use the knowledge.

At the funeral of a my wife's uncle last spring, his son spoke through tears and said his dad gave him a book in which the author claimed to have studied the Bible and was convinced that "what we learn in life we use in Heaven."

He said, "I guess God needed a carpenter. I'm sad that it had to be my dad, but I'm happy for him too."