Death and Dignity

“No, leave me alone!” she screamed as we attempted to examine her. Her body was frail, her bones forming sharp edges where contours once were. Her eyes rolled back in her head as she struggled for breath. I quickly assessed the scene, 2 bags of saline were running wide open just to keep her systolic blood pressure in the 80s. She was incoherent and relatively unresponsive as I tried to gather history. Her husband stood at the bed side trying to maintain calm in the chaos of ER nurses, techs, and now physicians, rapidly assessing his wife.

Though she was obviously sick, one thing was clear: she did not want our help. Every attempt at an exam was rebuked by screams and fighting. But was this her? Was this an altered state? Questions abounded. As we received records from an outside hospital the picture became more complex. Metastatic cancer with a poor prognosis. What were we to do?

As we looked to her husband, he struggled to answer. Would she want us to be aggressive in our care? Had they spoke about end of life matters? Was she really refusing care or was she confused about what was happening? He didn’t know how to respond to our tough questions.

Ultimately she was admitted and we managed as best we could, but her prognosis was looking grim and she was in very obvious distress. I found her husband sitting by her bed, struggling to come to grips with this sudden deterioration. “Perhaps we can talk outside,” I offered.

He and I sat together, in a private waiting area. “Tell me about your wife,” I said. He broke down, telling about her struggle with cancer. He spoke of her strong personality that he loved; the same personality that sometimes drove him crazy. He explained about her fear of hospitals, which resulted from her father’s experience dying in one. As silence filtered into the conversation I summed up what he had told me.

“If she could speak for herself, what would she want?” I asked.

“She wouldn’t want this.”

We outlined a plan moving forward, about how to manage the pain and symptoms. We called a chaplain to visit. And we stopped all invasive treatment. As I sat down, charting the discussion and decision, I came across a picture of her that had been placed in her medical record. It was a picture that had been taken the first time she came to our institution, years prior to her cancer diagnosis and treatment. I was shocked to see a vibrant, beautiful face staring at me. She was almost unrecognizable. The balding head I knew was full of dark curly hair. Her face was plump, the eyes not sunken in. She smiled at the camera.

I stopped by her room as I left that day. Despite her agonal breathing, she seemed much less disturbed. Her face was calm. Her eyes were closed. There were no signs of pain. Though I was looking at the aftermath of a body ravaged by cancer, I focused on that picture I saw earlier in the day, of a warm, vibrant, smiling woman. And that’s who I said goodbye to.