When Death is Imminent...

Merriam Webster defines imminent as: ready to take place; happening soon.

It’s too bad my patient’s family didn’t understand that. No one told them their 30-year-old family member’s cancer was so far advanced that death was ready to take place. The cancer had moved to his brain and nothing further, after three surgeries already, could save him.

“Intubate him and put him on a ventilator if you have to”. Those are the words I heard over the phone when I asked why the patient was coming to ICU. I knew this patient, I cared for him several times already, I knew his cancer was end-stage, I knew it was a matter of time, very precious time to be exact, before he would die. So why was he coming to the ICU?

«I looked to my right, into his wife’s eyes, and calmly said, 'Call your family. Tell them he is dying and if they want to say goodbye, they need to come now'”.

He was coming because no one sat down with the family to say that death is happening soon. The family was surprised to hear these words from me. They refused to accept that he was dying, imminently. They hadn’t entertained the idea that he wasn’t coming home again. His sister, unable to understand the reality of the situation had to leave the room. “Do something, please, do something!”

· My patient was unconscious and couldn’t speak for himself

· He had no advance directives

· His family was emotionally distressed and were fighting about what to do

· There was nothing we could do

I looked to my right, into his wife’s eyes, and calmly said, “Call your family. Tell them he is dying and if they want to say goodbye, they need to come now”. Many tears came from those in the room, I made sure we had boxes of Kleenex within reach and chairs in the room; I put the side rails down and guided his wife to a chair so she could sit very close and hold his hands, and kiss him and touch him and cry. The family now understood that he wasn’t going to come back; a breathing tube and a ventilator would NOT be placed because death was very near.

No more needles for blood draws. No more tests and tubes and medications that wouldn’t save him anyway; except medications and measures for comfort. Comfort care.

»If the family and patient had talked about what it could look like when he died, he might have been at home, possibly in a bed by a window overlooking the garden."

Think about this; a healthcare provider asked me to place a breathing tube and start a ventilator on a patient who was hours away from dying. It was well-intentioned but futile. Would our patient have wanted that in his final hours? A tube down his throat and a breathing machine to prolong the inevitable? Would you?

You have choices. Advanced directives have personalized options for your unique situation. If the family and patient had talked about what it could look like when he died, he might have been at home, possibly in a bed by a window overlooking the garden. Family and friends could be all around playing music he loved, telling stories about his life, sharing their fondest memories, saying prayers that provided him comfort and his children and pets could be nearby. Or maybe he would have chosen to be in a hospice facility. We’ll never know because he didn’t have his wishes documented and didn’t talk to his family. Will you? I can help you design your wishes.

“I asked the leaf whether it was scared because it was autumn and the other leaves were falling. The leaf told me, No. During the whole spring and summer I was very alive. I worked hard and helped nourish the tree, and much of me is in the tree.” -Thich Nhat Hanh

(For more information about end of life care, check out this blog. For more information about medical guidence for loved ones, check out this blog. )