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Spring 2014
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RESIDENT EXPERT
 
The Good Death
A graceful exit inspires lessons for life's final stage.


Last year I had the privilege to take part in a rare yet beautiful event: a good death. While physicians frequently witness death, it all too often catches us unaware, robbing us and our patients of the opportunity to prepare emotionally, physically and spiritually. It doesn't have to be this way.
 
As a child in the 1950s, my patient’s body had been ravaged by polio during one of the last American outbreaks. The virus paralyzed her legs and weakened her lungs. Nonetheless, this woman led a full and active life for more than 50 years. By the time I met her, the lung damage had become her biggest problem. For some time she had required a special tight-fitting mask at night to assist her lungs and prevent a dangerous accumulation of carbon dioxide. Eventually her breathing worsened despite the mask. She was admitted to the hospital where I made her acquaintance.

For several days we employed all the steroids, antibiotics and inhalers at our disposal but she continued to worsen. She now needed the mask at all times, only tolerating short breaks to eat or chat with visitors. To sustain her life further would require a tracheostomy and a ventilator. She had long known this day was coming. Rather than succumb to a seemingly endless cycle of intervention and complications that would prevent her enjoyment of life, she chose death.

Knowing the end had arrived, she summoned friends and family for one last goodbye. And did they come! I happened to be on call and witnessed an unending stream of visitors throughout the night. Young and old, family and friends, they came – laughing, crying, talking, hugging, sharing stories, and revisiting favorite memories. Her sister gave her a haircut. Her family brought her favorite meal. I visited her early on that final morning, listening to her lungs and her worries alike. She was scared but certain of her decision. Her trusted pulmonologist arrived around noon, gave her morphine to alleviate any shortness of breath, and removed the mask. She died quickly and peacefully.


 

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