I live and work in the house medicine. You would think that those of us who have chosen this profession would actually know what dying looks like. Furthermore, one would hope that if the doctor could identify dying, he or she could share this with the patient and family (given that this is fairly significant medical information).
I never cease to be amazed that most doctors cannot speak straightforwardly and compassionately about the reality of death and dying.
Case in point: I was just summoned into the room of an actively dying patient who’d been in the ER for several hours. Both the emergency physician had seen her, as well as her admitting doctor. All they told that the family was that she was “very, very sick” and that they would put her in hospital to try to treat this.
So where did this leave the family? All they heard was “sick” and”treat.”
Do these words suggest dying to you?
So back to the story: The nurse pulled me aside (because nurses can both recognize and speak of death) and pleaded with me: “I know that the earlier doctor has gone home, but will you please tell this son that his mother is dying? No one has told him yet, and I think she may die during the transport up to her hospital room.”
Accepting the job, I looked at the chart and the patient. The patient had a DNR armband on already. She was 95-years-old and septic, with a blood pressure of 40ish. Still peering through the curtain, I observed that she was completely unresponsive and had shallow breathing.
My nurse was right. She was dying.
I put my irritation at the apparent irresponsibility of my doctor colleagues aside and stepped into the room. (No, I am not perfect, but neither am I afraid to call a spade “a spade.”)
I gathered her son to my side and with great respect, I got right to the point.
“Sir, I am Dr. Murphy and I know that I have not been involved in the care of your mother, but your nurse has very kindly asked me to come speak with you. I know your mother is about to be transported upstairs to the room right now, and I also know that her wishes are to have a Do Not Resuscitate order in place. But I’m concerned that no one has told you that your mother is actually dying right now, and I’m sorry you have to hear this so abruptly and from a stranger.”
I grabbed his hand to ease the blow.
Then, I continued, “Furthermore, frankly, I don’t want to move her from this room. I think it would be best if you called any children and family you want to be with her.”
With a gesture of gratitude, he grasped my shoulder and said, “Thank you for telling me …” and he immediately made phone calls and sent text messages.
Within 15 minutes, the room was filled with children and grandchildren. One of the children who worked in the hospital came up immediately — he was so grateful that the nurse and I had identified the dying moment so that he could be with his mom.
I did my best to shepherd the family and looked on as a natural vigil unfolded before me. Small grandchildren climbed up on the bed to kiss their grandmother’s cheek while adult children held her hands. A hand-made blanket was draped over her legs. There were sweet whispers and loving goodbyes.
The priest was called in for last rites, and he arrived right on time. Her heart stopped at the end of the sacrament.
It was my honor and privilege to pronounce her time of death after such a beautiful farewell.
Finally, I turned to the family and asked, “What else I can do?”
The son whom I had originally spoken with responded: “Thank you so much, doctor, but there is nothing more we could ask of you. After all, we only needed to know that she was dying.”
Details have been changed to protect the privacy of the patient and date of publication has no relevance to the date of the patient encounter.
Monica Williams-Murphy is an emergency physician and author of It’s OK to Die.