7 a.m. began as it always did; the overnight doc was threatening to quit while rubbing her bloodshot eyes and smearing mascara beneath them. Between heavy sighs, she listed the patients transferring into my care ending with Mr. Mandel.
“He’s eighty-something,” she explained, “hospice care. Cancer with metastases. Came in from home because family ran out of morphine and he was in a lot of pain. Anyway, he’s actively dying now, so they don’t really want to put him back in the car and drive him home.” With that, she shoved a handful of dry cereal in her mouth and shuffled out.
I hung my stethoscope over one shoulder and started rounding on each of my newly acquired projects. When I pulled back the curtain in Mr. Mandel’s room, his daughter flinched, and her eyes darted toward mine, like a startled animal. She sat aside Charles’ stretcher on a folding chair, clinging to his railing in an attempt to hold herself upright with what energy she had left.
A cacophony of sounds filled the room: water dripping from a faucet and fluorescent lights humming overhead. IV pumps buzzed and whirred. Vital sign monitors beeped incessantly in unpredictable patterns, tones, and volumes.
“Good morning,” I offered softly, wincing at the absurdity of my pleasantry.
It was only then that I finally look down at Mr. Mandel. A few wisps of grey hair wilted on his shiny scalp. His skin glowed translucent, providing a paper-thin cover for the tangle of purple vessels visible beneath it. Beneath a thin white sheet, I could see that his skeleton legs were so thin that they barely made a dent in the pillows they were resting upon. Partially closed eyelids revealed piercing blue eyes and a strong Roman nose arched out over a cavernous mouth. He intermittently and unpredictably sucked in air with a deep gurgle known as the “death rattle”: the morbid melody of the dying, a hymn of the departing signaling to those keeping vigil that the end is near.
Not knowing what to say next, I listened to his heart with the stethoscope. The classic “lub-dub” was gone; a chaotic drumbeat in its place.
“How is he doing?”
“I don’t know,” his daughter stammered. “He just keeps moaning. I think maybe he’s confused and doesn’t know where he is. Sometimes he seems peaceful and others he looks scared. And these machines are just so loud. Every time he falls asleep, they jar him awake. They won’t stop beeping. What do the numbers even mean?”
Glancing at the screen, I immediately interpreted the numbers. Heart rate: 45. Respiration rate: 40. Blood pressure: 67/42. It was very easy for me to tell that Charles Mandel was soon to die. But as intensive care unit stretchers replace at-home deathbeds, digital tones replace guttural human noises and the ability of observers to slowly comprehend the reality of a failing body is diminished.
Ventilators can measure beats and breath. IV pumps quantify input and output. Monitors track every move. Devices alert when a blood pressure becomes low, but what alerts family or friends when to say goodbyes? Lost in the clamor are nature’s cues that death is imminent. Not only does the hospital noise distract visitors from focus on what is most important, it pollutes the peace of the dying.
“What would you say if we turned this machine off?” I suggested. “The buzzing stops. We remove his stickers and prods and cuffs. We make this room a bit more tranquil, for both of your sakes.”
Relief washed over her fatigued face, and she curled her lip into a small smile. “Yes, I think that would be better.” I delicately plucked the stickers from Mr. Mandel’s paper skin and turned off the machines.
Sliding the door shut behind me, a TV blared nearby. Reaching around a nurse sipping stale coffee I tugged open a nearby printer and stole a piece of paper from it, writing in bold letters: “Quiet Please. No Interruptions.” Just as I attached the final piece of tape affixing my sign to the door, it slowly creaked open.
“I … I think he’s gone,” Mr. Mandel’s daughter stammered.
Taking a few steps in, I knew that she was right. For the first time in days, the room was finally silent. And the silence, the silence was deafening.
Molly M. Murray is a physician assistant.
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