Monday, January 12, 2009

Strange Things I Know to Be True

One of my patients passed away at work today.

As a doctor, even one who has only been in the practice of medicine for going on a decade (including medical school), I'm definitely no stranger to death anymore. But the circumstances around his passing reminded me of a few strange but common occurrences related to dying that I've witnessed over the years.

Here's the story: my patient was an 85 year old, slightly demented and not for resuscitation, who had recently had a heart attack. He had been doing poorly for a few days, but seemed to be turning the corner clinically.

But by way of most cardiac patients, after having a restful night, he suddenly just stopped breathing and had no audible heart rate - his heart probably went into an arrhythmia. While we were placing the cardiac monitor leads on him, he spontaneously started breathing again. Given the length of time he was out, we figured he wouldn't wake up. We told his niece to let his family know that the prognosis wasn't good, and she had already phoned most of his relatives, who would be coming in shortly.

The staff and I left the room to give his family private time and so I could update my consultant about what was going on. When my consultant came a few minutes later, we came into his room and saw that while he was awake, we all got the feeling that he would not last long. Sure enough, he passed on within the next two hours - after all of his relatives in the area had come in to see him and say goodbye.

Which leads me to the first strange thing I know to be true: dying people can actually "hold on" in order to wait for certain people who they want to see before they die.

One more strange thing I know to be true - very sick patients, most often the terminal ones, have a final surge of strength or a "good day" shortly before they slip away. Sometimes we get lulled into thinking that these patients are clinically improving, only to be stunned the next morning to find out that they've passed on in the night.

It is also possible to die of a broken heart. And I don't mean that in a physiologic sense. Have you ever tried looking at old gravestones and noted how close apart old couples die one after another? It's probably because after one passes, the one left behind loses the will to live. I had a 80 year old patient recently who was quite well medically and good functionally until his wife died. After that, he was in an out of hospital, and he died of pneumonia six months after she did despite all our medical efforts. Quite simply, he had lost the will to live.

Non-medical people will find the concept difficult to understand, but health professionals - doctors, nurses, carers - can actually spot when a patient is on his or her way out. It comes from experience, of course, but we can tell. But one more weird thing my co-residents and I have noticed in our dying but awake patients - when they ask for water, death always comes close behind. Seriously. I don't know how true that is in other medical people's experience, but it's certainly been true to my and my co-residents' experience.

And you know the one about the dying calling out for people who have died or saying that they see people who have died calling for them? That one happens pretty often, too.

Sorry for the morbid turn. It's just amazing to be reminded that there are so many things that can't really be explained by logic or science but actually occur in the world.

Do any of the other medical people in the house have any other weird observations and anecdotes to add? Oh, there's still that one about what happens to people (specially psych patients) when it's a full moon... but that's another story.


drrayms said...

do you remember your patient who we had to intubate on the floor? he was so huge nobody bothered to bring him back to his bed?

ness said...

I agree with all your observations. Totoo talaga yan.

dr_clairebear said...

@rayms: oh, God, do i! it was the irst time i physically felt my age - my knees were creaking as i stood up after giving compressions! the leads wouldn't even reach the chest. and ang tagal pa dumating ng reliever natin! hahaha

@ness: weird, no?

Manggy said...

Gosh, so sorry to hear that Dr. Claire. Even if it's eventual for us, can't ever get really used to it. Some of the strange things you said are soooo Filipino (esp. the "waiting for someone" part)!

Marjie said...

Ow claire, what a tragic news. I'm so sorry to hear about it. I'm sure he's in a good place now, and how lucky must he be to have you take care of him.

BTW...thank you for your concern about my surgery. I have an update in my blog. I will pray for your patient because I know how it feels to have a weak heart. I was there once.
Thanks for sharing this story.

Panaderos said...

I agree with all your observations here. Through the passing of relatives over the years, my family and I have witnessed them too.

Walking on Water said...

claire, do you still remember that smell? death has a certain smell. and the ants just seem to get there first. and there's a weird look in a soon-to-be-dead person's eyes too. it's a glassy, distant look, terrifies me until now. yeah, the "i thirst" sign is infallible, even biblical.

will said...

i saw a feature i think in CNN about a cat sleeping on the bed and rubbing his body against a patient about to die in 15 minutes. pero yung mga cats natin sa PG walang precog powers, pero cute sila pag natutulog sa inbox/outbox ng chief res office.