Death and Dying Short Essay

Death and Dying

Death and Dying

The Emergency Room was bustling, my shift was busy, and the world continued to go on. Working as a hospitalist means that you never know what you are going to see, and each day presents new challenges. I will never forget the day when I walked into the ER and saw the hallways and patient rooms filled with people complaining of different ailments, all of varying degrees of sickness. The patient that affected me most in my career thus far, was a woman in her 70s, with very few chronic medical problems, and family surrounding her.

The ER called, as they typically do, for us to admit the patient to the hospital. She had presented complaining of shortness of breath, coughing, and just overall not doing well. She did have a history of COPD from 30 years of smoking in her youth. However, the rest of her medical history was minimal. She was only on one medication, and that was an inhaler for her COPD. She didn't go to the doctor often, and that was OK with her.

I entered the room, and the patient appeared ill. In the medical, world the first impression of a patient means a lot. To your attending, they are either sick or not sick. It is your job as a physician assistant, nurse practitioner, nurse, or other colleague, to decide which category they sit in. All of our training is geared towards making people who are sick, not sick anymore. To do this, we have to recognize the emergencies and compare them to the less critical.

Within 30 seconds of entering this patient's room, she was critical. The ER physician had mentioned that she wasn't doing well, and they were there for a hospice evaluation. The unfortunate statistic indicates that most people spend an average of fewer than six days on hospice care. This woman had been feeling ill for months and over the past few days had really not been doing well. She stopped eating and was having trouble breathing, and her family was really concerned about her, so they brought her to the hospital.

She had previously expressed wishes that she would like to have a code status listed as DNR/DNI. What this meant to her was that if something would go wrong, or she stopped breathing, the Lord would take her and that would be the end. To her family, this meant that she needed one last evaluation in the hospital just to make sure nothing else could be done. As she lay there in her hospital bed gasping for air, turning pale, and heart fading away, her family shed tears beside her and held her hands.

I entered the room to complete the initial hospice evaluation for admission, and immediately recognized that this was not a moment I should be a part of. The last moments of a dying patient should be shared with their family and the family needs to know that they are loved. As the heart tones faded, nurses from all over the ER saw the rhythm on the monitor and recognize things were not going according to plan. This patient was not going to make it out of the emergency room.

Despite the multiple attempts to make her comfortable with an oxygen mask and a dose of morphine, her body had had enough, and it was her time to go. I stepped towards the back of the room getting ready to leave, as nurses started entering the room. 4 strong women with tears in their eyes gathered around this family to comfort them even though their actions were not enough to change the trajectory of this story.

Something I am not very proud of, is my instinct to leave the room and not be able to face what was about to happen. In PA school we were taught extensively how to save people how to treat people, how to make them feel better, but we were never instructed how to deal with death. A lecture here and there on the concept of death and dying is a challenging one, and it's not something most people feel comfortable talking about. Each admission I do I ask the patient if, "God forbid, for any reason while they're staying with us their heart would stop beating, do they wish to be brought back to life? Do they wish to have CPR. Do they wish to be put on a breathing machine if needed to help prolong their life and hopefully bring back a recovery."

Most of the time, people look at me as if I'm crazy and say, "yes of course do what you can." Other times people, much stronger willed, will say "I've lived a good life and if it's my time to go, just let me."

As the nurses surrounded the room and the patient took her last breath, the family was crying, I was crying, and the nurses did all they could to make sure that the family felt respected and that the patient left knowing she was loved. For this moment, all we could do was stand in silence and share our deepest sympathies.

The challenge as a PA is to know when it's your time to speak and when it's your time to be quiet. For this woman and her family all they needed was to know that they were supported, and that she went as peacefully as she could.

This particular patient sticks out in my mind as someone who knew what she wanted, maybe didn't get to go on the exact manner she chose but was surrounded by family who loved her and had medical staff who supported her wishes. Some providers joke in the face of death to cope with it. Others face it, do their documentation, and move on with their day as if nothing has happened. Very few people are able to address that death is a part of life and are also able to discuss the risk of mortality.

As I sit here reading a book called "Being Mortal" by Atul Gawande, I am reminded of how fragile life can be, and how miraculous the medical field is. I could not be more grateful and appreciative of my decision to enter the world of healthcare as a Physician Assistant.

Despite its challenges with busy workdays, stressful situations, people who are regularly sick and repeatedly come back to the hospital despite multiple interventions, the medical field provides comfort and solace in the fact that I am doing everything I can to help people live the life they wish to. It has been an ongoing learning experience to appreciate the fact that even if you're elderly that does not mean that you wish to give up, as well as understanding that each person has their own views and wishes that deserve to be respected.

As a physician assistant I am just a single component on the totem pole in the medical community. Admitting people regularly to the hospital has created a sense of normalcy to those who are ill. This case is a good reminder that you are seeing people on the worst day of their life. Having an echocardiogram, or an MRI, might be the scariest thing that has ever happened to your patient. It is important to remember this compassion, explain what is going to happen while they are staying with you, and explain that you are doing everything that you can to make them feel better.

If the patient knows that they are nearing the end, and their wishes to be comfortable, it is our job to respect that and help the family in any other ways that they need.

I often think back to this woman who came to us because she couldn't breathe. She knew she was nearing the end, the sudden fear amongst her family, and they all wanting to be sure that she was not uncomfortable in her last moments of life. They did what they thought was right and brought her to the hospital, and despite the fact that she didn't make it out of the emergency room, we as providers did our best to make her comfortable and make it known to the family that we were doing as much as we could to help them. The nurses who stood in that room that day or some of the strongest people I know. It takes tremendous respect and honor to stand in the room of a dying patient, hold their hands or the hands of family members, and put a short pause on the insanity of an ER shift, to show that all who walk through our doors will be loved and cared for to the best of our abilities.

It is normal to fear death. When you take your oath to "first, do no harm," always keep in mind that you are to be fighting for what your patient wants and never your own ego. For me, this woman and her family reminded me of what it means to be humble. They reminded me that it is okay to cry and grieve your losses. I had never met this family or this patient before, but she will forever be in my heart.

My challenge to you, is to remember that everyone is going through something different. The angry patient yelling at everyone may just need to be listened to. The woman who comes to the ER weekly seeking pain medicine, may be struggling emotionally and needs more than just a pain killer. The hospital staff that is overworked, or late to see you as a patient may have just participated in a 90minute code blue to save another's life. When you encounter someone on the precipice of death, have the courage and respect to follow their wishes. Be honest with yourself and allow yourself to share your emotions when appropriate. Death is part of life, but it is also okay to be sad about this realization. Never apologize for crying with a family or sharing in the joy of a cure. Life and death are full of meaningful moments. Don't take any of them for granted, and never stop learning to do the best you possibly can.