Is There Ever a “Right Time” to Die? A Physician Speaks Out.

Doctors and dying, physicians and end of life care, respecting patient's right to die, death with dignity
A Patient’s Son Comforts His Father Who is Grateful for the Life He Lived

A Friday during my fellowship training, I was asked by my instructor to go place a dialysis catheter in someone in the ICU.  He needed fluid removed because his lungs were becoming congested to the point he couldn’t breathe. I just wanted to get into his room, do the procedure and get out of there because I had plenty of other things to do.  The patient was a man in his 80’s who motioned to me that he wanted to talk. Because he had a large pressurized mask on his face to help him breathe, I could not hear him well and I didn’t want to remove it. He kept motioning to me and spoke in muffled sentences while I prepared for the procedure.  I had been instructing him on what to expect but he looked at me with concern.  Eventually, I cautiously decided to remove the mask to hear what he had to say and what I heard shocked me:

“I AM 88 YEARS OLD.  I’VE LIVED A GOOD LIFE.  IT IS TIME FOR ME TO DIE.”

I was shocked by how loud and booming his voice was as he articulated these words.  During that brief time with the mask off, his oxygen saturation dropped to 80% and if you don’t know, that means he could arrest and die immediately if not for the help of that large pressurized mask. I had to put the mask back on, quickly.  The patient was not restrained and could do whatever he wanted at that moment but allowed me to put the mask on to briefly leave the room, though I remembered he grasped my white coat as I headed away as if to elicit my sympathy.

Outside, I saw the patient’s wife and I told her what her husband had said to me.  She told me that, in the past few months, he had spent more time in the hospital than at home and has been dealing with a never ending series of medical problems.  She called her son from the waiting room and asked him to come to the room quickly.  Again, I removed the mask and he repeated the words to them:

“I AM 88 YEARS OLD.  I’VE LIVED A GOOD LIFE.  IT IS TIME FOR ME TO DIE.”

His family was clearly moved and rushed to his side.  I was getting nervous because this was not the kind of training program where you just disobey orders.  There were complicated politics between the private and the academic docs in the ICU and you don’t just change management from aggressive care to end of life on your own.  Before I placed the mask back on, he grabbed my coat and said, “You’re one of us.”  I secured the mask and went outside.  There were no attending physicians available to discuss this matter further as they were likely starting their weekend early, but the Palliative Care team was still working and they explained to me that the patient was making a reasonable request.  I could not force him to undergo the procedure, and they taught me how I could use morphine to eliminate respiratory distress should we decide to keep the mask off his face.  I explained the options to his family, and they felt compelled to honor their loved one’s wishes.

We hung a morphine drip, not to euthanize him but to keep him comfortable.  His family stood in place while I told the patient what we were going to do.  When I took the mask off he thanked me and said:

“IN THIS HAND IS MY WONDERFUL WIFE.  SHE IS THE BEST WIFE.  AND IN THE OTHER IS MY AMAZING SON.  I AM 88 YEARS OLD. I HAVE LIVED A GOOD LIFE.  I KNOW YOU ARE ONE OF US. IT IS TIME FOR ME TO DIE.”

“What does he mean…I am one of you?”  I asked his son as we nervously watched his father’s oxygen plummet on the monitor.  The edges of the patient’s lips seemed to curl up into a smile of relief or pride or something I cannot describe.  The light from the windows was a dim orange as the sun was almost set. “What he means,” said the son, “is that you are a Jew.”  He motioned to the exposed inside of his father’s arm where a tattoo of numbers could vaguely be seen.  “He is a survivor of Auschwitz and knew you would understand.”

I’ve seen many people die, but none with a smile on their face; none with that look of satisfied peace.  It happened at the precise moment that Shabbat began and it truly was his day of rest.  I thought of all the horrors he had seen and I was moved that he could pass so peacefully and with control of his destiny.

Ever since that case, I began to wonder: if I was not one of them, who would I be?  On today, Holocaust Remembrance Day, I think about who I would be if I had taken this man and forced him to go through more painful and humiliating procedures.  Who would I be, if I did harsh and terrible things to unwilling people to deliver unnecessary ‘care.’  I would be the same sort of person who did similar things 75 years ago in one of history’s greatest atrocities.  It was an important lesson early in my career to remind me of the terrible power I have to do harm and how almost treating my job like a regular job could so easily shape my identity for the worse.  Who I wanted to be, I realized, was someone who could look back so satisfied at life, so grateful at the end like him, despite having every reason to lose faith and optimism.

Alex D. Hakim, MD: Editorial Writer at DoctorCPR.com–America’s #1 Medical Career Site.  Dr. Hakim is an Intensivist and ICU Director of Providence Little Company of Mary Medical Center–Torrance, California.

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