The Process of Dying

The process of dying can either follow perhaps the most serenely imaginable scenario of dying in your sleep vs a spectrum of possibilities from suffering in a hospital, being unconscious, or being murdered. I wish I knew why the process varies so much, person to person. And I would gladly suffer a miserable death to store my treasures in heaven. But I digress.

People rarely “code” and then suddenly die in the ICU. Virtually all natural ICU deaths are planned in a discussion with the family where an agreement is made for the date and time to extubate and allow death, usually when the family is all together in the room.

The best we can do is recognize what needs to happen, and facilitate it as best as possible.

Because one day, it will be our turn.

It was 2 am and was on call for the ICU when I got paged to Room 1011. Our patient was in trigeminy on the EKG monitor, an abnormal heart rhythm that makes big wave forms and isn’t a great sign for someone who is already critically ill.

We did the “knee-jerk” response: gave 1 gm of Magnesium Sulfate IV. It stopped the arrhythmia, and I noted the patient wanted to talk to me.

“Come here!” she rasped with a coarse whisper.

I briefly turned around to be sure she wasn’t talking to a nurse who may have been behind me. No one was there.

I hurriedly walked over to the other side of the bed and put my ear close to her mouth. What she said next would stay with me for the rest of my life.

Her eyes were wide open.

And she pointed to her right foot, to the end of the bed.

Nothing in my medical training prepared me for this, and I carefully selected my next words, knowing that she didn’t have much energy to spare, and I would have to wait until morning to call in her family to the bedside.

You see, earlier that same morning, I had an argument, really a fight, with her two daughters. I had noted that she may be about to pass away and her family was so large that not everyone could fit in the ICU; only two visitors were allowed per room. I had gently approached her two grown daughters about how their mother may be headed to go on to the next life.

“OH NO!” they shouted at me, flailing their arms in the air and pitching their heads forward with pointed fingers shaking at me. They were mad!

“She’s NOT going to die! Jesus is going to HEAL HER!”

There was nothing I could say, so I gently ended the conversation and walked away.

And now…

THIS happened.

We stabilized the patient, and as soon as Visiting Hours began the next morning, I walked up to the same two daughters and brought them outside their mother’s room, into the hallway.

“I want you to know that I was paged at 2 am to your Mom’s bedside, because she had an abnormal heart rhythm called trigeminy. We got her stabilized and her heart looks fine now. But your Mom pulled me next to her and then said something profound.”

They were still mad at me. All ears but skeptical, they looked at me with clear distain. One woman had her arms crossed over her chest, with one foot out.

“She pulled me over to her side and told me she saw Jesus standing at her bedside, right near her right foot. She said she is ready to go home.”

I repeated,

“Please do. And then know that if your family would like, we can move her to a regular room. She could have as many visitors as can fill it. And then you can have your privacy together. Just let me know.”

They went into the room and had a conversation with her.

I got pulled away for this and that, rounds, putting in an internal jugular central line, then an arterial line, then a family conference on a different patient, then evening rounds.

But for a cup of coffee on morning rounds, I suddenly realized that I had not eaten all day.

But I still had more work to do.

The next thing I knew, it was dinnertime. I hurriedly ate at the Stanford cafeteria, waiting for my beeper to go off again, as was inevitable.

As I walked out of the cafeteria, I looked to my left.

There was a young woman walking down the hallway toward me with a little girl behind her, holding up the most beautiful, long train of her wedding dress.

I had to stop my mouth from falling wide open. They were absolutely BEAUTIFUL!

I walked slowly, putting some distance between us.

Anyway, it sure looked like it was a good time to take a little walk before returning to the ICU.

I watched as they turned to go inside a room on the regular floor. I heard music. I heard singing. I heard HAPPINESS. And I kept walking.

As I came upon the door to their room, I couldn’t help but peek inside.

There was my patient on her deathbed.

With 20 family members and friends, celebrating the wedding of her granddaughter.

And then, she died.

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