Lessons in death and life

Dying is a strange sort of thing. I mean if you think about it, everyone dies because their heart stops beating….but why does their heart stop? It’s a complicated question that doesn’t actually have a great answer. The really weird thing (in my humble uneducated opinion) is that even though people die for lots of different reasons, the end sort of looks the same. They lose their appetite, they don’t eat or drink enough to maintain their weight, they get tired and sleepy all the time, and maybe even a little confused, they get short of breath and their heart doesn’t work the same any more. And then somehow – they know its coming. But I don’t. I don’t know what it looks like, or how to know if it’s going to be soon or not. I just know when the machines make me nervous, and when I think I’m not going to be able to solve problems in the long term…and the rest is a bit of a haze of guessing.

My patient has lymphoma (a cancer of your immune cells) and he's dying. He has had it for 3 years and fought it off once already, but last fall it came back. He has gone through chemotherapy and over the last few months stopped eating and drinking and came to the hospital this weekend because he doesn’t have the energy to leave his bed anymore. Now his blood pressure is really low and I can’t fix it because his poor heart is all worn out from the chemotherapy and wouldn’t be able to handle me giving him lots of IV fluid.... And he gasps a little when he breathes. I think he tries to hide it, but when he’s sleeping I can hear him.

*sigh*

So all I can do is make him comfortable. It is very hard to wrap your head around the idea that helping someone have a good death is just as important as helping them have a good life. Arguably even more so.

I learned that there are 5 things that people want to tell their loved ones before they die:
1. Forgive me.
2. I forgive you.
3. Thank you.
4. I love you.
5. Goodbye.

And part of me wonders - why do we save these things to say before we die? Why is it that it's only when we are down to the wire in terms of time that we can come up with the strength to say the things we should have been saying all along? Why do we waste our time on being angry and disappointed and frustrated? (And clearly I'm not saying this from some wise point of view wherein I don't fall into the trap myself. I am guilty of listening to angry bitter songs and crying at the state of my life and the relationships that have gone horribly wrong...)

So today he told his family to bring in his grandkids and he said goodbye. He let his wife know that he wants to be cremated. And still, even as he dies, he is the sweetest soul. He smiles just a little when I walk in (even though he can't lift his head off the pillow) and holds my hand while I talk to him. Tonight when I went in to say goodbye for the evening he told me that it is too long to wait until morning to see me again. If a person can be sweet and wonderful while dying, I think that says a lot about who they have been throughout their whole life. I think he probably didn't wait until the end to say all those important things, he's just reiterating them now.

I worry sometimes that every time a patient dies, a little piece of me will die too.
Or maybe I have that backwards and actually a little piece of them will live in me.
To be honest…I’m afraid to find out. I dread looking at the computer tomorrow morning in case there is the completely irreverent “expired” beside his name.

Pamela