I sit on my front porch, the smoke of a cigarette lazily curling around my fingers. I'm not a smoker, but from time to time I bum one off a neighbor when I'm feeling particularly stressed. An old habit from an old girlfriend.
My patient, Simon, is dying. Bacteria have riddled his body, already ravaged by chronic illness, and he has been dying slowly for months. Last week, with the input of his loving family, we withdrew all medical care on him, and I've been watching him die for days. This morning I heard the first telltale sign of the death rattle. I've never heard it before, but it is a chilling sound. The Reaper is standing in the room with me, and I can see his hand on Simon's shoulder. I have been with death before, but not like this.
Simon's room is beautiful, papered with carefully hand-lettered signs. "Simon, we love you." "Go with God." "Happy Birthday From All Who Love You".
His brother, Joseph, approached me today. Joseph and his mother are concerned that by not giving Simon fluids by mouth or IV, we are making him less comfortable while he dies. From a purely medical standpoint, I know this isn't true - at this point, hydration will only cause his lungs to exude more fluid, drowning him in his own secretions. He'll be far more comfortable without, but I couldn't find a way convey this.
And then, Joseph laid his hand on Simon's head. "I'm so sorry, brother. I love you so much." Simon, who barely focuses on anything any more, turned his head to look into his brother's eyes.
So I decided to take the middle ground. I started extremely low-dose IV fluids - so low that I hope it won't make a difference - and increased the pain medications in case it makes him more uncomfortable. But I know full well that more pain medications will hasten his death by decreasing his drive to breathe. He'll die faster now, and that decision must stay with me.
I sit on my front porch, the burden weighing heavy on my shoulders. Joseph and his mother may sleep easier tonight, believing Simon to be more comfortable, but I won't.
I just sit, and watch the trail of smoke drift up towards heaven.