"Bugle Notes" - "A Good Death"

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 In today’s increasingly technological, data-driven, depersonalized world of healthcare, I wonder if the concept of “a good death” is even possible. The COVID -19 pandemic, in particular, has caused me to reflect on this. What does it look like? How do you define it? As I did, a patient came to mind. He was a retired minister in his 80’s. I had cared for his wife as well until she died a few years earlier. He missed her terribly and longed to be with her again. He had his own significant health problems - severe ischemic cardiomyopathy with a left ventricular ejection fraction of < 10% and a 10 cm abdominal aortic aneurysm! Either alone would kill him and he lived with the knowledge that he could die at any moment. Surgery was no longer an option. Despite this, he lived every day to its fullest and always filled with joy! We often talked about how his death would be. One thing was certain, he was at peace with it because he knew he would be with God and with his beloved wife!

I remember vividly getting the page from the ED as I was rounding early one morning – “Reverend ___­­­__ was just brought in by EMS. His AAA has ruptured but he is still alert and wants to see you.” I immediately went to the ED and found him lying in bed surprisingly alert and oriented. He never complained of pain. As I stood by his side, held his hand, and looked into his eyes, I saw a calmness, a peace I had never seen in another person.  He spoke of not being afraid. Instead, he said he was ready to see his God and his beloved wife. As his blood pressure continued to drop, he thanked me for my years of care and for my “listening heart”. Tearfully we prayed together and within minutes after finishing, he lost consciousness and died peacefully.

It was “a good death”. As I walked away, my mind trying to process what I had just experienced, I was reminded of how privileged I was to have been a part of this man’s life and now his death and only because of the “sacred relationship” between a physician (or other providers as well) and a patient. We are allowed to enter into the most sacred place of all – that time between life and death, when “breath becomes air” and nothing else matters. May times such as this remind you of the difference you make in the lives of your patients. Your work is hard but it is sacred.

Andy Lamb, MD