My planned four day retirement only lasted 48 hours. I logged back in to our electronic medical record to complete some unfinished work. What remained in my queue was a discharge summary for a patient I had seen a few weeks before. Not sure why I hadn’t done it sooner, but I’m inwardly glad I had waited. It felt poetic. My last day in the hospital had come and gone, and so had my patient’s. He had died, as I’ve seen happen in the hospital more times than I can possibly remember. The words I was about to write would be the last physician note in his chart. We call it a death summary, and in it we explain how the patient got from here to There.
Some deaths are good, some deaths are horrible. This death was beautiful. My patient’s body was riddled with cancer and they knew he was going to die soon. I saw him in the morning after his overnight admission and he was having severe pain from all the fluid in his belly. The opiates helped some, but he was still suffering. I ordered a procedure to drain off the fluid and several liters were removed. I went back to see him after this and he clearly felt much better. He had a smile and a laugh.
And the room was filled with people. I don’t know if the fire marshal has a rule on the number of people we can cram into a hospital room, but I think he had passed the max. He looked so much better, I said my goodbye for the day and left.
The next morning, I walked in and fully expected to see more of the same. He had looked so good! This was not to be the case, the blinds remained closed and the air in the room was filled with the heaviness of death. His family was grateful for our care and shared how wonderful his day had been. He had exhausted his body with visiting and after all of this, they knew he was ready. The raggedy respirations were starting to take hold and I thought his mind and soul may have already moved on. He did not live to see tomorrow, and that was a blessing.
I’ve seen countless patients die. It is one of the incalculable job hazards we face as hospital physicians. In my first week as an internal medicine resident, I had a patient die in the ICU every other day. Just a few weeks ago on the hospitalist oncology service, I again had a patient die every other day. The point is, I’ve seen death a lot. And it always strikes me that patients’ bodies seem to shrink just a little into death. That the person they were has already moved on, and just an empty vessel remains at the end. And so it was for him. Dark and quiet at the end of the hall – away from the commotion that always streams from the nurse’s station. Peaceful.
His last day on earth. My last words in his chart. Amen.