Unexpected Death

N.B. Some details have been changed. This was written a while ago.

A patient I was following died today. He was the classic House of God "gomer," a pleasant elderly man with dementia whose neurologic disease had progressed so far that he could not answer questions, follow commands, or communicate at all. He had some pulmonary problems so we were consulted to help with his care. We made some recommendations about a week ago, and since then, I have been following him from afar. Unfortunately, yesterday he aspirated (entry of secretions into the lungs) and suffered an inferior MI (heart attack). Discussion between the primary care team and the durable power of attorney concluded that palliative care was the best route to take. He passed away today.

I was really affected by this. I think it is because when I saw him, he did not look that sick. He was frail, sure, and had lots of comorbidities, but every day when I visited, he talked nonsensically and seemed to be doing okay in his own little world. Then a small event - perhaps preventable - tipped him over and his body simply did not have enough reserve to heal. All we could do was let him pass painlessly and in peace.

Who's to say whether a life is worth living? Certainly, at my stage in life now, I would not want to live the life of severe dementia. But it would be absurd and arrogant of me to presuppose that judgment on others. I think this is why making advanced directives, appointing durable powers of attorney, and talking to loved ones about serious medical illness is so important. Pneumonia was once called an old man's friend because it was a quick way to go. Perhaps it was the best thing for this patient, but I don't know. Death and how to die are such elusive concepts for someone like me to understand, but oh - how important it is for me to try.