Wednesday, December 20, 2006

Passage

Jeane Kirkpatrick, former U.S. ambassador to the United Nations, died recently. Regardless of your political persuasion: Dicit nihil sed boni de mortui.

What interested me is that the news article said she "died in her sleep", a phrase we commonly hear, and I always wonder what that means. Do people really die in their sleep, passing from comfortable sleep and dreams seamlessly into non-existence? Or do they awaken for one or two terrifying, perhaps painful moments, maybe clutching their hand to their heart or struggling for breath before they die?

I have seen many human beings die, most of them, of course, very premature babies. When they die, most often they just sort of drift off. They are asleep or unconscious because they are very sick, and we know they are dying because we see the heart rate drop on the monitor, not because there is any significant change in their activity. Sometimes, if we take them off the ventilator before their heart has finally stopped, they will take a deep gasp or two, more of a primitive reaction than a willful last stab at life, although it can be very hard for the parents to see.

With adults, though, the circumstances are often different. Sometimes they are very ill and comatose and drift off like our premies do, but other times they have a fairly sudden event, like a heart attack, or have painful last days, especially if they have terminal cancer.

I remember the first time I saw an adult die. I was an orderly during my college years in a men's ward of a hospital, and we had an elderly patient with terminal cancer who was a no code. One day as he was sitting awake propped up in bed, he just started breathing deeper and deeper, and the breaths came farther and farther apart. As the interval between breaths increased, the nurse aide and I urged him, "Breathe, Mr. Doe, breathe!", but it was to no avail. He didn't seem in pain and over a few minutes time just sort of drifted off into unconsciousness and finally didn't take another breath. It was a little weird for a 19 or 20 year old kid to see, and I still remember it vividly. It wasn't a terrible way to die and was preferable, in fact, to waking up in the dark in the middle of the night, alone with your last gasp.

"Dying in your sleep" probably means different things for different people. I don't know why I worry about it; it's not like we can choose how we go, anyway.

11 Comments:

Blogger Laura said...

the only one i ever knew who "died in her sleep" was my husband's step mom. she kissed her husband after lunch and went to lie down for a nap. he found her a few hours later looking very comfortable in her bed. there was no sign or warning of what was to happen. i got the call about her passing just as i deplaned from a flight from harrisburg where i said goodbye to my younger brother after he died from the result of liver failure. his death was not painless or peaceful.
interesting post.

12:49 AM  
Anonymous Anonymous said...

I've been with many people as they died (palliative/hospice work). Only one that I was witness to, woke before their final breath. He informed me he was going fishing now... (His best friend and fishing partner of 50 years died earlier that year... I'm sure they are having a good time fishing now.) The only other one was a fellow who refused to die with his sister around. I said goodbye to her at seven. His breathing slowed and finally stopped within the hour. He chose when he would die.
Most did die peacefully. Most families were thankful for that. I stayed with these clients through the nights, as requested by the families. Strange how society does not want people to die alone... is it because of what you allude to? A final fearful moment before death comes?
Guess we will find out soon enough. My father is terminally ill with cancer. It is going to be a rough road.

10:40 AM  
Blogger Ex Utero said...

I think death alone is one of the saddest things in humanity and one of the greatest gifts we can ever give to another human being.

I don't know about death in sleep, but I'll never forget the moment of my father's death. He awoke from a stupor and said "I can't take it any more." I looked him in the eye and said "You don't have to."

And then he was gone.

If anybody is interested, it's in the book:

http://search.barnesandnoble.com/booksearch/isbnInquiry.asp?z=y&isbn=159113885X&itm=1

11:31 AM  
Blogger Shinga said...

The NYT published a piece on death doulas earlier this year (use Bug Me Not if you don't have a log in). The service coaches families in what to expect and what they might do during the final days of a loved one: they also provide a companion service for those who don't want to die alone.

I've discussed this with a number of people. Some are completely repelled by the idea (oddly enough, not one of them had been with a dying relative) others were more lukewarm or enthusiastic (mainly those who had spent time with a dying relative).

Regards - Shinga

6:44 AM  
Blogger Fat Doctor said...

I have chosen the way I want to die, and the date, thank you very much. On August 3, 2060, at approximately 8 p.m., after a fabulous 90th birthday party during which all of my friends and relatives have showered me with gifts and love, I will sit down and eat so much chocolate and drink so my Diet Coke that I will have a single dysrhythmia which will lead to immediate VF and I will pass painlessly into the great beyond.

Of course, Husband has to die that same day, preferably minutes after me. I haven't figured out how he's gonna go, but I'm sure he'll be cursing about Republicans at the time.

9:42 AM  
Anonymous Anonymous said...

i witnessed one adult death which the experience has remained vivid in my memory for years.while doing 'private duty' on a man with a terminal wound infection,at his home.every morning i would prepare his breakfast of a scrambled egg and he would only be able to eat about a spoonful.one morning when i arrived i found him in the cheyne-stoking mode of breathing.(gasping for air and breathing very irregularly)he was quite a remarkable gentleman,as i recall,always considerate to me as sick as he was.i remember thinking,"what if he's hungry and can't tell me ?" and i left the room and began to cry silently.when i had composed myself i reentered his room.he awakened briefly ,looked straight at me and winked! he then lay straight down again and passed away within a few moments.i remember thinking,"he didn't want me to worry about him" what a wonderful man.

5:56 PM  
Blogger purple_kangaroo said...

The one that always gets me is when people say that so-and-so "woke up dead".

2:06 AM  
Blogger neonataldoc said...

Thanks, all. The death doulas sound like a good idea to me. Fat doctor, if you're going to die that day anyway, why drink diet Coke? Go for the real thing! Purple Kangaroo, thanks for the laugh.

2:30 PM  
Blogger michele said...

Sorry this post is a bit tardy....but I just read yours and wanted to share a recent experience. My neighbors granddaughter, who was 2 months shy of 10 years old, died in her sleep on Friday Dec 15. She was one of boy/girl twins. Her mother went to check on her when she didn't come down for breakfast. She found her dead in her bed. She had died sometime during the night. The post attributed the cause of death to Myocarditis. How do you die from something you weren't even sick from? It is just plain wrong for a child to die. I have seen many babies die and though it is extremely sad, I can somehow handle these. A child is different. They are just getting started in really experiencing their life. They are totally reliant on you. And they talk. Maybe that's why I am able to work with babies and not kids. Working with ill children (PICU) would just tear me up. Abuse, some horrible disease, or some tragic accident is about the bulk of what your day would be filled with. Whew...that was a bit of a tangent....Anyway, I will stick to the NICU.

1:41 AM  
Anonymous Anonymous said...

My mum died a few months ago. She had made prearrangements to go into hospice care in a hospital but as it happened spent two days in the main hospital as the hospice didnt have room (she went down hill very quickly.) In the days before going into the hospital, she was waking up and actually getting out of bed to look for my father, quite agitated to find him sleeping on the couch. She was quite weak and so it was startling to hear of this. (In other words she must have been very upset to heave herself out of bed.) So after she went to the hospital (and having been told she may not last the next 2 days). and leaving her in the hospital overnight even for those two nights was very stressful. I was there by myself all day and went home and crashed. I felt awful and yet was in no shape to be there 24 hours a day. After my siblings arrived we arranged a schedule so that we could have someone there 24 hours a day. She seemed to be in a dreaming state for those last two days and certainly would wake up and acknowledge us the first day. She eventually breathed slower and slower and then nothing but it was peaceful. It was indeed as they say an honour to sit with someone as they die. It is difficult to describe but even to stroke their hand and provide a touch of comfort was wonderful ( in amongst the grief and terror of the unknown.) I had seen a documentary on a palliative care hospital beforehand and so had seen others die but really had no idea.. a death doula sounds like a real possibility or certainly something to share what to expect. even after she died, I couldnt find a lot on the internet on others' experiences but I think it helps to hear and be somewhat prepared via the documentary. (as well to be prepared for the practicalities as to how do you get extra pain meds, suctioning etc. Even if you are not yet the person making the decisions, that person e.g my dad, may no longer feel able to make the decisions..so prior research on the options and what number to call and exactly how you get extra help should be done in advance (even if it isnt spoken about) rather than when time is tight and your loved one is in discomfort. My experience also showed me how fast the end can come: you could have one day of full conversations and then not even that...(so be prepared..what do you want to talk to them about...look at photos, old school work or letters and go down memory lane?...some prep might be required..I didnt do this :-) )its true what they say that the person can still hear you: my mom acknowledged me one hour before she died although she had been "asleep" with her eyes wide open all day long before that. but also i would recommend people think of what they want to say and also talk about when the other perosn is no longer responding but maybe listening or going in and out of a dreamstate. (she even acknowledged she was dreaming and she certainly still had her sense of humour). sorry for the long post, i miss her dearly especially now at the holidays!

11:00 PM  
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8:11 AM  

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