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"He knew it was his time a month ago. We were sitting at the kitchen table, and he told me he couldn't feel half his face. He kept tapping the left side and saying he couldn't feel anything. I knew he had a stroke because my daughter had one. He was stubborn, didn't want to go to the doctor."
One week ago, I saw Mr. Samson for the first time in the ED. He was a 70-year-old gentleman with end-stage renal disease and cirrhosis but came in for blood in stool for the past few days. We did the entire GI bleed workup for him. No esophageal varices were seen, but we found the gastric ulcer causing the bleeding.
After 2 days, Mr. Samson wouldn't wake up from his sleep. Even hard sternal rubs only triggered some eye opening. It wasn't his liver or breathing that caused his obtunded state. A CT of his brain did not show anything, but an MRI of his brain showed multiple small infarcts. He had multiple strokes.
Miraculously, Mr. Samson started to say a few words and phrases to his family and us.
"I would like some water."
"I'm in pain."
"I want to go home."
That one good day of progress turned into hell. In the late evening, his oxygen levels plummeted to the 80s and the nurse called rapid response. My phone rang, and I ran across the hospital to his room, with all of his family at his side. I heard diffuse crackles in both of his lungs, and a chest x-ray confirmed what I heard.
Mr. Samson was dying, and I stood next to him in fear. He had a non-rebreather mask on, and his breathing was more labored by the minute.
He was DNR/DNI, and when my attending came, the family stated they did not want us to do anything more.
It was decided to transition Mr. Samson to inpatient hospice. The family wanted the breathing mask off of him and for no dialysis to be done.
As his nurse turned off the oxygen and slowly removed the mask, I can only remember seeing the family look at ease. They talked about memories of Mr. Samson playing with his grandchildren and how he was full of life until recent months.
I went home that night in tears, not knowing how long he would live. In the morning, the night team told me he passed away a few hours after I left for home. Brain stem reflexes were absent. No cardiac activity. No spontaneous breathing.
Time of death, 9:06 p.m.
Mr. Samson came to the hospital with one active medical problem. It ended with his sudden passing.
I've never had to write a death note until now. I had to come back to it several times during the day before finishing the note and signing it.
Mr. Samson is my first patient to pass away. I remember on that one good day, he opened his eyes for me and squeezed my hand when I asked him if he could. I think I saw him crack a small smile for me.
Life is tenuous, filled with both good times and hardships. None of us know how long we are on this earth. I was once told that death is what gives life meaning. We spend the time we have working, providing for our families, and sharing moments with those we love until it's our time to go.
I hope you are in heaven, Mr. Samson. Rest easy.
Ton La, Jr., MD, JD, is a physician.
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