She went on to live another 10 years, saw the birth of two grandchildren, and died with her children at her side.
My other grandmother died a decade and a half later. By that time, I had been practicing ICU medicine for years, and I was as aggressive at lifesaving as a Saint Bernard. But I had also acquired another skill—one I had not needed with my first grandmother. I now knew how to help the dying die.
It had taken me time to learn that death is ultimately unavoidable. I had seen too many cases where bodies were stretched beyond their natural lifespans like old, dry rubber bands. Our life-prolonging ministrations could not restore them.
I had learned to work in new ways with my patients to make sure that they understood the meaning of life prolongation. For some, it might keep a body going until quality of life was restored, but for others, it could prolong an already unacceptable condition.
Once they understood that, most people chose to die comfortably.
After 10 years of profound dementia, we all knew grandma would want to die peacefully, not at the end of a machine. She was enrolled in hospice and received wonderful care in her home. When she finally developed the aspiration-induced pneumonia so common to patients with end-stage dementia, she was admitted into the hospice facility for aggressive comfort management.
When I arrived at her bedside, she was delirious and short of breath. A pulse oximeter next to her bed showed that she only had 79 percent oxygen saturation in her blood, a critically low reading. It was a Friday night and, like deja vu, only a bare-bones crew was on. Where was the nurse? Why wasn’t grandma being given medication for her shortness of breath? Why wasn’t her delirium being addressed? Why was a pulse-oximeter on her finger when what mattered were her symptoms, not her numbers?
Again, I snapped into action. This time I wasn’t trying to save a life, but rather to midwife my grandmother through her death.
This time, I was unable to rally the troops. My request for help from the nurses was met with resistance and distrust. I had to fight for a dose of morphine for my grandmother, even though it was ordered in her chart to be given “as needed.” When it was time for a second dose, my request was followed by whispers at the nurses’ station. The rest of the evening played out in a tragic war, with me as the villain. My grandmother died the next morning, not as calm or comfortable as she might have been.
It has taken me years to come to peace with the way I was perceived by other healthcare workers during my second grandmother’s death. They were suspicious of a granddaughter who was not fighting to prolong her grandmother’s life. To them, my requests for morphine triggered the notion that I was trying to shorten her life further. (Opioids do not shorten life in patients at the end of life, a common myth even among doctors and nurses).