I was told about the patient before my morning rounds. A person with end-stage COPD who initially had oxygen saturation levels of 79 percent yesterday, but after a nebulizer and increasing her oxygen to three liters they had climbed to 89 percent. She adamantly refused hospital admission and had a DNAR (Do Not Attempt to Resuscitate) order. Was there anything I could do to help her breathe easier? I gave my usual response, "I'll give it a go!"
I pulled up to a house with a woman fluttering around near the door... hmmm, the hairs on the back of my neck stood up.
"Are you here to see -------?"
"Yes, are you a member of her family?"
"No pet, I'm just a neighbor, like. Eeeee, I tried to wake her, like, but she's just slumped over in her chair."
I now know my morning is going to take a dramatic turn and all plans are on hold. The neighbor has a key and lets me in. The television is on loud and there she is, slumped in her chair, blue from head to foot, no breathing and the DNAR prominent on her fireplace hearth. I feel for a pulse in her stiff and cold left wrist and her left carotid. I knew I wouldn't find one. I turned to the neighbor who held a hand to her throat and sobbed. Time to comfort the neighbor and call for the GP to come and declare her officially dead.
The woman took my hand, "Did you know her well?"
"I looked in on her on occasion, brought a spot of tea now and then."
"Was she a nice person?"
Well I was gob smacked.
The care attendant arrived. I informed her that her charge had passed on. "Oh my! I feel awful! I really didn't like her, I feel so guilty."
No sainting of the dead going on in this neighborhood, I see. When both women had left and I awaited the arrival of the GP, I looked at the photos on the wall. I presume many were of the patient, a woman in a uniform from the WWII period, another in a wedding dress, perhaps the patient or a sister with a strong resemblance; and snapshots of children tucked into mirror frames, all covered with a coating of nicotine. There were no children to inform, no spouse, just a nephew who lived in the next town. He never picked up his phone.
Like the character in the Beatles song, this woman would be "buried along with her name." I never knew her while she lived. I was told she wanted to die at home. Her nasal canula was on the floor when I arrived. The GP entered and I turned the situation over to him. Like "Father McKenzie wiping the dirt from his hands as he walked from her grave," I applied my Purell and went on to my next patient.