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Alia Moore

You were supposed to die of cardiac arrest as you circled toward home plate. Or of a brain aneurysm in the summer during one of your countless hikes through the mountains.

You weren't supposed to die here. Not in a hospital bed, inhabiting this fragile new body, with an oxygen tube in your nose and tumors in your lungs.

Two days before you left us, I traveled home to visit you. I'd last seen you six months before, shortly after your eighty-eighth birthday. You were a lifelong athlete and adventurer, but you seemed just a little less spry than I remembered.

Now, you were slumped in an old office chair in your bedroom, eating milkshakes to calm your inflamed throat. You choked with every spoonful, and your cough was so weak.

"I just want to ride my bike around the block," you told me. And then, "I wish I could sing again. I miss that a lot."  

You had sung as a tenor in the local opera chorus for years. Now you punctuated every third word with a rattling breath. This cancer had taken your strength, your stamina, even your voice.

That night, you were confused. The morphine that the hospice nurse had delivered was fogging up your brain--the same one that had taught math and woodshop decades ago and that had devoured the physics, nature and astronomy books lining the walls of your room.

You were jumpy and restless, so I spoke softly. I asked if you'd like to go to bed. You asked me to turn the thermostat to quarter past three. Eventually you fell asleep in your chair.

The next afternoon, you couldn't catch your breath. You'd never been afraid to scale mountains, sail the ocean or trek across foreign continents alone, but now you were scared. When we asked if you wanted to go to the hospital, you said yes.

I remember grabbing your coat in a hurry. My uncle rushed you out the door in a wheelchair and helped you into the passenger seat of your purple car. My mom and I followed behind.

As we all sped to the VA hospital emergency room, I could see your hand sticking out the passenger-side window up ahead, riding the breeze of fifty mph. It was the first time you'd been outside in days.

In the lobby of the ER you became listless. You crumpled deep into your wheelchair. Desperate little bird sounds escaped your lips with every breath. Graying and sick old men surrounded us. Veterans of Korea, Vietnam and, like you, World War II.

Someone in blue scrubs appeared from behind a set of double doors and spirited you away into a white corridor. Moments later, they asked for my mother--your daughter and healthcare proxy, who knew that you'd signed Do Not Resuscitate/Intubate paperwork.

I followed, not quickly enough, and the double doors eased shut.

I demanded to be let in, before they could insert tubes, lines and medicines into your dying body.

I tried to reason with the front-desk clerks.

"My mom needs me! She's alone, and I've got to help her! I have to make sure they don't do anything drastic!"

I was met with silence as the veterans looked on.

"I can help... I'm a doctor," I uttered, hopelessly.

"The ER physician says no more visitors until your grandfather is stabilized," someone said.

Desperately, I dialed my mother. There was a ring, then her hysterical voice. "They're going to intubate him!"

The call disconnected. I began to plot a way in when a nurse finally appeared beyond the doors, calling my name.

I ran through the corridor, past my mother sobbing outside your room and into the melee. People swarmed around you, directed by a man with a stethoscope standing at the head of your bed.

I stepped forward.

"You can't intubate him, he's DNR/DNI!"

"He's going to die. I'm not going to let him die."

"If you intubate him, you'll never extubate him."

"DNR doesn't mean do nothing."

"He doesn't want this."

"He says that he does."

I thought of all the people I'd cared for in the ICU. Terminally ill, poked, prodded and bled dry. Surrounded by endlessly beeping machines and blinking lights. And in the end, dead anyway.

"Who are you?" the man asked.

"I'm his granddaughter. I'm a second-year resident in internal medicine."

"A second-year resident," he parroted scornfully.

"He wants intubation," he said.

Hours later, I would imagine myself clocking him in the jaw. But in that moment, I pushed past him and laid my hands on your shoulders.

"Do you want a tube down your throat?" I asked.

"Yeah."

"Or do you want medicine that will make you comfortable?"

"Yeah."

Your eyes were foggy. You stared past the chaos into some distant nothingness.

You aimlessly pulled at the large checkered hospital gown they'd slipped over your wasted frame, and I held your hands to stop you. You were still so strong.

My uncle--a pediatrician--finally appeared. Between us, we convinced the ER physician to relent.

He turned the lights down, and one of the nurses let us know that there was fresh coffee.

Someone injected a sedative into your IV, and you went still. More family arrived as the doctor admitted you to comfort care.

Eventually we followed you upstairs, to a large room on a quiet floor with a view of the Sierra Nevada mountains.

We sat with you for a long time. As the hours passed, some people said goodbye, but I remained with my mother and my aunt. We huddled around your bed as darkness descended.

The three of us stayed up all night, curled into uncomfortable armchairs with starchy blankets. We told stories, and I recalled the day you clumsily, proudly placed the green hood over my shoulders when I graduated from medical school. We remembered your pranks, and laughed hard and loud as your favorite showtunes played on my iPhone. Sometimes, we'd fall into long stretches of silence, watching you with puffy, bloodshot eyes.

We listened as your breathing deteriorated into something strange and staccato, like a metronome.

The next morning, the others trickled back in.
 
I left. I needed sleep. My whole body ached, and my eyes burned with salt and fatigue.

I had just slipped into blessed unconsciousness when the phone rang. It was 10:05. You'd stopped breathing.

You were still lying in bed when I returned. You were cold, waxy and discolored. It didn't matter.

Two hours later a group of volunteers placed you in a box, draped you in an American flag and escorted you to the morgue.

We accompanied you as long as we could. Before they wheeled you away forever, my grandmother, mother and I placed our hands atop the box you lay in.

When you finally left us, the sky was blue, and sunlight had crested the mountains.

You weren't supposed to die like this, but maybe this way wasn't so bad.

I got to say goodbye.


About the author:

Alia Moore is currently completing her second year of internal medicine training in Denver, CO, and is writing a memoir about her medical-school experiences. "I aspired to be a writer long before I decided to be a doctor, and luckily there is a wealth of material in what I do now. Although residency is difficult and frequently leaves me feeling cynical, exhausted and overwhelmed, writing about my experiences has kept me connected to the sometimes sad, often resilient, human side of medicine. My family created a website to share my grandfather's amazing life: Kendrick Allen Westbrook."

Story editor:

Diane Guernsey

Comments   

# Diane Hage 2014-04-28 09:39
Alia, I am weeping at my desk because this is coming soon to our family. I care for both of my parents, now 89 and 91. They were once so lively and vibrant and their bodies are failing them. Unfortunately in Mom's case her mind is failing as well. I read your story putting myself in your mom's place with my son the medical student in yours. We need to look for the grace in each day and each experience we share. The fact that you were there to stop the interventions was meant to be. Thank you for all you shared.....This will give you such power and compassion as you continue on with your career. I think of our family pcp...he just lost his father last year. It has given him the strength to speak honestly and compassionately my parents and me about end of life.
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# Vicky Mahn-DiNicola 2014-04-27 21:26
Your story touched my heart. Thank you for your vulnerability. It will touch many and give strength and fortitude to our future thoughts and decisions as we make similar journeys with our own families.
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# Lisa Vipperman 2014-04-27 15:52
This piece moved me, as only four years ago I watched my mother die. I went to the website and read more about this amazing man, the author's grandfather. Thank you, Dr. Moore, for writing this essay. I think that it was healing for you to write, and I know as a reader it was helpful for me to read.
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# Ann Poznanski 2014-04-26 01:46
Thank you for this wonderful story. It captures the poignancy of conflicting emotions and combination of mourning and celebration of a life well lived. It also reminded me of Shakepeare's sonnet 73 that I read at my father's memorial:

That time of year thou mayst in me behold
When yellow leaves, or none, or few, do hang
Upon those boughs which shake against the cold,
Bare ruined choirs, where late the sweet birds sang.
In me thou see'st the twilight of such day
As after sunset fadeth in the west;
Which by and by black night doth take away,
Death's second self, that seals up all in rest.
In me thou see'st the glowing of such fire,
That on the ashes of his youth doth lie,
As the deathbed whereon it must expire,
Consumed with that which it was nourished by.
This thou perceiv'st, which makes thy love more strong,
To love that well which thou must leave ere long.
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# C. F. Collins 2014-04-25 23:30
A story well written. A story well told. One that will not be forgotten anytime soon.
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# Muriel Murch 2014-04-25 22:07
Dear Alia,
What a story, what a lesson. Ask another question. What is the response? How difficult is this for a doctor to do? Luckily for your grandpa and your family you did ask another question - and understood where you all were.
Bless you.
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# James Kemp 2014-04-25 18:14
Thank you for sharing about such a difficult time of Life.
It clearly was for you, for your family and your Grampa But as one of those who have much less time to look forward to than to look back on--it gave me joy to know that I too might have such a grand daughter as you.
Never lose your ability to be in touch with lifes losses as well as gains and to be able express them so sensitively
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# Emily Theroux 2014-04-25 17:53
What a beautifully written and poignant remembrance of your grandfather's last hours. I'm sure he's smiling down on you
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# Lois Gerber 2014-04-25 17:34
Moving story that illustrates our ambivalent attitudes toward death and end of life care.
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