Descent

She's gasping for breath, using all of her energy to weakly yell, "I don't want it... just let me go... just let me go...." She turns her head away from the oxygen mask the nurses are trying to put onto her face. Her wrinkled right hand tries to wave all the help away: she refuses the small satin bear, the oxygen, the nurse's hand.

"I just want to go... stop it... let me go."

The resident asks the nurses to give her narcotics through her IV. She takes my stethoscope and listens to the patient, who is moaning from the agonizing pain in her chest, in her back.

The patient writhes feebly, trying to escape the nurses, her body, her life. "Let me go...."

The attending physician eventually breezes in, and he and the resident deliberate aloud: "Well, it could be a pulmonary embolism, but that wouldn't explain her chest and back pain." "It's probably an aortic dissection." "A portable chest X-ray is on its way so we can take a look."

The patient is DNR and DNI.

They banter about the cause of her dying while she lethargically thrashes in her bed, her left breast hanging out of her gown, her breathing ragged and tired.

"Probably not an MI, no big changes in her EKG." "Well, we'll give her morphine and wait for that chest X-ray."

They depart, and I watch the patient quiet down as the morphine takes effect. She's breathing irregularly. She's no longer moaning.

Her limbs are unnaturally cold, her chest and face still warm. Her chest heaves with each breath. Her eyes are closed, her dry, cracked lips slightly parted, her head slumped against her shoulder.

I leave the room and join the attending and the resident. "Here comes our young doctor," announces the attending. He's writing a note about the whole affair, with orders to keep her comfortable as the patient dies. They excitedly swap stories about other aortic dissections they have seen.

I turn and walk away, fleeing the cacophony of intellectual theories behind etiologies of death.

A kind janitor, whom I had befriended earlier in the year, walks past.

He is supposed to clean her room. "She's dying," I mumble, and his face immediately softens and darkens.

"Wow," he says. He's the only person who has shown any sadness over this patient's dying since I have arrived. "When the good Lord is ready to take people, it's time for them to go. I hope she lived a good life."

I hear his cart rumble away as I step into the room.

She's breathing softly now, more regularly. Her head occasionally twitches, but she's no longer in any conscious pain. Her television is on: it's the Weather Channel. I watch her breathe as I hear about tornados in Illinois. I do not turn the television off, because otherwise, only the sounds of her death would fill the room.

I wonder if she hears the weather reports.

I exit the room to notice that the attending and the resident are nowhere to be found. The orders are written, the note is documented. There is no more work to be done. I trudge down the hall, despondent.

I later meet my resident, who asks if I have any questions. I know she is referring to the dying patient.

"No," I say.

"Maria," she begins, "I don't know how to say this, but you always look annoyed. The attending thought you were bored back there. I mean, you looked like this - her shoulders slump over, her mouth hangs open; she looks bored - and then you walked away. He said, 'She doesn't know what to do with herself.'"

"I know this sounds weird," I reply, "but I wanted to see her die. I wanted to be there."

"Yeah, I know," the resident says. "But you look annoyed or bored or something. Use that information any way you want, but I think you're doing yourself a great disservice. We want you to ask questions. We won't be annoyed."

"What is there to ask?" I counter. "She's dying, and -"

"There are plenty of questions to ask!" she retorts. "You can ask how much oxygen she needs. How much morphine. When will she die? What could have caused her death? There are always questions to ask, Maria."

I fight back the tears and keep my mouth shut. I thank her for her input.

I cry as I walk down eight flights of stairs, as I pack up my bags, as I walk out of the hospital.

I walk by the ward the following morning, and curiously, her name is still on the board.

Wow... she's lasted this long... still unconscious... still dying, I muse.

I walk to her room and look in -

She is eating breakfast!

After my lamentations regarding the insensitivity of medicine, the medicalization of the soul, the pain of loss... she didn't die.

I gingerly step in and greet her: "You don't know who I am, but -"

"Yeah. I speak to a lot of people I don't know in this place," she snaps.

I introduce myself. "I'm not going to exam you. I'm just here to talk."

And we do. She waxes philosophical about her situation. She remembers her pain, her yelling, her wish to die. She remembers feeling thrilled about falling asleep and never having to awake again.

Then she woke up. "I was so disappointed. I feel like I'm in prison. No matter how much I want to die, you won't let me. It's like getting all excited about finally going somewhere, only to wake up to find out you're still... here," she says with great disdain.

My resident then strolls in. Her face shows her disbelief when she realizes that I am having a lucid conversation with a patient who is supposed to be dead.

We talk about the situation at rounds. I offer an explanation to the attending regarding my seemingly aloof behavior - I was not purposely disrespectful. I simply wanted to witness the process of dying. He listens to my remarks about the medicalization and intellectualization of death, about how I wanted to appreciate her moments of dying.

"It's hard," he replies. "We still have a job to do. We aren't obligated to 'do nothing' simply because of an order of DNR/DNI."

Nearly three months have passed since I witnessed the woman's descent into death and unexpected resurrection. While I can no longer remember her name, I can still hear the agony in her voice and feel my frustration and grief during what I thought were her final breaths.

I will not ask questions when someone is dying.

mcmyang@ucdavis.edu