A Life and Death in 7 days
Friday: He walks in to the ER, tall, tanned, thick silver hair. A French accent, loping gait, and an easy smile, he could be mistaken for a Hollywood actor. But he is here with new lung cancer, new confusion and a calcium
level which needs to be corrected before his treatment. A CT-scan of the brain also confirms bleeding metastases - tumors which migrated north from his lungs. I settle him in his room as he flirts with me and his nurse.
Saturday: His calcium trends down but his confusion is ramping up - he needs a 1:1 nurse to keep him safe, keep his IV line in, keep him from falling. I prescribe sedatives, anxiolytics, benzodiazepines. I bring more teams aboard, take recommendations, tweak medications.
Sunday: His family is at the bedside, processing his diagnosis, prognosis. I increase the sedatives as he blitzes through them in his delirium, tossing in bed, reaching for what isn’t there, moaning. His daughter points out that my mascara is running. I accuse her of the same.
Monday: Still weakly tossing, occasionally moaning, hazily moving his hands in the air, grasping, seizing, roaming. His calcium level is normal: it was a red herring. This is terminal delirium, nothing more, nothing less. I play with the drugs and doses and watch him carefully.
Tuesday: He settles. We sigh. His family sobs. He tosses again, moans. I increase one drug. He settles. We watch. He tears at his chest, at the tumors encasing his thorax. I add more morphine. For twelve hours, we duel.
Wednesday: He’s comfortable. He’s at peace, he’s sleeping, he’s covered. He’s not ripping off his sheets, ripping off his clothes, ripping out his lines. I pray.
Thursday: He sleeps, deeply. He’s still comfortable. The magic liquid in his veins keeps his delirium at bay. His family collapses into chairs, wild-eyed and sleep-deprived. They try to rest, as he rests.
Friday: He dies in his sleep: heart stops, brain sleeps, lungs deflate, hands gently at his sides. He’s still tall, tanned, with silver wavy hair.
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