In the prior thread about the woman with the feeding tube and the right to die, I mentioned that there was only one person of the thousands of souls I have cared for who "went at his time". I also mentioned that he had an angel in the room with him, but that that was another story.
Since it is Halloween, here's the true story about that man and his angel:
I was working in open heart and taking care of a patient whose respiratory status was doing a slow, downward spiral. Over the course of my 12 hour shift, I put him on nasal cannula (those little nasal prongs) at 2 liters of oxygen, gave him aerosol treatments, gave him chest percussion therapy, induced deep breathing and coughing to clear his lungs, cranked the O2 up to 4 liters, then aerosols, then chest percussion, cough and deep breathe, increase the cannula to six liters, watch him hang there for a while and finally put him on a non-rebreather mask. This was the final step before returning him to a ventilator, so he could rest and the vent can breathe for him.
It was around 4 in the afternoon and I had him sitting up in a chair, deep breathing and coughing and then resting on the nasal cannula. He was tired, but completely oriented, conversant and making sense....until he pointed to his empty bed and said: "You don't see that old boy over there, do you?"
"No", I replied, thinking that he was hallucinating, maybe a lack of oxygen to the brain, most likely just another part of his progressively downward spiral. Then, concerned that maybe he was going to be 'doing what the voices told me to' I asked him if it was telling him anything.
"No" he said in his soft, Southern voice "He don't say much."
"OK, score one for the good guys", I thought as I busied myself with worldly thoughts of his crappy lung function. "At least he's calm and I don't have to worry about him acting nuts."
Time went by, I returned him to his bed, cranked up the O2, put him on the nonrebreather mask and notified the cardiac surgeon of the events of the last several hours and my interventions.
My patient smiled up at me "You really don't see him sitting there, do you?" pointing to the foot of his bed. No, I did not. But I did see a patient who was calm and quiet - more than that I really didn't want to know.
The family arrived at 7 pm, as I was going off shift. I explained everything to the wife and told her that it was very likely that we would put her husband on a ventilator that night, to not be afraid, that the machine would breathe for him and he would be able to rest.
Three hours later the patient CARDIAC - not respiratory - arrested. Meaning that his heart, which we had just fixed, which had excellent blood supply and pumping function, simply stopped beating for no reason. Quite simply, it was his time. All of our vigilance and all of our resources could not change that.
The code team was led by the best doc I've ever known, bar none. This man was triple certified by the time he was 34 years old in anethesia, critical care and internal medicine. None of our resuscitation measures worked and the patient died for apparently no reason at all.
I deeply regret the missed opportunity. I should have asked him to tell me what he saw, describe it in detail. I do believe that if the "old boy" was someone who my patient had known who had already passed away, he would have told me. I am certain that the "old boy" was an angel, sent to help my patient onto the next part of his journey. There was never any fear, distress or upset...just a very calm, peaceful acceptance by my patient.
BTW: This was a Christian family with deep faith. So much so that I went to the funeral home to tell them about what the patient had seen and entrusted to me. They were home, having dinner at the time and the funeral director gave me directions to their house. They were relieved and deeply comforted by my visit and our time together.
"Unless you're sharing what you have, you don't have as much as you think you do."