Thursday, September 17, 2015

What if the sound that you hear is the death-rattle?

Answer this question, especially if you are not a healthcare professional: how many deaths were you witness to?  As in you were there watching a dearly loved one of yours die?

Even though we know really, really well that death comes to every one of us humans, few among us bear witness to the very process of dying.  Right?  To watch a person die in your presence is perhaps one of the most humbling moments ever.  I believe that the dying that I witnessed has made me respect death, and respect living even more.  I consider myself immensely privileged that they died in my presence.  Prized learning moments.

I don't understand why death happens behind sometimes a literal curtain, often with the ICU as the magical separator, when in this modern world we have such a sophisticated understanding of various aspects of life.  Isn't death a part of life itself that we want to understand?  If giving birth is now an event that is even recorded for posterity (whose, I wonder!) why this collective wanton ignorance about dying?
Most people in western societies die in hospital or in institutional care. Keeping death out of sight and out of mind in this way means that most people have little real experience of death and dying.
Which is also why practically every medical student witnesses the first ever deaths only when they are well into their twenties.  Our daily lives are like what the prince Siddhārtha lived--a life of comfort, and well protected from ailments and death.  But then all of us cannot transform into the Buddha, I suppose ;)

The ones who have witnessed the dying know all too well that it can be messy.  It can be uncomfortable.  It can be traumatic--to the observer!
As the end nears, it’s not uncommon for the breathing pattern to change, involving repeated cycles of breathing stopping (for what seems like ages) only to start up again. This restarted breathing is often quite rapid and deep. It then slows and stops again, and this cycle repeats over and over. ...
For family this can be difficult for each time the breathing stops it seems death has finally come, but no. Death seems to toy with them.
On top of this, breathing often becomes noisy. This is the so-called “death rattle”. During dying, swallowing becomes impaired and secretions, which would normally be swallowed or would provoke a brisk cough, sit at the back of the throat. With each breath, air bubbles through this fluid, and the resulting guttural noise often causes concern and distress to onlookers.
You watch that happen and you know you cannot do a damn thing.  You can be the richest person around, the most powerful ever, but the most one can do is to speed up the process of dying and make it less traumatic.
A recent letter I received from a grief stricken lady who sat with her husband for many hours through a long and difficult death, reported how he coughed, choked and wheezed, breathed erratically and gasped sporadically. He kept appearing to have died, only to start breathing again. This poor woman was completely traumatised, sitting through a night and day with her much-loved husband.
“It was a complete nightmare, like something out of a horror movie,” she wrote “… I just wanted the it to end, but it went on interminably. I will never forget it and I so wish it could have been made more dignified.”
In the old days, people took turns at the death-watch.  Not only because it might be unbearable for a single person, but also because there is no way to know beforehand if the end is five minutes away or after five days of deathly struggle.
Maybe it is time to question the belief that it is wrong to treat a dying patient in order to minimise the distress that their dying may cause their closest relatives. After all, few of us would desire our own deaths to be viewed as “something from a horror movie” and would support actions that might help our family at this difficult time.
Exactly.  I don't want my death to be "something from a horror movie," especially when I have had such a wonderful life.  I am prepared; are you?

4 comments:

Anne in Salem said...

Please elaborate on treating the dying in order to minimize the distress of the survivors.

Sriram Khé said...

I have no idea.
But, I am aware that the medical and nursing professions (even in India) are doing quite a bit to figure out in "palliative care" how to not only decrease the patient's discomfort in those final stages but to also make sure that the survivors get the support they need.
The growing number of books on the subject of death and dying, and the dedicated section at NY Times (http://opinionator.blogs.nytimes.com/category/the-end/), for instance, are all evidence on how the conversation is shifting, finally, to thinking constructively about all these.

Ramesh said...

Oh yeah. I was wondering at the rather long (three weeks) absence of the favourite topic.

How about a four week absence this time around :)

Sriram Khé said...

I highly recommend this piece in the NY TImes (http://nyti.ms/1UUw4yO)
Choice excerpt:
"For most of human history, death has been an intensely spiritual experience. Frequently, some religious figure, a pastor or a shaman, would be at a patient’s side at the end to help make it a deep and meaningful experience not only for the patient but also for his or her family and friends. Studies show that most patients have great spiritual needs and many derive strength from their faith. These days, instead of a shaman, patients are surrounded by strangers in scrubs. Death – one of the most complex events that can occur in a hospital – is usually handled by the youngest physicians."

Posts popular the last 30 days