43 Minutes

2012
Ching, Jody

Winner, AMS–Mimi Divinsky Award for History and Narrative in Family Medicine for a story from a family medicine resident or medical student.

While on general hospital call one evening, I was asked to lay eyes on an elderly lady who was in particularly bad shape. She had just been transferred to the palliative ward, and the nurses felt that she was nearing her final hours.

* * * 

The door was open, and being curious, I peeped into the room before actually knocking. Although I only took a momentary glance, I can remember almost every detail of the scene as though it happened moments ago. The sun had set and a single lamp in the corner next to the window was casting a soft, deceptively comforting glow over the small room. The frail body of an elderly woman was draped diagonally across on a home-style single bed, barely heavy enough to make an indent on the hard mattress below. 

I knocked gently on the door and entered, introducing myself as the resident who had come to check in on her. She did not acknowledge me, and had I not walked directly through her line of vision, I doubt that she had been aware of my presence at all. I approached her bed and pursed my lips in pity – never before had I seen someone so thin and lightweight look so heavy. It seemed as though an invisible weight was holding her down, making it impossible for her to even consider the immense effort necessary to lift a single finger. It was quite eerie to see someone lying there, too weak to move – yet wide-eyed and strangely alert. 

I put my stethoscope down on the bedside table. This was one of the first times that had I seen someone so close to death, and I marveled at the fragility of the life that lay before me. The simple task of breathing seemed to be thoroughly exhausting; it seemed as though the moment she stopped drawing a breath inward, her chest would collapse and shove all of her hard-earned air back out again. It reminded me of the motion of waves lapping the shore – a sharp rush of inward air, swept away before it could ever truly be appreciated. Her mouth gaped open to allow for easier air passage, but the attempt was clearly in vain. It simply left her lips, gums and tongue bone dry. Even her salivary glands were too exhausted to continue fighting. 

I pulled a chair next to the bed and gently took her tiny, frail hand in mine, moving it as little as possible for fear that I would break something or cause some sort of pain. Her skin was soft and thin like tissue paper, intricately folded over the delicate bones that lay beneath. I did not dare squeeze. I did not dare stroke. I just sat there, motionless, her hand in mine. 

Before long I began to notice a lack of consistency in what should have been a very rhythmic breathing rate. A few proper cycles would be followed by five to ten seconds of silence before a new breath was drawn. Though I knew the science and theory of apneic spells, I could not stop my heart from pounding with each pause in her respiratory efforts. My imagination quickly began to play tricks on me, and I was almost certain that the pulse in her neck was fading to the point where I was sure it would not continue. 

What would I do if she died at that moment, her hand in mine? Would I feel her go? Would her skin get cold right away? Should I record the time? Should I pick up my stethoscope and officially pronounce her death? What would her family say? Would they be resentful that I was there, instead of them? 

Oh my, her family. I suddenly felt horrified. Not at the thought of spending time with this woman during her last moments, but rather, at the thought of her having to spend her last moments with me. I did not know her. I had not been a part of her life; I had never met her relatives, or her for that matter. I did not even know if she wanted anyone there with her in that moment. Maybe she just wanted to die in peace, without some scared, guilt-ridden stranger quivering at her every pause. 

Then, as if to jolt me out of my paranoid delusions, her hand twitched in mine. I snapped back to her face and found her looking directly at me, though nothing else in her posture had changed. She gazed at me through warm, powder blue eyes that I knew had captured a thousand memories. Her face was soft and kind, and its features had been traced over three-quarters of a century. My heart rate slowed and steadied as I realized just how long her heart had been pumping before I had come along.
 
    Years. 
    Decades. 

There had been billions of beats before me; beats through elementary school and through those hard teenage years. Beats through Christmases and weddings, babies and grandbabies, new friends and old jokes. What an honor it would be for me to be there, with her, at the moment that faithful muscle decided to stop. It was not something to be feared, but something that would inevitably come – and after years of pokes and prods and treatments from doctors, she knew it as well as I – that time was near. These moments were her parting gifts to me. 

Looking back on the experience, I can see that it was a privilege that very few doctors take the time to truly experience. There was no chaos, no guilt, and no tragic sense of responsibility that clouded my thoughts or marred the purity of the situation. We both knew that her body could not be fixed – it was broken beyond repair. Her spirit, however, remained intact and could be tended to until the moment it left its prison. To this day I still marvel at the vast expanse that lies outside the realm of physical medicine, and will always remember the 43 minutes I spent holding a stranger’s hand in her final hour of life.

Theme: Death and Dying | Décès et le mourir
Theme: Patients | Patients
Theme: Physicians | Médecins

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.

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