Late in the Day

She had been bleeding for weeks. It seems an insignificant afterthought to me now that she never knew her diagnosis. Is it better to die with or without the knowledge of what kills you? She had a few visits to the doctor. What was done for her was unknown. She was pale and confused. Profound blood loss leads to shock: The body prepares itself. Non-essential tissues constrict blood vessels in deference to the brain, heart and other essential organs. The hands and feet are cool and clammy. Ultimately, the brain and the heart have nowhere to turn for oxygen and an inexorable series of events occurs that lead to death. There’s panic, hunger for air and system wide suffocation, then delirium. Is there suffering at this point? It certainly looks like suffering. Flailing arms, retching, gasping….clinging to a loose piece of rock that has detached itself from the face of this earth and only has yet to fall to the ground. We happened upon her when it was late. Late in the day, late in the course of her illness and too late to make a difference. The gasping and the flailing stopped and she lay still. There was nothing notable otherwise. She had been so pale that her now increasingly dusky appearance was barely noticeable. She could have been asleep. Asleep with no breathing..no pulse. A B C’s. Airway, breathing, circulation. IV’s, Fluid, Oxygen, Blood, Epinephine, Atropine…… and the blessed return of pulse, blood pressure and…… breathing. Semi-consciousness returns. Did she have any idea what was happening? Did she have some last fleeting thoughts of her six children. Down again, 1,2,3,4,5,6,7,8…… Breaths, more fluid, more blood, more drugs…….Up again…A continent of vast resources and potential. Motherhood stolen from countless children. Children stolen from countless mothers. She died later that evening. My thoughts returned to a patient in the US with nearly the same condition who survived……. No flailing, retching or gasping. No broken ribs and near death experience. I remember the discussion I had with her about “worst case scenarios”. If she only knew.