Katie’s Choice

I’ve seen prolonged dying many times. Usually there is a good explanation, the individual is young or has kids they don’t want to leave.  Sometimes it’s an unresolved conflict or an irrational fear of dying. Regardless of the reason, if a reason, the process becomes extremely tough on the family.

One of the tougher ones for me to explain happened in a young woman I cared for recently named Katie.  Although there were young kids involved, they had been removed from the family. Those by Katie’s bedside each day were her mother, brother’s and sisters. Katie had fought cancer for several years, far outliving her original prognosis.

While I had explained initially to family I supposed this would be long and hard – They and I weren’t prepared for the 4 weeks without any food or water that Katie laid in our hospice bed.  She was incredibly thin, bones outlining her face and jaw, eyes sunken. She was rarely awake, but when so, in terrible agony, not from physical pain but internal fighting and issues never dealt with.

Her family was devout, cradling her in bed, attending to any sigh or moan, never leaving her side. Each morning they looked at me with strained eyes and weary souls hoping I would tell them she would die that day.  But each day Katie’s un-readiness allowed her body to somehow exist past the point of human understanding.

Her final week she had stopped making any urine. Her blood pressure, barely palpable stayed around 50/30. Her toes black from no circulation, and the blood pooling we normally see after death called liver mortis was present despite the fact that she hadn’t actually died.  She was no longer able to move or talk or moan. It was as if her physical body began it’s decomposition in lieu of her utter refusal to actually die.

The family became more and more erratic in their exhaustion. Telling her often that it was okay for her to die. In one unbelievable moment, as this living corpse lay with family in tears surrounding her, they began to angrily plead, “Katie, you must go, let go… it’s okay, it’s time to die…we can’t take this any more, won’t you please just die!” It was in those moments that a defiantly strong voice suddenly echoed gutturally  from the skeletal figure shaking the room to silence, “NO!!!!”

Don’t tell me that Katie’s prolonged dying wasn’t in her control. I am not sure how to envision her intangible will, but it was physically keeping her “here”.  In medicine we can’t measure will or fight or some one’s “spirit” but one thing I’ve come to learn, it can play a huge role in the way we leave this earth.

While her death was prolonged and many would say full of suffering, I must respect that it truly was Katie’s choice. And had we interfered medically, shortening her time, like so many had pleaded for us to do, ultimately we would have disrespected that choice. Katie of course finally did die, likely against her will, a few days after her outburst.

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