The Death-with-Dignity: The Fantasy

Abstract

As unique as each death is, fantasies of the ‘good’ death tend to coalesce around identifiable cultural scripts, deathbed discourses or, in the terms I have chosen, paradigms.¹ In this book, I shall follow current literature in maintaining that, despite the enormous variability found in the dying process, two deathbed paradigms have come to dominate contemporary Western culture. One is the well recognized ‘death-withdignity’, a cultural item that has been subject to intense scrutiny over the last 40 years. The other is what I have chosen to label the ‘hi-tech death’ — the breathless, chest-pumping, electricity-sparking explosion of resuscitative activity that occurs on city streets and in hospital ERs.²

Anyone can stop a man’s life, but no one his death; a thousand doors open onto it.

(Seneca, Phoenissae 1. 152)

It must have been about one in the morning when I was called. The sixteen-year-old girl with lymphoma on 4 West was in a lot of respiratory distress. The lymph nodes in her mediastinum had become so enlarged that they were now pressing upon her trachea, obstructing it so that she had to fight for every breath. She had had radiation, which had shrunk them for a while, but only for a while. When I arrived at the nursing station, the charge nurse told me they had put her on maximum oxygen, but with little effect. The patient was agitated and anxious because of her inability to get enough oxygen. I pushed open the door to the girl’s room and took a few steps in. My eyes had not yet adjusted to the dim nightlight, when suddenly a figure leapt from the bed. Startled, I jumped. It was the girl’s mother, a short, middle-aged woman. She began to apologize, afraid she had been caught breaking some rule. I tried to reassure her, but she remained upset and apologetic. I went over to the bed. Her daughter was awake and conscious, picking and pulling at the ties of the hospital gown. Too breathless to speak, she looked terrified. I took the mother outside the room and explained that we really had few options: I could intubate her, put her on a respirator and perhaps prolong things another couple of weeks; I could do nothing and perhaps she would last a few days; or I could give her morphine to ease the choking sensation and anxiety, but the morphine might stop her breathing entirely. The mother asked whether the morphine would make her comfortable enough to be able to talk. I said I thought so. I started with a small dose, and as it took effect, the girl ceased fidgeting and began to breathe easier. The mother sat in a straight back chair beside the bed and murmured to her daughter. I went out to the nursing station and grabbed a cup of coffee. In fifteen minutes, the mother came out, and said that her daughter was asleep. I checked the girl — and it was merely sleep. I told the mother that when her daughter awoke, if she seemed distressed, to ring the call bell, and I would give more medication. I left. In two hours, I returned; the mother leapt out of the bed, apologized. The girl was again distressed. I gave the morphine. She spoke with her mother. She slept. The leap, the apology, the medication, a little talk, then sleep — this same pattern repeated itself through the night at increasingly shorter intervals. At about 07:30 when I was getting ready to go off, I slipped back in to check on them. Mother and daughter were both asleep in the bed. The mother turned and saw me, but this time did not leap out of bed, did not apologize; she remained lying next to her daughter cradling her head. The girl was dead, and had been for some time.