I walked into a full but silent room at the nursing home. My patient was the skeletal figure laying on the low bed, mouth agape in the way only those near death display. I introduced myself to the assembled relatives: the wife, a nephew, a brother and the brother's wife.
"Hello...I'm NinjaMedic, and I'm with hospice....how are you all doing?"
His wife - small, grey and, as I was about to find out, incredibly difficult to deal with - sighed heavily.
"Well. you know, I'm not a well person. I'm really pretty ill and I don't know how much longer I can stand to be here. He's been like this for hours now. How much longer do you think it will be? I'm not a well person, y'know..."
Over the years I've worked for hospice, I've become pretty good at judging how close people are to death. There are signs: Kussmaul respirations, Cheyne-Stokes respirations, mottling of the extremities, livor mortis in the parts of the body making contact with the bed....but none of them are a sure-fire sign that death is imminent. I've been called out to people who have been Kussmauling away and who have been cold and a blotchy purple color but who have clung to life for another 12 hours. On the flip side of that, I've gone out to people who have been talking to me when I got there but who were dead 2 hours later. Everyone is different and there's no hard and fast way to tell when someones time is up.
"I really can't say, ma'am. What I'm going to do, though, is introduce myself to your husband and let him know who I am. Hearing is the last.."
"NO. NOBODY IS TO TALK TO HIM."
"Umm....can I ask why you feel that way?"
"IF PEOPLE TALK TO HIM HE'LL REALIZE HE'S STILL ALIVE AND WON'T DIE. NOBODY IS TO TALK TO HIM OR TOUCH HIM."
"Ma'am, I think it's important that he know that we ARE here, especially..."
"FINE" and then she leaned over the bed and hollered in her husband's ear
"LOUIE, IT'S IRMA. I DON'T KNOW WHY YOU'RE HANGING ON, BUT YOU'RE NOT DEAD YET AND I'M GETTING TIRED AND I WANT TO GO HOME. I DON'T KNOW WHY YOU DON'T JUST GIVE IT UP AND DIE ALREADY."
Then, looking at me, she said "Why isn't he dying like he's supposed to?"
I was stunned. Truly speechless for a few seconds. That doesn't happen too often.
"Uhhh.....errr......I...err.....I beg your pardon?"
"He needs to just die. I'm tired."
(To myself) "Wow. WTF do I do now?"
The nursing staff and I ended up persuading Irma to take a nap in an empty room down the hallway. As soon as she left the room, the mood lightened by an incredible amount. I talked to the nephew and got some background of the saga of Louie and Irma: he'd been diagnosed with colon cancer a month prior and had expressed a wish to die at home. Hospice had provided equipment and nursing staff to come to their home and take care of him. Most people, when they have a loved one who has come home to die, put the bed in the living room or den. Not Irma. Nope, she had stuck Louie, his bed and gear in a poky, dark little bedroom and wouldn't let anyone go back there to see him - or go back there to sit with him herself. The day before he was admitted to the nursing home, Louie decided that he was tired of laying by himself in the dark and had tried to get up and walk into the living room to visit with his wife. In the process, he'd ripped out his Foley, his PEG tube and his IV port and had gotten into a physical confrontation with Irma when she tried to force him back into his bed. The police came, as did the nephew, and it was decided that Irma simply couldn't look after Louie at home (I was told that she said she didn't want to. I tend to believe that) and that he needed the 24 hour care of a nursing home.
So, Louie got admitted. He became unresponsive 12 hours later, and it was determined that his death was imminent. So, I got called in....
Almost immediately after Irma left the room, Louie's condition declined rapidly and he passed away 45 minutes later. He was waiting for her to leave, I think. He didn't want her there.
I didn't blame him at all.