posted on Jul, 9 2009 @ 10:55 AM
JAMA Nov. 23/30, 1984-Vol. 252, No. 20
A Piece Of My Mind
My teachers in medical school were responsible people who realized that students often have difficulty in dealing with the issues of death and dying.
Thus, we had to read several papers and books on the subject and we all attended discussion groups. In these groups we talked a great deal about
death. We discussed terminal illness, euthanasia, how we experienced death in our own families, and even how we felt about our own eventual death.
These groups met weekly for a whole semester, and when all this scholarly work was done, we had a simple pass-fail essay examination. At the time it
all seemed quite sensible and the course left us with that satisfying feeling of having reasonably mastered another subject. A year later, I met Mr.
He was a typical veteran, a middle-aged bachelor with no known family. He had come in very short of breath with almost constant hemoptysis-a legacy
of 30 years of smoking. There was little we could do for him, since he had been through the whole gamut of surgery, chemotherapy, and radiation.
Yet, as usual, the tumor in his lung continued to grow. He spent the first two days in the hospital sitting up in bed gasping for air, coughing up
bits of blood-tinged sputum. We all tried to comfort him as much as possible and he was always very appreciative. But he knew the end was coming
soon and sometimes during a coughing fit, he would choke badly and I could see terror in his eyes. I stopped by his room as often as I could to check
on him and ask how he was doing. He would breathlessly reply "Not good" and shake his head.
On the third day of hospitalization a nurse burst into the chart-room yelling for us to come quickly because Mr. G. was in trouble. We ran to his
bed and found him sitting up with a wash basin in his lap already half full of dark, slithery clots. He was struggling terribly-drowning in his own
blood. His face was deep purple and his eyes bulged out in stark terror. As the bleeding became worse, so did the struggle. There was less and less
of real breathing but more awful choking. Violently he would attempt to take a breath only to have it cut short by choking and coughing. Great
quantities of blood bubbled out through his mouth and nose, ran down his chin, and dribbled into his lap. He then would cough explosively,
splattering us with blood. The sound was horrifying, like someone screaming under water. Meanwhile, the nurse and I were trying to help as best we
could. I tried to keep the oxygen mask close yet emptied of blood. She tried to help him clear the bigger pieces from his mouth and throat. The
intern was frantically working the phone trying to get some help. But it was hopeless; the blood just kept coming and the scene became more macabre.
A beard of stringy blood clots swung heavily from the man's chin and nose. Between coughing spells he rocked back and forth, gasping "Oh please, oh
Suddenly it was quiet; it must have been a big clot. His mouth was open and his chest was heaving but no air was moving. He looked at each of us in
turn, pleading with his eyes. We pounded him on the back but nothing helped. Still, he kept straining desperately to breathe, opening and closing
his mouth like some strange, soundless imitation of a fish. During what seemed like an eternity he silently struggled. Finally his eyelids began to
sag and we gently eased him back on the bed. He continued to make feeble respiratory attempts as he turned bluish grey. Then he had a seizure and
lay there, twitching and quivering with the bed making little squeaks as if to keep time. It was a long time before that too finally stopped.
No one moved. The nurse looked stupidly blank, covered with blood. The intern was still holding the phone, weeping. I thought about my class on
death and dying. They hadn't considered a terrified, helpless old man dying a horrible, gory, painful death. The books, the papers, the discussion
groups-all seemed irrelevant and far away. But close at hand was fear, sadness, and futility.
Hugh F. Johnston