Higher Institute of Medical Sciences
Hospital Dr. Salvador Allende
Monday, December 28, 2009 4:19 PM


Friday, January 08, 2010. 
During our lifetime we make plans to celebrate the birth of a baby; we plan our vacations and our retirement; but often times we fail or refuse to think about our death or the death of our loved ones.  When the time comes for us to confront death we find ourselves unprepared and with little or no time to do so.  As a medical student I find myself unwilling to let my patients go when their time has come; it’s difficult for me to accept the death of my dear patients.

Today I was caught off guard when I arrived at the hospital to see my patient.  When I asked my patient how she was doing, she started crying and quietly said, “Doctor, please help me die, I am suffering.”  For a minute the vibrations of her frail voice invaded every empty space in the room.  Her unexpected call for help was followed by a grisly silence.  I reached for her wrinkled hands and they were cold and rigid as if death was forthcoming.  Her daughter was not ready to hear those words and started weeping very quietly in a corner of the room, thus breaking the dreadful silence.  It was a tense moment where every second seemed like an hour.  My classmate Blanca Cespedes looked directly at my eyes and communicated to me her sorrow without saying a word.  I felt powerless.  Only God knows and understands why so much suffering is inflicted upon one person.
 
This patient is a seventy-three years old female with multiple health problems.  She lives with her family in the outskirts of Havana and recently was brought to our center because she was having difficulty breathing.  Amongst other pathologic antecedents, she presents with type II diabetes; glaucoma; blindness; an amputated lower limb; numerous abdominal hernias as a result of an accident years ago; ascites (excess fluid in the peritoneal cavity) causing a massive abdominal distention; and a malignant cancer that has spread to her intestines, uterus, and breasts.
 
The excruciating pain is slowly killing my patient and there is nothing we can do about it.  Her religion practices do not allow blood transfusions as well as other procedures that are urgently needed to treat her health problems.  The patient’s family understands that there is nothing else that can be done for their loved one.  At this moment all we can do is wait for her final moment.
 
Tomorrow she will be discharged from the hospital.  The family wants her to spend the last hours in a more friendly and comfortable setting.  It will be a difficult moment for me.  She will leave the hospital without knowing her diagnosis because the family wants to keep it a secret.  They believe that it will be best for her not to know that she has cancer.  God bless my patient and her family. 

Wednesday, January 20, 2010         
Death is a mystery indeed.  Today, for the first time, I accompanied an 81-year old patient through the mysterious ritual of death.  She entered a coma early in the morning and was unresponsive to all stimuli.  My professor notified the family members that the patient was not going to make it through the day.  Her final moment was imminent.
 
This morning I was writing the results on her chart of her daily evaluation when my classmate Blanca Céspedes noticed that the patient opened her eyes.  It all happened so quick that when I looked at the patient, her eyes were already closed.  Seconds later her eyes opened again and, at that moment, her normal respiratory rhythm changed to an abnormal rhythm.  When she opened her eyes I was standing by her side.  From the expression on her face it appeared that she wanted to say something.  As soon as she changed her respiratory sequence I called for help and within seconds my professor and two other physicians walked into the room.  My patient was dying.  Her time was due.
 
One of the physicians stayed with us in the room through the entire process.  She took the opportunity to teach us the signs that allow us to know that the patient is dying.  For instance, the pupil dilated and lost all reflexes.  This dilation of the pupil is a mysterious process.  It seems to be the door through which the soul exits the body.  The cardiac sounds slowly disappeared and were no longer audible with my stethoscope.  The radial pulse disappeared before the carotid pulse.  Every system in the body shuts down slowly.  In less than ten minutes my patient’s life disappeared before my eyes.  I will never forget this experience. 

Sincerely,

Alejandro Bernal
Website:  www.pnhpwesternwashington.org
Email: alex238209@yahoo.com

Website: www.pnhpwesternwashington.org