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Education  |   August 2015
One Last Day
Author Affiliations & Notes
  • Neil J. Mehta, M.D.
    From the University of Colorado School of Medicine, Aurora, Colorado. neil.mehta@ucdenver.edu
  • The author has received permission from the family to publish the information included in this article.
    The author has received permission from the family to publish the information included in this article.×
  • Accepted for publication February 12, 2015.
    Accepted for publication February 12, 2015.×
Article Information
Education / Mind to Mind / Cardiovascular Anesthesia / Coagulation and Transfusion / Critical Care / Gastrointestinal and Hepatic Systems / Hematologic System / Ophthalmologic Anesthesia / Pain Medicine / Palliative Care / End-of-Life Care / Pediatric Anesthesia
Education   |   August 2015
One Last Day
Anesthesiology 8 2015, Vol.123, 475-477. doi:10.1097/ALN.0000000000000640
Anesthesiology 8 2015, Vol.123, 475-477. doi:10.1097/ALN.0000000000000640
For many generations, people have posed the question, “What would you do if you had one day left to live?” Of course, this kind of question often leads to more questions about how to spend that day. “Who would you call to say goodbye? Would you make one last visit to family to say I love you? Would you try to reconnect with those with whom you’ve long since parted ways, but whose impression on your life has stood the test of time?”
As a physician, I’ve been privileged to care for patients on their last day of life, and I’ve realized that all too often, death catches us off guard, leaving us no opportunity to say goodbye. Families go home to get some sleep, and their loved one is gone in the bat of an eye, too quickly for them to make it back to the hospital in time. Other times though, physicians see death coming. We see the steady downward spiral and know that the inevitable is near. Even more rarely, the decision to withdraw life support must be made, and sometimes, patients themselves are part of this decision.
During residency, my first experience in withdrawing life support left an everlasting impression on me. My patient, Mr. R, was dying from end-stage liver disease. A history of coronary artery disease and a recent myocardial infarction meant that he was no longer a candidate for liver transplantation. Mr. R was receiving blood products daily to counter severe coagulopathy and anemia and was requiring vasopressors to maintain blood pressure and cerebral perfusion. Despite this, Mr. R was remarkably lucid and able to converse normally with his family and medical team. Thus, while years of chronic liver disease had taken a physical toll on his body leaving him weak and fragile, his mind remained sharp. I took care of Mr. R in the intensive care unit for several weeks and we formed quite a bond. Our conversations centered around more than just pain control and how his night went, but included discussions about baseball, his kids, and what he wanted out of the remainder of his life. Unfortunately, as the days passed and his clinical course was deteriorating, it became apparent that the end was approaching.
Over the course of my rotation, we had multiple discussions with Mr. R and his family about the nature of his medical condition and lack of any definitive treatment options. Finally, on a Thursday morning, we sat down to discuss comfort care with Mr. R and his wife. We all agreed it would be best to no longer give transfusions and to discontinue vasopressor therapy. Once the decision was made to stop these life-saving measures, we all knew that the end would be near. Mr. R asked us for one last day to “get his affairs in order.” Because I was on overnight call, I had the opportunity and privilege to be near him during his last day.
Mr. R requested to see his dog and, thanks to some help from hospital administration, we were able to arrange for his beloved pooch to make a bedside visit on the final evening of his life. He spent a great deal of time with his wife and had set aside time that evening for a visit from other family members and friends. None of this was unexpected; it seemed appropriate – things that all of us would do if we knew that we had only one day left to live.
What did surprise me, however, was that Mr. R spent three hours earlier that day watching a baseball game. His wife had left the hospital briefly to help arrange things for the evening, and he told me that though he had some things he needed to get done, they could all wait until after the game.
You might be wondering, was this a World Series game, a playoff game, or even a game in the midst of the pennant race? No. Mr. R was simply watching his favorite team in the dog days of summer, and they were about 15 games out of first place. While I don’t remember the exact number, I do distinctly remember that ESPN had pegged his favorite team as having approximately a 0.1% chance of making the playoffs that season. And yet, as he sat in bed and watched the game, he couldn’t have been happier.
Seeing him that day reminded me of the important role that sports have played in my life. Growing up in Kansas City in the 1990s, the Royals were never any good. And yet, I never cared. Every summer, I’d still be glued to the TV if the game happened to be televised. Otherwise, I’d have the radio on. Whether the Royals were 67-51 (which they never were) or 50–75 (which was more often the case), it never mattered. It was summer; I was with my dad; baseball was on, and everything was right with the world.
So Mr. R sat in bed, watched baseball and smiled. I’m not sure what he was thinking about - maybe he was reminiscing about his childhood, maybe he was thinking of his father. It seemed too intrusive to ask, but from observing him, it was apparent that he was at peace.
When the game ended, Mr. R let out a sigh. It was back to reality. He had his affairs to tend to and he had to work up the strength and energy to face his loved ones and say his goodbyes. But for those three hours, he had been carefree, a child again. Baseball had provided him that feeling for a lifetime, and he had been able to experience it one last time.
The next morning, when life support was withdrawn, his wife was by his side, holding his hand. I’ll never know what thoughts crossed his mind but I didn’t need to know. When he flashed that final smile before the monitor read a flatline, I’m sure he thought of his wife, his kids, and his family first. But also, for just an instant, he was thinking about baseball and how much enjoyment it had provided him, not just on his last day, but throughout his entire life.
For an outsider, baseball, or sports in general, might seem like a superficial interest - one that should be forgotten about, especially on the last day of life. But for Mr. R and those of us who love sports, it means so much more than that. It reminds us of another time - a time when everything is right in the world, a time to be with family and friends. Baseball was an integral part of Mr. R’s life, and the way he spent his last day left an indelible mark on mine.