Dust to dust….

I will never forget the first time I saw someone die. I was a very naive, very inexperienced 3rd year medical student. Up to that point, I had only been in the classroom and the gross anatomy laboratory where my focus of study was on the long-dead, well preserved human body. I was doing my first clinical rotation in the hospital and I was assigned to the emergency room.

A man was brought to the major trauma room by emergency medical services. Although he was not much older that I was at the time, he was well known as a ‘frequent flyer’ in the ER because he was an alcoholic and a drug abuser – cocaine being his preferred addictive substance.

Within 2 seconds of his arrival, he was surrounded by circles of ER personnel – nurses, techs, doctors. As a medical student, I was the lowliest member of the team and occupied the outer periphery of all those circles of people. My job was to watch, fetch, and stay out of the way.

The man was attached to monitors that displayed beat to beat heart rhythm, blood pressure, respiratory rate. Intravenous catheters were placed in both arms, a urinary catheter was inserted into his bladder, oxygen cannulas were placed in his nose, chest radiographs obtained and blood samples taken. All of this within 7 minutes of his arrival. When it was obvious that he was not going to immediately die, the medical team began dispersing to analyze all the data. The plan in place was ‘expectant observation’. If anything went awry, all the equipment to which the patient was attached would immediately begin alarming.

Ten minutes after his arrival and I was now the only person remaining in the room with the man. He was pretty agitated, thrashing around on the bed, and I felt pretty helpless watching him. I wasn’t sure what I was supposed to do but decided that maybe a few words of comfort would help so I advanced toward the stretcher.

Suddenly he sat bolt upright on the stretcher, pulling tubes and catheters and restraint straps with him as he violently propelled himself up. He looked straight into my eyes and said, ‘Please don’t let me die!!’ Then – he died. That is to say, his heart quit any functional beating, he stopped breathing, and he lapsed into unconsciousness. Pulmonary edema foamed from his mouth and nose and every alarm in the room was shrilling.

The entire medical team rushed back into the room and I was unceremoniously shoved into the corner. Everyone was shouting and equipment was being pushed and pulled. The ‘thumper’ was started – a machine that was placed above the patient’s chest with a piston that pushed up and down on the chest to massage the heart through the chest wall.

All to no avail. His heart had fibrillated – a chaotic, functionless spasm of cardiac activity that did not propel blood through the system. Then, his heart stopped all activity and even after 30 minutes of frantic effort by the medical team, never restarted. The ER physician finally ‘called’ the code – he asked the team members to stop what they were doing, looked at the clock, and pronounced the time of death. Once again, the entire team, moving almost like a single entity, exited the room. The doctors begin dictating all the events that had transpired, the nurses gathered material to shroud the body and arrange transport of the body to the morgue, and the ER secretary began the long series of telephone calls to the medical examiner, the police, organ donation, family members.

Once again, I was alone in the room but now with a corpse. I was stunned. Up to this point in my life, I had believed that no one was really aware of the moment of their death. That dying was just a slow ebb of life away from the body and consciousness ceased long before the actual moment of death. The only experience I had with death up to this point was being with my beloved pets when they needed to be ‘put to sleep’ and it was always a very sad, tearful, but quiet, peaceful death. The moment of death occurred AFTER sleep – one was not aware of it at all. I guess that’s the only experience I had of death.

I had never experienced this violent, wrenching, tearing tug of war between life and death. I had never known anyone that was acutely aware of the moment their life had ended.

I have since witnessed many, many different ways of dying and I know that some ways are better than other ways.  I know that some go ‘gentle into that good night’ and some do not.  I don’t know how many of my patients were aware of their moment of death. Who are we to say what transpires in the mind of someone in the last few seconds of life? Perhaps, we are all aware of that moment.

But I will never forget the eyes of the man who looked right into my eyes and begged me not to let him die and I, helpless to intervene, served only to witness the moment of his dying.

 

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.

Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.

Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,
And learn, too late, they grieve it on its way,
Do not go gentle into that good night.

Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.

And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.

Dylan Thomas

Do animals grieve?

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This is Abba, my youngest Yorkie.  He was named after the musical group, ABBA, and when people tell me he is too petite and cute to be a male dog, I tell them he is ‘my dancing queen’ 🙂

Abba has always been part of a pack of dogs.  When Abba came into our home, I had 2 other Yorkies – Mick Jagger and Stevie Nicks.  Mick was the first, the oldest, and the alpha male.  Stevie was a female, a few years younger.  I had not planned on adding any more dogs to my household.  We were pretty content as 2 dogs and 1 human.  But a school teacher neighbor, who had adopted Abba as a young puppy, could not keep him.  So, Abba who was 7 years younger than my youngest Stevie, was added to the pack.

Mick and Stevie died a few months ago.  All 3 of my dogs became ill with a severe gastroenteritis. I suspect they became ill from a huge pokeweed plant in my neighbor’s yard that was continually dropping toxic berries into my yard.  I asked her for months to eradicate the plant and it took notification to Huntsville community development and subsequent threats of fines before she finally had the weeds removed.  But that is a story for another time.

Abba recovered but Mick and Stevie, who were much older, developed acute renal failure.  Mick was 13 and had multiple medical complications – including chronic liver disease and diabetes.  Stevie was only 2 years younger but also had her share of infirmities of the aged.  Despite keeping both Mick and Stevie on IV fluids at home for almost 10 days, they both succumbed to the complications of their illness.  I had Stevie euthanized and less than 24 hours later, Mick died in my arms.

It was a traumatic time for both me and Abba.  We are still finding our way through our grief.

The first photo is Abba standing on the outside looking in the pet door.  You see, he’s waiting for Mick to come through the pet door.  I have a studio located behind my home and I spent most of my time there in the evenings.  Stevie was always content to stay in the house, in her bed, sleeping.  But Mick and Abba always scrambled to join me as I would walk out the back door, no matter how late it might be.  Mick, being the oldest, was frequently the last through the pet door and Abba would always wait for him to come out.

Abba still waits for Mick to come out, even now, months later.  Breaks. my. heart. Everytime.

But that’s also a different story.  The story I want to tell is the one behind the other 3 photos of rawhide bones in a variety of locations in my home.  Mick was always the ‘king’ of the rawhide bones.  Whenever I brought new bones home, he would chase Stevie and Abba away from them.  The only way Stevie would be able to chew on them is if I locked her in a room by herself, where Mick couldn’t get to her.  Abba?   He never even tried to chew on a bone. He was too afraid that Mick would come charging, growling and mock-biting at him.  So, he left them alone.

But a few months ago, Abba started a strange pattern of behavior.  He would go to the dog toy boxes (of which I have 4!) and dig through the stuffed animals until he came upon one of the old rawhide bones.  Then, he would bring it to wherever I was and let me see that he had it in his mouth.  I would play with him, like I would with Mick, threatening to come and get the bone.  Abba would run off with his prize.  Then I started seeing the bones in any area of my house where there was a corner.  It could be a corner with 2 walls or it could be a corner between books or a corner between furniture and a wall.  Regardless, I started finding these old rawhide bones all over my house.  So, I started surreptitiously watching Abba.  I saw him retrieve old bones from the toy boxes and take them to a chosen corner.  He would stuff the bone into the corner with his nose, then brush over the ground with his paws.  For all the world, it looked like he was ‘burying’ the bone.  After he finished, he would walk away as tho he had completed his task.

A friend asked me if Abba had ‘buried’ his bones when Mick and Stevie were here.  She thought maybe Abba was trying to hide his bones since he was afraid of getting caught with them when Mick was around.  When I thought about it, I realized that no, Abba had never exhibited this behavior before Mick and Stevie had died.

So, in reflecting on this strange behavior that started AFTER we had lost most of our fur-family, I started thinking that maybe, just maybe, what Abba was doing was putting rawhide bones in places where Mick and Stevie, if they were still around, would be able to easily find them.  I’m sure these old rawhide bones carry Mick and Stevie’s scent.  Abba doesn’t understand why they are not around but surely he misses them.  I think my last little Yorkie is leaving gifts for the family that is gone.

I don’t know but that’s the explanation that I want to believe.

Is that so different from us?  We visit the graves of our loved ones that have gone.  We leave flowers.  We reminisce over times when they were part of our lives.  We grieve.

I think my little Abba is doing the same.