BEHOLDING DEATH

I watched a man die the other day. It took 43 minutes. It was hugely confronting. To witness at close range the ending of a life is not a regular thing in most peoples’ lives.

The vast majority never see such a thing at all. Many see the aftermath, sure. But life has already left and what remains is not the person they knew, because we are not, at our fundamental core, our bodies. There is more to us than our physicality. There’s the ineffable “us” that makes us…well, us, I guess. And when that is gone, what remains is no longer us.

I have seen life depart on more occasions than I would have liked. Once, when a friend died in my arms on the Putty Road, I had no choice in the matter. I was right there. I could not have been elsewhere even if I had wanted to be. It was tough.

When my aunt passed, I did have a choice. But I chose to be beside her when she came to the end of her amazing life. I did this again when my mother followed her a few years later. I did this more for them than for me. I’d like to think the last thing they saw or felt was me, not some stranger.

What I saw on those occasions will stay with me always. It’s a scar. It cannot be anything else. The passing of time certainly denatures the savage immediacy of the pain and loss you feel, and you can and do get on with your life. But that scar remains fragile and easily bleeds when you choose to pay attention to it. Or even sometimes when you don’t. That’s the interest earned on the emotional investment you make as you make your way in this world.

On this occasion, I was not emotionally invested in the passing of this man. We were certainly not friends. And his passing came as no surprise at all. The end of his life was always going to be what I saw that day. There was an inevitability to it. I knew that, and his family knew that.

Anticipated deaths hit us differently to sudden and unexpected ones. I knew my mother and aunt were dying. I watched death come for them like a lengthening shadow as the sun goes down. Part of me wished it would hurry up and end their obvious suffering. For there is mercy in death.

I knew my great brother, Neale Brumby, was dying. We spoke some days before his end. Death was a mercy to him as well. I knew the wondrous Brendan Akhurst, the man whose last brilliant work graces my book, The Wisdom of the Road Gods, was dying. I saw him a week before he passed and we both knew this was the last time we would ever see each other. Once again, death’s mercy was evident.

When my brother, Gary Rule passed, it was sudden. And that shit catches you off-balance. It’s a deep cut, that one. That is when death is merciless. When it tears someone dear to you out of this life. The callous indifference of such a thing is like a cracking punch to the face. Suddenly, your own mortality is front and centre. If death could take him like that, then it can surely take me like that too.

I’ve lived long enough to bury some people, as many of us have. That is how life and death work, and there have been countless words written about our mortality, most of which seek to rationalise the utterly banal inevitability that awaits us all.

I will not pretend I can rationalise death. I will not even try. I would rather just tell you what I saw and what I felt, and maybe in some simple and childish fashion, expiate my own soul.

The hospital called the man’s family and told them to come for a meeting at a certain time. The man had been hospitalised some seven days prior, and it was his second hospitalisation in three months. Once again, he had been placed on a breathing machine, and this time it looked like he wasn’t coming off it…except he was. That was what the meeting was about.

His lungs were no longer lungs. They were now made entirely of cancer and Stage Four emphysema. He could no longer breathe on his own. And because breathing tubes are essentially torture devices that ironically give life-giving air when the patient cannot breathe on his own, he was heavily sedated. Patients who are thus intubated and not sedated, tend to go insane and will pull the breathing tube out at the first opportunity.

But a patient can only be intubated for a certain period of time. The breathing tube causes many complications as it does its business. After about two weeks it has to come out, and if the prognosis is relatively favourable, the doctors perform a tracheostomy and reinsert the breathing tube through the hole they have made in the patient’s throat.

The prognosis in this man’s case was not at all favourable. I was in the room when the doctor explained there was nothing more they could do, and he was advising us they would remove the breathing tube. The family was being informed to make what phone calls needed to be made and to say their goodbyes.

The man’s family was very big. He had three sons, and six grandchildren. Both his parents were still alive. There were also multiple nieces and nephews, one of whom was my son, for this was his mother’s eldest brother.

It was her, her younger brother, and me, who were sitting in this small room inside the ICU, with the doctor, the nurse, and a social worker with an annoying speech impediment.

No other family were present. Nor would be. For that is the path this man’s life took.

My wife and her younger brother were numb. Of course, they were. So, I asked the questions…

“How long will it take for him to pass?”

“It varies,” the doctor said. “In his case it should not be very long.”

“I have no terms of reference. Are we talking an hour, a day, what?”

“I would think it would not be more than an hour or so,” he replied.

“It’s crucial,” I said, “that he not suffer in any way. You must assure us of that.”

“The nurse will be present the whole time and he will be heavily sedated. We closely monitor this sedation. You may stay with him the whole time, or you can come back when it’s over.”

That was some option, I thought.

“We will be there with him the whole time,” my wife said. Her voice was steady, and her brother echoed her position.

The doctor nodded.

“OK,” I said, standing up. “We’re going to process this and make some calls. We will be back in a few hours.”

“Take all the time you need,” the doctor said. “And if you have any questions, please don’t hesitate to ask.”

I felt I’d asked what needed to be asked, and we went to a nearby pub to eat something. My son arrived to offer support to his mother, because I have raised him right, and at times like this, a man does what is required as well as what is expected. My son did not know his uncle, they had never met. And that was also a consequence of the path this man had chosen to walk.

My wife and her brother discussed what was about to happen. They pushed their food around on their plates, while my son and I ate, and I watched my wife closely to see if cracks were forming. None were evident.

“I want you both to consider this very carefully,” I said quietly. “I have seen both my mother and my aunt die. It’s not something you forget. It stays with you. You can’t unsee it. Not ever. And it’s not always like you might see in the movies when they take a deep breath and pass peacefully on. You’re going to see your brother suffocate to death. Because that’s what’s going to happen when they remove his breathing tube.”

My wife looked me unflinchingly in the eye. “I will be there the whole time,” she said.

“Me too,” her brother agreed.

“Do you want me to come?” my son asked.

I looked at him with all the love I hold for him, and that’s a lot. “No, mate. You don’t need to see this. I’ll look after your mum.”

And he certainly did not need to see this. Life will hand him enough pain and misery in its own good time without me thinking some bullshit about hardening him up by getting him along to see what happens when a breathing tube is removed.

Then we went back to the hospital and the process commenced. It went like this…

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Two nurses came in and the head nurse explained what she was going to do, and then did it. And what she did was slightly increase his morphine, and begin the un-taping of the breathing apparatus. Then she pulled out the breathing tube, turned the overhead vital signs monitor into a clock, and left the room. But she went only as far as the doorway. She was just giving us space.

The next 43 minutes were appalling and fascinating in equal measure, and all three of us cycled through being horrified and intrigued.

The man immediately began to take very shallow gurgling breaths. There was phlegm somewhere deep in his throat and twice the nurse came in and used a suction wand inside his mouth. The gurgling did not abate. She explained the phlegm was very deep in the back of his throat.

The man’s breathing continued and it became faster. The gurgling was constant. His head moved to one side and his legs bent and then straightened. The nurse had said if there was any discomfort, it may make itself evident via a furrowed brow, but that was not happening.

The man’s breathing started to slow down. But it was still shallow and there was still gurgling. Then it stopped. We all exchanged looks. Was this it? No, of course it was not it. He started to shallow breathe again after maybe thirty seconds. It was very irregular, and first his fingers and then his face began to turn blue.

This was what they call “agonal breathing”. But this is not true breathing. This is the end game. It’s a reflexive state the body goes into as it dies. And its link to the word “agony” is no coincidence.

But that’s what morphine is for, right?

Some foam started coming out of the man’s mouth and the nurse came and wiped it away. I took this opportunity to go outside and look at her monitor, which had not been turned into a clock like the one above the man’s head. His heart rate was 48bpm. And dropping.

I was suddenly terrified he’d lurch into consciousness, his eyes popping out of his head, spraying phlegm around the room, and utterly destroying his brother and sister on an emotional level. Because as awful as what they were seeing was, something like that was several orders of magnitude worse.

The nurse came out. She had increased his morphine level ever so slightly. I saw her do it. I thought it was a good idea. I went back into the room and gently stroked my wife’s shoulders. They were rock solid. Her Pilates class has worked miracles.

I gave her brother a piece of Nicabate gum. I knew he wanted a cigarette, but they don’t let you smoke in an ICU no matter how upset you are.

A few minutes later, the man’s breathing stopped. The gurgling stopped. It did not start again for a long time. Maybe several minutes. And then it started again, but it was barely what could be called breathing, agonal or otherwise.

And then it just stopped forever. I went outside and looked at the monitor. No life signs.

“Is that it?” I asked the nurse.

She just looked at the monitor for a while and did not immediately answer. Then after what seemed like forever, she nodded. “He’s passed,” she said.

She went inside the cubicle, and in a very quiet tone expressed her condolences to my wife and my brother-in-law. Both of their eyes were full of tears, but they were keeping it together remarkably well.

The sheer and almost incomprehensible magnitude of what they had just seen, on top of the fact their brother had just passed before their eyes, could not be easily or quickly processed. And while there are certain stages of grief, and it’s true that everyone grieves differently, seeing a man suffocate to death over almost an hour is not something most people can easily digest.

I’d seen similar things a few times, but it’s not something that gets less terrible with familiarity. It’s momentous and confronting and terrible and fascinating – all at once and one at a time. It’s the end of life, of ‘a life’ – and whether that life was good or bad, great or sad, is of no consequence beside the enormity and actuality of its ending.

I wish you all health and happiness.

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