A Good Death

As I entered into the exam room, Mrs. Corine Walls was sitting slumped in a chair and moaning. She had just been discharged after yet another admission for congestive heart failure. She had no records, just a few empty pill bottles. "My stomach hurts," she groaned. I started asking her about her pain. "If you can't help me, just leave me alone!" "Who brought you here?" I asked. "My daughter." "Where is she?" "In the waiting room." Quickly, I found her daughter, Doris, and brought her back to the examining room. She was happy to be able to help and was a good historian. After the exam, we called the pharmacy and obtained a complete list of medications. Corine had been taking Indocin daily since her last gout attack five months ago. It was stopped. She improved. She was now my patient.

Reviewing her six volumes of old charts revealed that she had heart failure for ten years. In the last year, she had been admitted monthly. Our goal was to decrease the hospitalizations with close outpatient supervision. It was unsuccessful. Several months and more than several hospitalizations later, I went to visit her in the hospital. Unlike previous times, she did not seem to improve, even in the hospital. She became short of breath just rolling over in bed. Simultaneously, her visiting nurse and I began discussing home hospice care. Her daughter was very willing to provide twenty-four hour care in the home, but her son worried about calling the hospice nurse instead of calling 911. Corine looked forward to home visits from her nurse and doctor and no more trips to the clinic or hospital. Finally, after two weeks of intensive discussions, everyone agreed.

We began hospice care. I looked forward to home visits with Corine. Her home was near the clinic, bright, clean and well kept. Her bedroom was downstairs by the entrance. Relatives began to come from far away for a final visit.

On my second visit, Corine said that she was afraid of being short of breath. "Perhaps some oxygen could help," I said. She smiled. By the next visit, she had oxygen. I don't even remember signing an order and I surely didn't complete the customary oxygen request form in triplicate! Hospice care is wonderful for both patients and doctors. Corine shared that the oxygen made her more comfortable, and in addition, her daughter couldn't smoke. She had been hesitant to tell her daughter how much smoke bothered her because Doris was working so hard to care for her. Now she didn't have to.

On a later visit, Corine surprised me with the gift of a "motto" for my life that she read to me from the book of Isaiah. Then she said, "Do you want to know my motto? - 'I do the best I can.' When I was six, my parents went canoeing on the lake near our house. The canoe turned over. They drowned; they couldn't swim. I was raised by my aunt and uncle in the church. He was the preacher. I learned the Word. But when I was older I went away from it for a time. But still, I did the best I could for my family. Now I'm back with Him. Go in the dining room. Get the vase in the china cupboard." She gave me a pretty brass vase with a single rose. "This is to remember me by," she said.

I went into the kitchen to speak with her daughter. She was with her cousin and the hospice nurse. "Have some hash browns." I did. They were delicious. Her daughter showed me pictures of Corine in the "old days" before she got sick with heart failure. I didn't recognize her. She was well dressed, attractive, much larger. Doris reminisced. I left to return to afternoon clinic.

Early that Sunday morning, I received a page from Doris. "Mama died quietly in her sleep. Everyone is here. We just wanted to let you know."

A couple of weeks later I was called to the lobby. There was Doris with a friend. She gave me a card and thanked me. "The funeral was beautiful. Lots of people were there. It was just like Mama wanted it - it was just like she wrote it."

The single rose sits in the vase on my mantle to remind me there can be such a thing as a "good death."

Bonnie J. Tesch, MD
Former Associate Professor of Internal Medicine
Medical College of Wisconsin

"Reflections" is a collection of essays by the health professionals of the Medical College of Wisconsin.