Passing Gentle Into That Good Night

Yesterday (Monday), we had the autopsy of the first case of H1N1 Flu to die in our area. It was very sad because the young man was so young and previously healthy. I wasn't present at the post-mortem because of the high level of precautions being taken. However, I did hear about the case during morning report, and one of my colleagues is on their PICU (Pediatric ICU) rotation, and I heard some information from them.

Today we had three cases. Three people who died in their sleep and were found after a friend, relative, or neighbor grew concerned enough about them that they sent someone to check on their welfare. In one way, I think most people would like to just pass from this life in their sleep. A simple blink from existence. However, I found myself somewhat saddened by their stories, because to me they died alone. Although someone checked on them, thought enough about them to be concerned, no one was actually with them when they passed.

I think I've only been at the bedside of one or two patients when they've died. Both of which I later had to deal with guilty feelings for turning off the ventilator. Medically, I knew that they were brain dead. I knew that the best thing I could do for them was to let them go. Emotionally, though, I still felt as though I was the one ultimately responsible for their death. I talked to their families and got them to understand that their loved one wasn't going to recover. I signed the orders for morphine and to stop medications to keep their hearts going and their blood pressure up. I turned off the breathing machine. I pronounced them when they flatlined.

I thought a lot about Dylan Thomas' poem today. As a physician, and especially one who works the "front line" in the E.D. , I can't help but daily think I "rage, rage against the dying of the light." And, when we lose the fight, I am glad that someone was there to witness and to pray.

Do Not Go Gentle Into That Good Night
by Dylan Thomas

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 grieved 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.