way to go

In England people believe death is imminent, in Canada people believe death is inevitable, but in America people believe death is optional.

-- Ian Morrison, health care futurist

If I’m being completely honest about why it was so disconcerting for me to go directly from saying I didn’t feel sleepy at all from the intravenous Valium I was given to being woken up in the recovery room after my donor nephrectomy (kidney removal surgery), I would have to say it really had nothing to do with wanting the whole movie-scene of counting backward with the mask over my mouth and nose. It wasn’t even about being robbed of the possibility of a dramatic last-second change of heart.

It was about the lack of consciousness. Completely unaware of what was being done to my body. Poked. Prodded. Flipped around to the surgeons’ desires.


But on the other hand, what if I hadn’t woken up? Tragic, sure, but when I get down to it...dying on an operating table doesn’t strike me as such a horrible way to go. Not suffering. Not in pain. Assuming I would be waking up in a few hours, so not even anxious about it.

I’d say this is second only to living a long, relatively happy and productive life then dying in your sleep from a massive heart attack— after a lovely meal with the non-dysfunctional part of your family followed by deeply satisfying sex with the love of your life. This massive heart attack would have to be unwitnessed, of course. So maybe around 2AM when it will be hours before anyone realizes you’re not going to wake up—even with rib-cracking chest compressions or shocks to the heart. Unresurrectable.

But perhaps a not too distant third way to go would be dying of kidney failure after you’ve lived a long life. Just getting progressively sleepier and sleepier. Over weeks. Months. Even years. So slowly, you’re not fully aware that you are sleeping more. Sure some nausea and shortness of breath. Maybe even some pain. But nothing that couldn’t be managed with a little shot of this or that—until you just don’t wake up anymore. Until your potassium rises to a level—exactly what no one will know because they stopped poking you for blood tests some time ago—that will silently stop your heart.

At least that’s what I read it’s like and heard it was like from doctors who took care of patients in the days when dialysis was a novelty. I’m not completely sure, because now we tend not to let people die of kidney failure. As if the fact that dialysis exists and is readily available automatically means people should never die from it. Like the tragedy of a woman dying of cervical cancer when regular Pap smears can detect it so it can be cut out before it is a truly grown up cancer.

We doctors are in the business of saving lives after all. We save them in a hail of compressions, shocks, IV lines, tubing, beeping monitors, dialysis catheters, and dialysis machines. And often pain. And often moaning. Suffering.

Sadly, despite our best efforts, people die anyway. Because, contrary to popular belief, death is not optional.