Taking Our Last Breath

Taking Our Last Breath

By Richard P. Holm, MD
 
It’s a holy place when a patient is taking their last breath. For the most part, I’ve tried my best to give comfort at that time. There are many who have stated, “There are worse things than death.” One study in 2016, asked end-stage patients about dying and found that more than 67 percent stated that “needing a breathing machine” was a condition worse than death.
 
Mr. B was an 84-year-old retired farmer who had been struggling with chronic obstructive pulmonary disease (COPD). This condition is related to the loss of ability to exhale normally, which, in turn, is due to the destruction of tiny alveoli which are oxygen and carbon dioxide exchange units. This results in large unfunctional pockets of air which block the flow of air going out.
 
He had smoked and had extensive exposure to toxic farm dust throughout his life, and now he was on continuous oxygen therapy and couldn’t do anything without running out of breath. He had been on pulmonary rehabilitation (exercises to stay in shape), a low carbohydrate diet, metered dose inhaler (MDI) bronchodilators and repeated antibiotics for a few years. This was the third time he was hospitalized in the last two months for “exacerbation of COPD.”
 
He was suffering from a worsening of his lung disease with the added challenge of bacterial pneumonia. His oxygen levels were dropping, and survival was going to require a breathing machine (intubation). He had been intubated over several days during his previous hospitalization and this time, he did not want it.
 
His wife had died a year earlier, all siblings had passed away, but his only child, a son, lived nearby. I will never forget the conversation the three of us had that day. We talked about Mr. B’s poor quality of life. His options were either to be intubated again or to go with comfort care using an opioid. Mr. B realized death was likely, as did the son. Mr. B said, “Let’s try the comfort method.” His anxiety and shortness of breath were reduced immediately after making that choice, and over the next two hours, as the pain medicine kicked in, Mr. B slipped away with his son at his side.
 
This is very serious business, and I usually encourage people who are aware of their situation to fight on, but Mr. B was very tired of fighting for breath. He was ready to let go. In his case, “needing a breathing machine” was a condition worse than death. After his last breath, he finally found relief.
 
Richard P. Holm, MD is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.