Portal de Periódicos da CAPES

Good Death

2018; Elsevier BV; Volume: 56; Issue: 3 Linguagem: Inglês

10.1016/j.jpainsymman.2018.04.005

1873-6513

Paul Rousseau,

Nursing Education, Practice, and Leadership

“You hang ‘round here long enough, you hear things.” Don's words pass cracked and flat. I nod. “I can imagine. Some of it must be frightening.” “Yup, some of it's damn scary, even for an old Marine like me.” He smiles. “But doc, the words “good death” really bother me the most.” He pauses. “I hate those words, I hate ‘em. But it's not ‘cause I'm afraid of dyin, and that's the truth, I ain't, it's ‘cause I don’t see any death ever bein’ good.” “Well, I think …” He interrupts. “I'm not talkin’ ‘bout if you ain't got pain, or if you ain't throwin’ up your insides. I'm just talkin’ ‘bout dyin’, leavin’ this earth and your loved ones, leavin’ ‘em forever.” His eyes travel the room. “I was in Vietnam, saw four of my buddies die, but none of ‘em was a good death, not even the death of my best friend Bobby. He was killed by a sniper. Hell, he didn’t know it was comin’, he was just standin’ there smokin’ a cigarette, enjoyin’ the taste of tobacco, talkin’ ‘bout meetin’ a woman when he gets his R and R, when boom, he fell to the ground, dead. He died in a second. He didn’t have no sufferin’.” He grabs his arm, then pushes the button on his morphine pump. “My damn bone's all corroded by cancer.” He sits still for a few moments, then continues. “Some might say, considerin’ the situation and all, Bobby's death was a good death. In fact, our sergeant said, ‘If you gotta die in Nam, that's the way to die.’ Bullshit I say.” “I think I know what you're saying, but war …” “Doc, it don’t matter if it's war or not, what I'm tryin’ to say is no one wants to die, no one, no matter what they say, so ain't no death a good death. You understand where I'm comin’ from?” “I do.” I let him continue. “The guy down the hall, he died the other night, I think he had leukemia or somethin’ like that. I went up to the nurse's station after the ruckus was over and they'd taken his body away, and heard them sayin’ he had a good death, family and all at his bedside, no pain, and no bleedin’.” He looks at the ceiling, his eyes restless. “Jesus doc, he died, he's gone, his family ain't gonna see him ever again; seriously, was his dyin’ good?” “I understand, I do.” And I did. My wife died 10 years ago, so I understood. “Death is never wanted, and death is never forgotten,” I say, “and grief is never absent, it just hides and festers, like the pain of an abscessed tooth softened by antibiotics. So no, death isn't good, and you're right, maybe we should stop using those words.” “That's what I'm sayin’ doc, dyin’ ain't good, no matter the circumstances. Ain't no good for the dyin’ person, ain't no good for their family.” “But I want you to know that when doctors and nurses say good death, they don’t mean any harm. They mean symptoms were controlled, issues between family members—if there were any—were resolved, the person was accepting of death, and they died the way they wanted and where they wanted. They mean the words in a good way.” “Doc, let me tell you somethin’ ‘bout acceptin’ death. There was this guy named Jimmy, he was always in chemo clinic with me. We became good friends, always sat next to each other when they put the venom in us. But I could see him failin’, I could see the nails bein’ hammered in his coffin. He'd sit in his wheelchair like a wilted flower, barely able to hold his head up. It got to where all he did was sleep. He knew he was dyin’, told me the cancer had laid eggs all over his body. But he didn’t want to die, he had five grandkids. He'd tell me he had to live to show ‘em how to go fishin’ and huntin’, and make sure no bad boys got ‘hold of his granddaughters.” His eyes fill with a storm of tears. “Anyways, one day, he wasn't there.” He stops, wipes his tears, and takes a deep, shuddered breath. “His wife called me a week later, said he'd passed, that he was ready, that he was acceptin’ of his death.” He pauses. “I miss him, I miss him a lot, it's like my heart's got sciatica, and there ain't no salve to help the hurt.” “I know that …” “Doc, I don’t mean to keep interruptin’, but acceptin’ death like Jimmy did only means you been beat down, you're worn out, you can't take no more, it don’t mean it's a good death. He didn’t wanna die, he told me so.” His eyes meet mine, then slide to the window. “You slog through chemo and radiation and all the side effects, and sit day after day after day in the hospital, all tryin’ to hang on one more day, one more week, one more month, all ‘cause you don’t wanna die, and yeah, sometimes during all that sufferin’ you might say you're ready to die, but that don’t mean you're really ready, and it don’t mean your dyin’ is good. Ya know?” “Yes I do. The acceptance is reluctant, and unwanted.” “That's right doc, acceptin’ dyin’ is like puttin’ your hand in your pocket searchin’ for coins, and only findin’ lint and crumbs—it's not what you wanted, but it's what you git.” “You're right,” I say. “We need to think about the words “good death,” because if they bother you, they bother others, and to be honest, they bother me.” “That's all I can ask doc.” “It's like the military words we use when talking about cancer—battle, fight, war, giving up, losing—they're inappropriate and insensitive.” He smirks. “Well doc, bein’ an ex-military man, I don’t mind the military words, but I know what you mean.” He leans back in bed, his eyes heavy from morphine. “I need some sleep doc.” “I'll see you tomorrow,” I say. “You got it doc.” He pulls his right hand up and salutes. “Semper fi.” “Semper fi,” I say. I see Don every day for two weeks. His body withers, and his skin turns an ashen gray like a rainy sky. His words dwindle, as does his wakefulness. Then, during the inky darkness of an early morning, I receive a call from the hospital. “Doctor, this is Don's nurse …” She hesitates. “Doctor, Don passed in his sleep at 4:15 this morning.” I take a deep breath and slowly exhale. “Thank you for letting me know.” “Doctor?” “Yes?” “He died peacefully.” She knew of Don's dislike of “good death”; her words were ones of respect and propriety. I smile. Don would have been happy. Epilogue: Don's death surfaced memories of my wife's death, and the importance and consequences of words. My wife died, at least outwardly, without symptoms, and with family bedside. I was told her death was a good death by well-meaning clinicians. But they were wrong, and their words grating and empty. Her death was like a sundering of the fabric of reality: horrific and unbearable. She didn’t want to die, and her death wasn't good.