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Guest commentary: Love is stronger than death

Guest commentary: Love is stronger than death

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Like many of his patients, Dr. Jack Kevorkian apparently died alone. His patients were supplied with one of two machines, a Thanatron or a Mercitron. One machine delivered a concoction of medicines intravenously; the other delivered carbon monoxide. Both machines caused death. Kevorkian responded to the anguished calls of people who were suffering with an efficient technological answer.

I remember watching on "60 Minutes" the death of Thomas Youk, the one death at which Kevorkian was present. Just two years earlier, I had finished my residency training in internal medicine. Watching Youk's death, I thought about all of the machines that kept people alive: the ventilators I had tweaked, the infusion pumps I had titrated. Seeing Kevorkian work on Youk, I was struck by the cold, procedural efficiency that Kevorkian and I shared. Yet, there was a stark contrast. On the one hand, technology was used to cause death; on the other, technology was used to cause life to continue, often in people who would die only a few days later.

On Jan. 1, 1994, I was present for the death of a woman named Becky. She was in her late 20s. She had AIDS and was admitted with a particularly bad case of pneumonia, complicated by her frailty and other AIDS-related infections. Becky had not been improving; in fact, she was worsening.

As I read her chart that day, a woman walked out of Becky's room; it was her sister, escorting a boy of about 5 years of age. She was teary eyed; the boy did not seem to know what to make of it all. A few minutes later, I walked into the room and into the middle of a conversation between Becky and her mother.

"It is time," Becky said, with tears streaming down her face. She struggled to take off the facemask delivering oxygen.

"No, Becky," her mother said, as she struggled to put the mask back on.

"Momma," Becky said, with her East Texas accent, "I told you that after I saw him one more time, I would be ready. We have said our good-byes. Now it is time."

Her mother, not knowing what to do, shook her head in defiance. "No, dear! He still needs you. Please leave the oxygen on, honey."

Within a few seconds, everything became clear. I realized that Becky was talking about her death, that the boy was her son, and that she had made her peace with him. I sat down next to Becky's bed, asking a few medical questions. She redirected me to existential questions. She wanted to stop the medications and to be allowed to die. It became clear that Becky had been planning her death after she had one last visit with her 5-year-old son. I stepped out, spoke with the attending physician, spoke with Becky's mother, and then returned to Becky's bedside to tell her that we would work to make her comfortable and to allow her to die.

To this day, I remember the relief on Becky's face, like I had taken from her a heavy load that she had carried up a long hill. I wrote orders to discontinue antibiotics, and to begin her on a little morphine to reduce any air hunger. I changed her from the uncomfortable face-mask delivery of oxygen to oxygen delivered by nasal cannula.

Becky died rather quickly, as these things go. Her mother sat at the head of the bed, cradling Becky's head in her lap, stroking her hair. Her sister sat at the foot of the bed, tenderly holding her foot, occasionally kissing it. Becky died peacefully surrounded by those who loved her most.

I have seen it a hundred times. Those surrounded by loved ones seem to require less narcotic pain medication. They seem to be diverted from their pain, or perhaps to have transcended it. Perhaps it is as Solomon's wisdom has said: love is as strong as death, perhaps stronger than death because it changes death, redeems it. Perhaps we reach too often for the technology that would save us from our dying and our living, and not for each other.

I do not know the details of Jack Kevorkian's death. The reports said he died alone at William Beaumont Hospital from pneumonia and renal failure. I hope the reports are wrong. I hope he had more than the trappings of medical technology with him. I hope he was surrounded by those whom he loved most, and those who loved him most. I hope that as he reached out, he did not find a cold machine, but a warm and loving hand.

Dr. Jeffrey P. Bishop holds the Tenet Endowed Chair in Health Care Ethics at St. Louis University. His book, "The Anticipatory Corpse: Medicine, Power, and the Care of the Dying" will be published in October by the University of Notre Dame Press.

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