Death/Medicine

Maybe It Was Just Her Time to Die

A somber moment of discovery for our medical team

During morning report, Daan B., one of the emergency medicine residents, was recounting the case of a 96-year-old woman he’d seen several days earlier. She had been brought in due to altered mental status. Concerned neighbors had summoned the paramedics.

She’d been found on the floor, hypotensive, delirious, and weak. No other history was obtainable. A check of the patient’s medical records indicated she’s been generally well with limited physician contact. She had no advanced directive on file.

I halted the case discussion at this point and asked Daan to describe his patient management approach. He very correctly described an assessment of airway, breathing and circulation, oxygen administration for hypoxemia, IV fluid resuscitation for hypotension, a blood glucose check, vital sign monitoring, and a full physical examination, among other key points.

Daan’s patient was found to be hypothermic, with a core temperature of 28°C. At the point, the discussion shifted to the differential diagnosis and management of hypothermia.

Daan — along with others in the room — handled this with a fair degree of sophistication.

Then, we focused on the patient’s diagnoses and outcome. Not unexpectedly, Daan’s patient had died within 18 hours of hospital arrival. No extraordinary life-prolonging measures had been part of her care.

I continued with the next natural question. ‘‘Why do you suppose she died?’’ My intent, to stimulate further conversation about the case.

I waited for a reply, expecting something well-reasoned: septic shock, acute myocardial infarction, pulmonary embolism, or perhaps some multi-factorial cause. I saw the resident pondering, considering his answer, head bowed, gaze unfocused, concentrating.

After a few moments, he turned to me, soberly responding, ‘‘It was just her time.’’

His response hung in the air for a few beats longer than was comfortable, compelling us to confront it.

Surprised, I was caught off guard by the transition from the purely medical to the philosophical. I said nothing.

Slowly everyone else in the room began nodding gently, silently agreeing that this was in fact the correct response.

Pondering Daan’s answer, I had to agree. How reasonable, caring, appropriate, and medically sound. It was just her time; nothing more needed to be discussed.

Our morning educational session was at an end; point well taken.

A different recounting of the incident above appeared in Academic Emergency Medicine in 2004. The setting for this story — Amsterdam.