This week I had two patients with Stage IV liver cancer. The first was given two weeks to live, three weeks ago. He's been fighting the disease, living at home, suffering the pain of the disease and the pain of the treatments. His family was of some help, but by the appearance of his house, not much. The house doesn't qualify as a "hoarder" house--but given another year or so, I'm sure it would.
We were paged for the unresponsive male. When we arrived, he had gotten to the bathroom, lay down in the bathtub, and apparently waited to die. That's where his family found him. He was severely jaundiced. His extremities were ice cold. I couldn't get an IV stick no matter what I tried. We settled for an I/O. His GCS was 5. His family stood in the garage while we packaged him. No one had arranged for a DNR, so medical control was contacted to get a standing order to hold CPR. And we transported. He survived the fifteen minute transport--much to our surprise. We transferred to the ER bed and said our goodbyes. I very much doubt he lived more than an hour or two.
The next morning, another page at 0530 for the unresponsive male. Another stage IV liver cancer patient. This one had family support--his ex-wife moved in to take care of him during his treatment. He was, in appearance, okay. No jaundice. Sclera paper white. No edema. He looked like a normal 62 year old man. Except, of course, for the fact that he was dead. Sitting in the driver's seat of his antique pickup truck, in his detached garage. A hose leading from the tailpipe to the driver's side window, secured with duct tape. The tape was ripped from the tailpipe where his ex-wife desperately tried to intervene when she found him. His note was left on the workbench.
I opened the side door upon my arrival. I had mentally prepared for a hanging or shotgun wound. I admit I was relieved at his choice of method, The smell of exhaust fumes was overwhelming and I refused to enter until we could open the main garage door to vent the room. I paged for an engine to bring a CO meter, and while we waited, I spoke to the ex-wife. When it was safe, I confirmed definitive signs of death. Pulseless, rigor mortis, dependent lividity.
I keep going back and forth between admiring the fact that he took control and left on his own terms, and thinking he's a bastard for letting his ex-wife deal with this. Not for me to judge. But obviously, it's deep in my mind this week.