The Last to Go?

Making my rounds at our inpatient hospice unit early on a Saturday morning, I sat down at the bedside of an elderly woman very close to death. No one else was in the room. Other than her quiet, irregular breathing, the only sound in the room was the quiet strain of hymns being played on a CD player in the corner of the room. She had been unresponsive for days, at the end stage of a typical terminal course following a devastating stroke on top of her previously diagnosed dementia.

I took her hand (as I always do with my patients), spoke to her about her care, our attentiveness, and our discussions with her family. Of course there was no response, but I’ve always presumed that at some level even obtunded patients have an existential awareness of people, activities, touch, emotions, and sounds in the room around them. I instinctively placed my fingers over her radial artery to check her pulse. Consistent with an actively dying course, it had been thin, rapid and irregular, barely palpable – even absent at times. But today, to my surprise, it was strong, firm, and regular. As I continued to marvel at the mysterious and unexpected ways in which dying processes evolve (it’s rarely as predictable as one might imagine), I became aware of the song playing softly in the background, a solo piano playing a testimony to Hermine’s faith: “Search me, O God, and know my heart today . . . “ And in perfect rhythm with the song, so did Hermine’s heart beat. As the song accelerated, so did her pulse. “Lord, take my life, and make it wholly thine . . . “ As the melody retarded to the hymn’s conclusion, her pulse followed, in lockstep with the rhythm. “I now surrender, Lord – in me abide.” As the final chord faded, her pulse reverted to its expected thready, irregular character. Within a couple of hours, Hermine took her last breath.

I can’t claim with medical certainty when certain bodily functions or senses are no longer physiologically functional. It is cliché to claim that “the hearing is the last to go.” What I do know is that even in deepest levels of profound unresponsiveness, the spirit is alive and receptive. Hermine reminded me of that. And so must we all continue to honor the people we serve, through every phase of illness, life, and death.