On a Death-Bed, Surrounded By Care

Commentator and psychiatrist Elissa Ely remembers a patient who, at his death, was surrounded by those closest to him: the doctors and nurses who'd cared for him through the years.

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MICHELE NORRIS, host:

Everyone wishes for a simple, fortunate death, usually with their family surrounding them. Illness and complicated circumstances can make that difficult. It's even harder when there's no family to serve as advocates for the dying. Commentator and psychiatrist Elissa Ely was witness to such a passing at the hospital where she worked.

ELISSA ELY:

A while ago a former patient of mine died in the hospital. It wasn't a peaceful death; he suffered air hunger from his lung cancer. But he was surrounded by the nurses who had known him for almost a decade. When we first met, he was full of confident stories. All his businesses had succeeded, he told us. He had a second home in Florida and was going to retire to a deluxe fishing boat there. He'd bunk in the hospital briefly to take care of his pneumonia, but only if he could smoke all he wanted. Records from shelters and detoxes showed he'd been deteriorating for years but had never stayed in one place long enough to treat the lung disease and infections. He was also showing subtle signs of alcoholic dementia, including widely embroidered stories he believed himself. There was no second home or fishing boat. Outside the hospital he wasn't going to survive for long.

When our smoking restrictions began to annoy him, he contacted a patient advocacy group. He told them he wanted release from our toxic grip so he could fish in Florida. A team of lawyers arrived. They Xeroxed the chart and informed us that we were holding a competent man against his will. A few months later there was a court hearing. Sometime during that long day his lead lawyer came up to me in the hallway. She seemed to want to chat. What she said illuminated her world for me forever. `I know how you feel about this, Doctor,' she said. `You're interested most of all in his care, but I'm interested most of all in his rights.'

The hearing was arduous and hostile. Eventually, the judge ruled on behalf of the hospital and the lawyers disappeared. A few years later they contacted him again. By then, his dementia was open and he only knew his nurses' names. In the end, he died in what had become his own bed. Faces known to him adjusted the oxygen and morphine. In the end, it was better to be interested most of all in his care.

NORRIS: Elissa Ely is a psychiatrist who lives in the Boston area.

ROBERT SIEGEL (Host): You're listening to ALL THINGS CONSIDERED from NPR News.

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