I Don't Want to Die an Old Person

His pristine young skin was whiter than snow, topped by a flame of true ginger red hair. Unfortunately, his Scottish genes were to be the risk factor for the metastatic melanoma that was now infiltrating throughout his tall and lanky body.

He spent a month preparing for his death in his focused methodical manner. On arrival to the inpatient palliative care unit, he set about “putting things in order”: organizing his laptop, creating photo albums, and spending time with his young family. He created an end-of-life bucket list that included outings to see the glistening downtown Christmas lights with his children and a Celtic pub greasy breakfast with his mates, while watching a hotly contested European soccer match on the big screen.

His laconic sense of humor was loved by all the nurses. One day, he even shared with the evening shift nurse that he didn't want to live until the age of fifty: “I don't want to die an old person.”

Then, after Christmas, his gnawing bone pain grew steadily worse, even trespassing his world of usually peaceful sleep. The team worked to titrate his opioid, ketamine, and ketorolac and other medications. His pain was better, but by no means perfect. It now confined him to bed for most of the day. His tumor burden and weight loss increased as his interest in life diminished.

“I've had enough,” he announced to me one day when the fog of an end-of-life delirium started to cloud his thinking.

Overnight, he became significantly more confused. Another devastating blow to his intellectual being. He was agitated and becoming distressed when I entered his room that morning, fuelling his wife's distress.

I could sense that the call of death was approaching.

“You have to sedate him,” his wife urged. “His sister won't mind.”

I looked at my watch. It was only 11 am. That meant that his sister, who was currently on the direct UK air flight, was due to arrive in five hours' time.

My gut told me no. Although he had intimated to me that he wanted to be less aware at the end of his life, this was not the right action to take for him at this time. I explained to his wife that first he needed medication that was more specific to his delirium. I prescribed a single low dose of haloperidol. He calmed down within the hour.

His wife asked my junior resident: “What was it again that she gave him? It's magic!” My earnest resident was impressed. So was I, combined with a gratification that the medication had worked so efficaciously for him. He remained tranquil all afternoon before I left for the day.

On my return the next morning, I discovered that after staying up until the wee hours, all the while talking and reminiscing with his sister, he had drifted into a peaceful unconsciousness.

His wife also recounted to me what had happened earlier the previous evening. As soon as his sister had walked into his room, an enormous beaming smile had appeared over his pale face. “It was like the movies,” his wife said. “You couldn't have written a script for it.”

On hearing this, a wave of warmth flowed across my heart and caught my breath.

And nature granted him his final wish: he died six days before his 50th birthday.