A Dying Man

The last 2 weeks or so I have been taking care of a dying man. He's an Afghan who came here after an IED attack like many of our patients. The main difference is that he is an old man in this society. He is somewhere around 50 years old. The Afghans do not keep track of birthdays, so you never know exacatly how old they are. 50 here is like 80 in the western world. So, imagine your grandfather getting blown up by an IED, then you can picture this frail old man. But, he was not a frail old man before the attack. He was a very important person actually as we came to find out. For security reasons, I won't elaborate.

The dying man did well in his first 24 hours at Bagram. He had multiple complicated fractures which our Orthopedic surgeons worked very hard to fix. He was on the road to recovery. He was talking. He was articulate. Then, things took a major turn for the worse. He reportedly had a heart conditiion that would drive his heart rate up from time to time. That's all we knew. He had some medication called propranolol for this to slow down his heart. Every once in a while he would take it at home. Well, his heart began to race one night. Our on call doctor ordered some medication to slow his heart. We think that his son having good intentions also gave him medication that was brought from home. The result was a precipitous drop in heart rate and blood pressure. We need a certain pressure to "nourish the squash" as one of my mentors used to say. The blood flow to his brain was not adequate for some period of time, probably a few hours. He essentially had a stroke from low blood pressure. The patient was never the same. He began to die.

His "mental status" as we call it changed rapidly then began to decline gradually over the next 1-2 weeks. It was hard to watch. This was an important man. This was a strong man. First he could not speak. Then he would not move. I would give him a vigorous sternal rub and there would be nothing day after day. It was disheartening to say the least. Even harder was trying to explain this all to his son. Each day he would ask me if the dying man would get better. I tried to be as honest as possible. We all knew he would not get better. His son was like most family in a situation like this. It just takes a long time for it all to sink in because it is such a difficult message to digest. I try to be compassionate but it is hard to do that through a translator. I wish it could all be different.

It's been a while since I have taken care of dying patients. Most of my patients are young and healthy at Charleston Air Force Base. End of life care is not a typical issue for them. Because of this, I think this has all hit me a little harder. The dying man will be in a better place soon.