Into the spirit world

He might go this weekend. Just keep him comfortable.”

I was on call for the small hospital for the weekend. There was one inpatient who had come in earlier on Friday with acute shortness of breath. He had a long cardiac history and was essentially palliative. He was all right with that. He was an aboriginal guy, and pretty traditional in his mindset. I got handover from his doctor, one of the three in town.

“Oh yeah,” she stopped at the door on her way out. “He has an implanted defibrillator. It’s never fired though. Maybe it doesn’t work.” She paused again. “He cried when he found out that he had it put in. I remember. He came back from the city and they had put it in. But he hadn’t understood when they explained it to him. Same old communication barrier. When he came back, and I told him about the procedure that he had had done on him, he cried and said that he didn’t want to be shocked back to life when he died.”

I got a call around 8 PM the next day. The nurse sounded stressed.

“He just got a huge shock. His wife said it lifted him off the bed. I think it’s his defibrillator.”

The thing that supposedly didn’t work had fired. It did work.

I walked out the door of my house. The moon shone pale and full, and a faint breeze rustled through the trees. I looked down the lane. There were lots of grizzlies in town this time of year, and it was always a strange sensation stepping out into the dark alley.

I thought of my medical school classmates. I was pretty sure that marauding bears were not a problem for most of them while on call. Neither were implanted defibrillators that kept firing while a man was trying to die.

I walked through the doors and past the nursing station, directly into the man’s room. He was in bed and his wife was standing beside him. Four other relatives were there. I said hi and sat down. His wife explained what happened. It was definitely the defibrillator.

I explained what was happening. I told him I thought that his heart was starting to not work. I asked him what he felt about that.

“I am ready to go to the spirit world,” he replied. “I have been ready for a while now.”

We sat and talked. He had great stories of growing up, and we chatted for quite a while. The stories were wonderful and full of feeling and humour. He talked of his grandparents and how he looked forward to seeing them.

Then it went off. He jolted in the bed. His eyes filled with terror.

“You have to do something!” cried his wife. His niece in the corner moaned and started weeping quietly.

I thought for a minute.

“I can give you something to make you more comfortable. It might make you drowsy, though.” I went and got the nurse and we started a morphine and benzo drip. I was wondering what the next step was.

“Can’t you turn it off?” he asked quietly as the infusion started. “I am not scared to die but I am scared of that machine inside of me.”

I wasn’t sure and was secretly hoping that it wouldn’t go off again. I figured the next step was to put him out, to give him a general anesthetic. I told him that. He didn’t look very excited by that idea. I sat down again and we talked some more. But there was an edge in the room now, even as he got more sedated.

We talked for about 15 minutes before it fired again. The drugs didn’t take the edge off. There was a palpable panic in the room.

I pushed more drugs and went out. A nightmare was brewing. I got on the phone and called a tertiary care centre in the city, a two-hour flight away. I asked for the palliative care department. A nurse got on the phone. He didn’t know what to do. He said that by the time people got into the palliative program they had had such devices removed. He suggested calling cardiology.

There was a cardiology fellow on call. He sounded excited about the situation.

“Wow,” he said. “Haven’t had to deal with that before. Have you talked to the surgeon?” I explained to him that “the surgeon” didn’t exist where I was.

He paused.

“A magnet will turn if off. But if it has to fire again he’ll die.” I thanked him and got off the phone. A magnet.

Miraculously there was a magnet around, for pacemaker patients. The nurse dug it out. The thing had fired again while I was on the phone. I walked back into the room. I started to give the spiel about how the magnet might be able to turn off the machine inside his body. While I was talking to him, it fired again.

He looked up at me. I will never forget his eyes. Terror. Sheer terror.

“Please,” he sobbed. “Turn it off. Please.”

“It’s torturing him,” his wife was sobbing as well. Everyone in the room was.

I leaned over him and placed the magnet on his chest. He looked at me with relief that I can’t put into words. For whatever reason, he trusted me completely. I was still not sure that this would stop the defibrillator. I left the room to get some tape to fix it in place. My plan was to sit with them again for a while. I went back into the room and started to place a strip of tape across his chest. His wife was beside me rubbing his hand. I could feel her breath on me. Suddenly he leaned forward and made a choking sound. He shook and then fell back into the bed. He literally turned purple. His tongue came out. He was gone. My hands were on his chest.

I held his body and then I held his wife’s body. She was shaking uncontrollably. I wasn’t sure what else to do. After a few minutes, family members arrived, wailing. And after some more minutes, more people. Until there were so many that it felt like the whole town was there. And it probably was.

I had missed the class on how to deal with this situation.

After hours of greeting community members, hugs, tears, and feelings of sadness and calm stirred in with anxiety and trepidation, I walked home to bed, but I tossed sleeplessly unable to stop my mind. I finally gave up and left the small house beside the hospital and got in my truck. I pulled out onto the gravel road and drove. As the sun came up over the mountain ridge, I drove hard down one of the logging roads that carved a path out of town into the mountain range. My body felt electric.

There was a spirit dance two days later. A second time, I watched as he passed into the spirit world.

Andrew Lodge MD

Winner, AMS–Mimi Divinsky Award for History and Narrative in Family Medicine for a Story by a Family Medicine Resident.

Dr Lodge is a family physician in Bella Coola, BC.

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