Sudden death

Sudden death: non-violent death that occurs within 24 hours of the first symptoms.

I've seen more people die than I can count (and I've seen many more not die, which would have been better). After so many years and so many deaths, I've come to the conclusion that death isn't such a bad thing. It's the way to get there that's often just too difficult.

What would be the ideal death? If we think about ourselves and the inevitable death that awaits us sometime in the future, what would we like it to be like? "Oh, I'd like to die in my sleep, without realizing it, I'd fall asleep and then never wake up," is what I hear many people say. The problem is that we have no power to influence when and how we die. Or do we?

When he came in, I didn't recognize him right away. He was panting, his nose connected to the tube that fed him oxygen from the machine his son carried slung over his shoulder. His son was pushing the wheelchair he was sitting in. Sitting, and still panting.

– Good morning, doctor.

It was only when I heard his voice that I recognized him. Now he seemed like a different person, because before, he always came to the appointment alone, on his own two feet, determined and quick, despite his 86 years. Before… What had happened?

It was his son who told him while he was panting and only making short comments, interrupted by his breathing. His son told him, especially since he hadn't noticed anything.

It was the anniversary celebration of the local philharmonic, the philharmonic he had been a member of for over 40 years. They had given him a seat in the front row to watch the ceremony. Afterward, he sat at a table with his old-school friends. And they ate, drank, told stories of the past, and laughed at the blunders and nonsense that had happened to each other over the years.

“It was one of the best days of my life!” he managed to say with difficulty at the appointment.

And he didn't remember anything else about what happened next. His son told him.

His father had suddenly fallen onto the table, unconscious. His comrades, both senior and senior, screamed. Luckily (they said), the room was full of local firefighters, many of them also members of the Philharmonic, and everything happened very quickly. His father was thrown to the floor, and the firefighters immediately began CPR, learned and practiced so many times. Everything had gone smoothly: the CPR was maintained, the call to the National Emergency Medical Service (INEM) and their arrival, the transport to the hospital, the unblocking of the blocked arteries in his heart. And his father had finally woken up, without serious head injuries, although he had lost a piece of his heart. At 86, it was still working well, albeit without reserve, and now, having lost the piece that had been lost, it was struggling to pump enough blood for the most basic needs, to stay alive and breathe and not gasp for air, even at rest. As if he were always drowning, little by little. Always.

“Thank God those firefighters were there, doctor!” he said to me.

I didn't say anything. But I thought about what I've thought about so many times. This dilemma, this permanent paradox of Sudden Death and our relationship with it.

Dying without realizing it is the best death there is. But, on the other hand, cardiorespiratory arrest (the most common cause of Sudden Death) is the death with the greatest potential for reversal with few or no after-effects. It's the closest thing to raising Lazarus: the person is dead, and then they're not, and they may even return exactly the same as before.

(It might... sometimes. Only 10 to 30% survive a cardio-respiratory arrest, and not all of them do so without neurological sequelae, although films, series and the media convey the idea of ​​a much greater success.)

And it is in the name of the possibility of resurrecting a Lazarus, completely and without after-effects, that Sudden Death, the seemingly ideal death, is also the one we combat with the greatest energy, dedicating efforts and resources to reversing, avoiding, and defeating it. And the greater our success in this struggle, the more non-sudden deaths, non-ideal deaths, deaths that linger over time, in days, weeks, months of sustained, increasing, constant suffering.

If we all end up dying in the end, why suffer so much until we get there? Why should we suffer so much? Like all difficult questions, there is no single answer, no simple and complete explanation. But there may be partial causes, reasons that explain part of why we suffer so much to die. And I think our fight against Sudden Death is one of them.

Some time ago, at a Cardiology Congress, there were three doctors on stage, two younger and full of drive, enthusiasm and bright eyes, and one older, almost retired and retired, a former glory of Cardiology.

This conference discussed treatments and interventions for patients with various heart conditions, invariably severe and serious like all heart diseases, which seem to always be associated with imminent death. And the young doctors enthusiastically discussed new interventions and studies demonstrating a significant reduction in mortality, through a dramatic decrease in Sudden Death.

(avoiding death, overcoming death, the old dream of Humanity, right? But at the cost of what quality of life? And at the cost of what quality of death?)

After several minutes of presentation and some questions and answers between the audience and the doctors on stage, nearing the end and closing of the lecture, the older doctor took the floor. And he said:

He said that, in his personal case, they were prohibited from treating him and placing devices that prevented Sudden Death. That not having Sudden Death and dying first from heart failure, gasping for air, as if slowly drowning, even if months or years later rather than before, wasn't worth it, wasn't worth the effort; it was exactly what he wouldn't want for himself.

There was an awkward silence in the room, a bucket of cold water thrown over all the enthusiasm and optimism previously expressed. The session was quickly adjourned, and everyone began to stand. I sat for a while longer, pondering what had been said.

We began by combating deaths caused by infectious diseases. At the turn of the 19th century, pneumonia was the leading cause of death among humanity. The great William Osler called it the Captain of the Men of Death. Today, respiratory infections account for only about 6% of deaths worldwide.

Then we declared war on cardiovascular disease. From 1960 to today, we've managed to reduce deaths from these diseases by 60 to 80%. Later, we tackled cancer. From the 1990s to today, we've managed to reduce deaths from this cause by more than 30%.

None of this is bad; all of it is good. But sometimes we seem to forget that, one way or another, we all die eventually, and that it will happen in some form. If we avoid infectious, cardiovascular, and cancer deaths, we will increase other ways of ending our lives. Neurological degeneration is one of them, and Alzheimer's and other dementias have increased by almost 150% since 1990…

We should reflect on the fact that we are resuscitating people, avoiding Sudden Death (considered by many to be the least bad way to go), and thus condemning those resuscitated to one of the other forms of death, often in continued suffering until they reach that point. And we avoid these deaths, which would be painless, only to later discuss euthanasia for those whose suffering we fail to prevent.

The man left the office, pushed in his wheelchair by his son, his breathing audible, along with the purring sound of the oxygen machine, his indispensable companion now. Slightly drowning every minute of the day.

I watched him and imagined how he would have lived those 86 years, so well lived, until that epic end, ending his life with his friends at the table in the Philharmonic Hall, pain-free, still full of happiness and laughter—that end they wouldn't let him have. And I thought of the suffering and the end that still await him.

I've seen more people die than I can remember. And I also think Sudden Death is the best way to go. It's how I'd like it to be when my turn comes. Like falling asleep and never waking up again.

That's why I don't want to be resuscitated if I ever go into cardiopulmonary arrest. After all, it's one of the few ways we can influence the when and how of our death.

And each of you, have you ever thought about how you would like it to be for you?