My patient was actively dying—unfocused eyes opening and closing, brow furrowed. She was speaking urgently, but her words only emerged as softly articulated sounds in the back of her throat. With each inhalation I heard the crackling of uncleared respiratory secretions. Each exhalation came with a long moan as her vocal cords collapsed together in fatigue. After quick consultation with her husband and friends who were gathered in her bedroom, I pressed a syringe full of midazolam under her skin. In a few minutes her eyes were closed, and she was breathing more easily. One of her friends asked me what was going on inside her head. Could she still hear them? Was she still present or somewhere else? As a palliative care physician, I’m asked these questions frequently. I told them that I didn’t really know, but I liked to think that she was somewhere in a deep, peaceful dream.
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Wales J. Terminal Delirium in the Opera Kopernikus. JAMA. 2019;322(21):2058–2059. doi:10.1001/jama.2019.18865
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