An Unwilling Consultant

Two weeks ago we learned that my wife's 96 year-old Grandmother was in the final stages of kidney failure--a terminal condition. I only knew her for a short time, but it is really difficult to overstate the life that this woman led. She was mother to 13 children who all turned out to be wonderful people, and grandmother to 36 grandkids, 36 great-grandkids, and 1 great-great-grandchild. She was very independent, and lived alone until the age of 94, attending mass at the Catholic church down the road every morning. Perhaps most telling was the love and respect that her family had for her. I often joked with my wife when we saw her at the immense family weddings that she loved to frequent that she looked like a Polish "Godfather" with all of the people that visited her while she sat comfortably in her chair, receiving each family member in turn and treating every one of them like the only person on earth she would like to speak to at that moment. I don't throw compliments around lightly, but she was truly a stunning woman.

You can imagine the turmoil that her imminent passing threw my wife's family into. Of course they all knew that sooner or later her body would fail at her age (or, as she liked to say, her body would go "kaput") but I'm not sure they could imagine a life without her, or their immense family without her as the matriarch. The family that I had joined only a year previous was on the cusp of great change, and I soon found myself thrust into the situation, honored and more than a little terrified, as I found those I love looking to me for medical knowledge for the first time.

We received word of Grandmother's condition on the eve of my nephew's 6th birthday party. The whole family had made the 400 mile weekend journey to a small town in Michigan to attend, but the celebration was completely overshadowed by the phone call late Friday night about their grandmother's kidney failure. The next morning my father-in-law decided that he should make the trip back to Wisconsin early to be at his mother's side. While he was packing up his van and waiting for my mother-in-law to say her goodbyes, I found myself alone in the doorway with him, completely at a loss for what to say in such a time. Unsurprisingly the "touchy-feely" empathy classes at my school had failed me. With concern on his face, he said to me, "I guess they found a blood clot in her kidney. They said there was nothing they could do to help it heal."

I immediately found myself searching through my long forgotten knowledge of renal physiology and cursing the fact that I had not yet had renal pathology this year. I was not surprised that she had thrown a clot to the renal artery, as she was suffering from a heart condition that left her at great risk for an embolus. Fighting a feeling of disgust for my dispassionate medical evaluation of the situation, I simply replied "I understand."

"I guess her doctor said she probably had about 7 days..." he continued, clearly hoping for me to fill in the missing pieces of the story. I felt relief that this was a topic that I had at least a basic understanding of, having given a presentation this year about dialysis discontinuation and the stages of the subsequent death by renal failure.

I replied, "I've read that in a situation like this it can go anywhere from 5-10 days usually. I would say that's a pretty fair estimate. The good news is that for most of that time she'll be conscious and able to visit with you guys. Probably during the last two days or so she'll start slipping away peacefully. She really shouldn't feel any pain." I timidly placed my hand on his broad shoulder, trying to provide some degree of comfort.

I knew this was a bold prediction to make for a mere second year student. Part of me trusted the references I had researched on renal failure. I also knew the palliative care nurses that were tending to his mother would be experienced in renal failure, and would be capable of easing any discomfort she might feel during the week. Most importantly, the human side of me, maybe the part that has yet to be claimed by the ofttimes dispassionate profession of medicine, knew that this was what he needed to hear right now. To him, at that one moment, I was an insider source on the secrets of human life and death, and my juvenile opinion held the weight of the world. I can say with all honesty that I did not relish that position, and do not look forward to facing it again in the future.

Grandmother died 9 days later, surrounded by her family, who had kept a vigil at her bedside throughout the week. Her final wish to pass on a Sunday was granted. In fact, she died the day before her 73rd wedding anniversary to her husband who had passed 9 years prior, and the family took comfort in the thought that they would once again be able to share a "first dance" together.

By all accounts, she felt no pain.