In the hours before we die, regardless of the cause, we're likely to experience one or more of three common "symptoms," Dr. Sara Manning Peskin previously explained for the New York Times. But what if dying takes months? In a new piece for the Times, Peskin, a neurology resident at the University of Pennsylvania, looks at "protracted dying," illustrated by the case of Geraldine, a 56-year-old woman who suffered a heart attack that left her in a vegetative state. Her family needed to decide next steps, but Peskin writes that even doctors "are scared of our own medical opinions. We don't offer cancer patients six different chemotherapy regimens and ask them to weigh the pros and cons. Yet when it comes to end-of-life decisions, doctors are terrified of violating patient autonomy."
And so Geraldine's husband and daughters—hopeful that her age, her fighting spirit, and the fact that she had begun occasionally breathing on her own meant there was some hope—opted to keep Geraldine alive rather than transition her to hospice. And then four months of dying began, with her family learning the grim and brutal complications that result from immobility. "Like mosquitoes in standing water, infections proliferate when the body is still," and Geraldine was no exception, writes Peskin. She also suffered blood clots borne from that infection, inflammation, and lack of circulation. And then there are the bedsores, "an understated euphemism" for what Peskin writes are horrific instances that can quickly progress to the point where bone is visible. Sepsis ultimately took her life. Read Peskin's piece here. (Read more vegetative state stories.)