How would you like to die?

How would you like to die, Mr. Bond?

Not everyone has choices like 007 (although personally I think the baddies are idiots. Just shoot him, because you know if you try to kill him in some slow methodical way, he'll escape and hunt you down, with a grin and a vodka martini in one hand, beautiful Russian spy in the other arm).

Anyway. Morbid as it is, this was what our lunch topic was about. Bunch of docs, pondering on the Grim Reaper. Thinking aloud of our cases. Death by sepsis. Myocardial infarction. Metastatic pancreatic cancer (that's a bad way to go). Intracranial bleed. Fatal arrhythmia. Seen it all. If we could choose, what would be the way to go?

As expected, the joker in the group wanted to get a heart attack during sex. He thought it would be a great way to end life. Poor girl though. I mean, can you imagine?

Someone else wanted to go in her sleep. Sudden cardiac death.

Another, skydiving accident. May be a quickie, but boy, I bet those few seconds between realizing your chute's not working and impact would feel like an eternity. And you're probably cursing the guy who packed your parachute too.

Me, none of that. Choice number one, probably stems from my watching too many hero movies... villain takes out his concealed revolver, points it at beautiful princess/President/Pope... and then here I come, leaping into the air... right between them... hammer cocks... BANG... I take the slug in the chest (kinda like Clint Eastwood in In the Line of Fire).

Damsel kneels down, crying "TK, TK, don't leave me...".

Like I said, watched too many movies in my childhood.

Choice number two, would be to burn up on re-entry of the space shuttle. Or on take-off, like the Challenger. While those NASA accidents were tragedies, I think of the astronauts as heros, dying for a cause they believed in; the discovery of space.

Anyway, I doubt my time (hopefully in the much distant future; there is much to do and learn still) would be anything like that.

I'm not sure if 'normal' people outside of medicine think about things like this, about their own mortality, but I know we do for sure. And for me, if I have to go, go with a bang. None of that withering away stuff. Or being mechanically ventilated for months before pulling the plug.

My greatest fears? Drowning. Some neurodegenerative disease such as Lou Gehrig's... and for that I will always admire the strength of the character in my favourite book, Tuesdays with Morrie. And pancreatic cancer's got to be near the top of my most-feared list too. My current patient comes to mind... 42 year old man who's probably got weeks to live, in much pain, and a new baby who was born when he was in the hospital on a PCA morphine pump. Had no answers for him when he asked me how God could let this happen. We're gonna attempt a celiac block tomorrow for pain control. Acetaminophen OD probably isn't a good way too. This seems to be the choice of suicide for many young people. But they don't know that fulminant hepatic failure is a slow, torturing way to die. And you turn yellow.

Our speaker at Medical Grand Rounds today spoke of several things. Bright lady, a master clinician from University of California. One of the things she touched on was Death. And she ended with this quote:

Do not go gentle into that good night. Rage, Rage against the dying of the light.

~Dylan Thomas