Death and Taxes

 It is true what they say.. " in this world, nothing in certain except death and taxes." 

Whether we are rich or poor death is certain and will come no matter who we think we can cheat or buy more time from. 

In this world of youth, material, and peer obsession we are still guaranteed to come face to face with mortality and death.. taxes will even follow you there. 

If we are at the end whether it is due to age, terminal diagnosis or a state related to an injury we can hope for comfort. A good death.. yes there are good ones and it is the goal of hospice to provide one. 

A few weeks ago one of my patients died. No surprise there except he died alone, afraid and without hospice present to hold his hand to his next phase. 

Sam lived a the part of the city that few would venture into unless you were headed to a specific place, ie a concert venue, sporting event or eclectic authentic cuisine. 

It was government housing at its finest. Small brick structures piled into narrow streets with the inevitable corner store filled with junk and lottery tickets. 

Sam was married, he had a wife, a disabled adult son and daughter that just gave birth to a beautiful baby girl. 

On the first day I met Sam he greeted the nurse and I at the door with a crooked smile and disheveled clothes. Sam was small, maybe 5'11 and the brain tumor was visibly protruding on his head. 

Poverty sucks and Sam was smack in the middle of some of the worst I have ever seen, poor doesn't have to mean this. Poor doesn't have to mean any to this.. 

Sam was wearing a sweatshirt that was crusted from the elbows down with what looked to be snot wipes, years of using his sleeve as a tissue. His baggy pants were barely hanging on his thin body, his feet shuffled on the house carpet as be maneuvered his way in to the kitchen. 

The tiny kitchen counters were loaded with frozen meal leftovers, take out food wrappers and junk food scrapes. Sam was a lover of the Honey Bun. 

Sam was on hospice and a Full Code. He made a choice to be resuscitated if found unresponsive, this is unusual in hospice care but it was Sam's choice. 

Over my following visits to Sam an AND or Allow Natural Death was discussed. Every time Sam made the same decision and it was his to make. 

Sam's family lived in tight quarters but it seemed that they lived separately and quietly apart. So it wasn't a surprise to the nurse on her visit when the nurse asked where we was for them to say.. " I think in the bedroom, he's been in there for a few days." 

The RN creaked the bedroom door open to find Sam.. 

He was on his knees feet from the door, face down on the end of the bed with his unopened Honey Buns at his side. 

Sam had died. No one knew, no one checked on him, no one cared he was alone and scared. 

911, the coroner , the hospice chaplain were called and it seems poor sweet Sam had been like that for at least 24 hours with not a person present even knowing he passed. 

Sam was a husband, father, grandfather and sweet man who deserved better. 

This doesn't have to be about Sam's not having money or paying his taxes but his not having someone at the end.. he did not have a good death. Everyone deserves a good one. I could not find an obituary for Sam just know he was here and someone who touched others.