Over the next 2 days, Mr. M becomes less agitated and he does not appear to be in pain, however he has sleeping much of the day, has become progressively less responsive and is not eating or drinking. Despite decision to treat with broad spectrum antibiotics, his chest x-ray shows progression of his pneumonia.
On hospital day 5 he is unresponsive to any stimuli and you note that his respiratory pattern is irregular with periods of apnea. You recognize that Mr. M has signs of syndrome of imminent death (see reference attached) and you and the team inform his wife and family that Mr. M is dying and explain what they are seeing and what to expect. All unnecessary therapies including blood draws and oral medications are stopped. IV morphine is continued for treatment of pain and dyspnea/tachypnea, titrated to respiratory rate of 10-15 breaths per minute. Scopolamine is administered to decrease secretions.
Over the next 2 days you come by and sit with Mr. M and his family, answer questions you are able to and hear family stories about Mr. M’s life. On hospital day 8, Mr. M dies. You express your condolences to his family. His nurse encourages the family to sit with Mr. M as long as they like and then later prepared the body for transfer to the morgue. You speak with your attending and resident about his clinical course and decide that the team will send a condolence card to his wife.