I am an English trained GP who has been living and working in Holland for the past five years. My patient was 72 years old; a nice man with a caring wife by his side. I had seen him only twice before. The first time, a couple of months ago, he complained of tiredness. His ensuing blood test results were normal. He returned a few weeks later, this time with dizziness. His neurological examination was normal, so I referred him routinely to the local ear, nose, and throat clinic and gave him some cinnarizine for the weekend. His weekend didn't go well; the on-call GP thought he had probably had a transient ischaemic attack. I telephoned the local neurologist early on Monday morning, and, because of lack of space in the outpatient clinic, my patient was admitted to hospital the same day. A few scans and a few days later, he and his family were told that he had a large, inoperable, non-treatable brain tumour (glioma cerebri). He was sent home without hope and with a prescription for dexamethasone. He didn't come back to our surgery.
At my first home visit after his hospital discharge, he sat on the couch in the lounge chatting. At the second visit, he was sitting in his bed (also downstairs in the lounge) chatting. By the third visit, he was lying in bed. Early on, he and his family began to talk gently about the possibility of euthanasia. However, the practice was about to close for two weeks for our summer holiday (as they do in Holland). We agreed to discuss the matter properly when I returned form holiday. Unfortunately, the patient went downhill more quickly than we had anticipated, and he slipped into a coma one day before our surgery reopened.
At this point, euthanasia within Dutch law was no longer possible: my patient could no longer give verbal or written consent. His family naturally wanted him to suffer as little as possible and were unanimous in their views. I contacted the helpdesk of the local palliative care team to inform myself about the possibility of terminal sedation. This was my first time, and I didn't know much about the procedure. The team were very good, and I had a lot of help from the agency that had to supply a pump and from my local chemist, who had to provide the midazolam.
I met with the terminal care nurse and the family 24 hours later ready to set up the pump. The terminal care nurse ran the show (I hadn't got a clue). She explained to the family how it would work and what to expect, spent lots of time answering questions, and allowed the family to say goodbye before she attached the pump. She would remain in touch with the family twice a day and gave them her telephone number should they have any questions.
My patient died in a deep sleep 48 hours later in his own home and without any pain, discomfort, or suffering. I believe this was a great source of comfort for his family. I have never felt so emotional about seeing such a dignified and peaceful (and in some ways natural) death.
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