Guppy Breathing

There’s a type of breathing when people die called agonal respirations.  The best way to describe this is a deep, regular breathing that often involves movement of the jaw and shoulders.  The jaw movement is what I almost always notice.  If you think of it, normally when we breathe your jaw doesn’t move at all. This forward thrust of the jaw is an ominous sign, and usually means death is minutes to hours away.  Another name for this type of breathing is guppy breathing, named I suppose for the movement fish make when trying to get air out of water. We have pamphlets in all the rooms explaining these things for families,so they can also recognize the signs of the dying process.

All this is background for a funny story.  We had a lady here at the house that was very curious about the dying process. She decided to read the pamphlet too, so she could be prepared for these changes in her body.  That’s understandable, but she went even a step further. The nurse went in her room one morning and found the patient sitting in bed holding a mirror up to her face. She had put on her brightest lipstick, a deep red that was in shocking contrast to her pale skin. There she sat with her cheeks sucked in, making a fish pucker face,moving her lips up and down.  “Mrs.Rose, what are doing there making that face?” the nurse asked in bewilderment. “OH, I’m just practicing” she said matter-of-factly.  “Practicing what?” the nurse wondered.  “Well, this book here talked about guppy breathing as you die, so I thought I should practice it to see how it looked…I want to do it well.”  

The nurse could hardly contain her laughter at this misguided attempt.  If she only knew how different the fish pucker face was from actual agonal breathing…and how strange it would be if that’s the face we all made when we died!

Irish Lament

People express emotions in so many different ways. I've met a very facinating person this week at the house.  He's in his 80's and is the husband of one of our patients.  The two of them had been living at home alone, never having had children. She had been getting jaundiced but neither one of them seemed to notice until a cousin stopped by and called 911. 

She was subsequently diagnosed with cholangiocarcinoma, a type of cancer in the bile duct and given just days to live. That's when she came to the house for her end of life care.

Her husband is the one who impressed me.  What I first took to be dementia, I soon realized was actually misplaced brilliance. He was an electrical and mechanical engineer and worked on the Apollo space missions in the 60's and 70's.  His way of thinking was in a plane so different than mine, that he had a hard time grasping why his wife was dying. 

Everyday I'd see him walking down the hall, hunched over with time, a blue and yellow knit stocking cap on to match his green polyester pants, blue knit sweater and stripped shirt. Never once in the week he was here did he change clothes. And everyday he'd carry his violin, to and fro, having been a concert violinist as well. 

For all that he could do in explaining how valves of her biliary drain worked, and remembering every blood pressure reading she'd had in the course of the week, he lacked in emotionality. I could sense that he loved his wife of 60 years, but never once did he sit by her side to tell her so, never once did he whisper he'd miss her.  It was all numbers and mechanics.

She died today. As peacefully as she could. He had been in the room with her all morning, knowing it was getting close. As she took her last breath he picked up his violin and played "Irish Lament", the music piercing the silence of the room. I realized then, that was how he was saying goodbye.  Unable to put his feelings into words, the music was his way to do it. A few tears dropped as he played, causing all of us in the room to cry.  A brilliant man saying goodbye in the only way he knew how.