Filler

His own way

I was looking forward to my brother's weddingat last he was settling down, and it was a chance to see my family, including my grandfather. It was a bright, sunny September morning, but Grandad did not look righta bit pale and short of breath. After a few puffs of his glyceryl trinitrate spray, however, he felt better. The ceremony went without a hitch, but I sat next to Grandad to make sure he was all right. Then the photographs were takeneveryone was happy and laughing, and Grandad was back to his normal ebullient self. We walked up the slope to the car park when he almost collapsed and had to be supported by my husband and a friend of my brother. We gave him an aspirin and more glyceryl trinitrate while we waited for the ambulance to arrive.

He looked better that evening when we visited him on the coronary care unit, and, as I was on call the next day, we said our goodbyes and went home. At 10 30 pm the consultant cardiologist telephoned me: "Your grandfather has had a myocardial infarction, and now he is in cardiogenic shock with renal failure." As the only medic in the family, I was asked for my opinion on further management. No, I did not think that, at 83 years old, he should be resuscitated if he arrested, but should he have a central line and inotropes? I waveredI knew it was probably hopeless, but I wanted him to live and I felt guilty that I had not realised what was going on earlier. Then it occurred to mewhat did my grandfather want? He was always a man to know his own mind. He had not been asked, but when the consultant explained it all to him he chose to be left alonehe died two hours later.

Sudden death, whatever the patient's age, is always difficult to cope with. But what gave me and my family the most comfort was the fact that he did it his wayand I believe he knew he was dying that day anyway. When making decisions in these situations, we often shy away from asking the patients directly what their wishes are for fear of distressing them and because it is difficult for usinstead, we place the onus on their family. However, I now believe that, if possible, we should talk to the patients rather than their relatives, who will be grateful in the long term.

Ginny Bowbrick, specialist registrar in general surgery. 

London