Suddenly gone.

Tomorrow I am going to a Surgical ICU to stand with a woman who is taking her 48 year old husband off of life support. He has a traumatic brain injury from a motor vehicle accident and is now considered brain dead.

We do not get these types of referrals often in hospice.

I am often asked by people what type of death I think is "best". A sudden death or a long, drawn out death.

And that is a tough question.

A lot of our patients have known that they have a terminal illness for a very long time. But they live with that illness through various phases and still consider themselves very much alive. One MD I know calls each phase the "new normal".

I hate that phrase. There is nothing normal about dying from a terminal illness.

Most of the patients I have met thought they could beat the disease. And why wouldn't they. Many MDs have told patients that they have less than six months to live and many have outlived that death sentence by years.

Some have beaten it all together.

But if they have not, and the cancer progresses, they do have some time left to take care of personal matters if they wish and to see people they have not seen and to "get their affairs in order".

But the truth is, most do not.

When a 'sudden' death occurs, the family is always in shock. I would hear over and over the sad stories of an argument the day before, or the goodbyes that could not be said, or the sadness that comes with realizing someone died alone.

But, I hear these same stories in hospice. Even in hospice, the "expected" death comes as a shock.

So I don't think there is truly a better way. Each ends the same. The person is gone too soon and we miss them so much.

There will always be conflicting emotions going on with the survivors; anger, relief, guilt, and mind-boggling grief. Those occur with any type of death.

One terminally ill patient once told me that he was glad for the time he had even though he had always said he wanted to "die suddenly of a heart attack while golfing".

"I am happy that that did not happen. It would have left too much chaos in its wake."

But all deaths leave chaos.

His did, too.

So, when I am asked the question of which death is 'best', I usually just shake my head and say that I do not know. That they are both equally as bad. They all end with someone we care about going away.

And that is never good.