Blog | Thursday, March 29, 2012

Death smells like vanilla


She lay in bed, her breathing erratic; she would breathe in deep and fast, then exhale slowly, as if she'd just hit her first cigarette of the day. In place of a cigarette was a tube, about a quarter of an inch wide. It was stained brown, and every few minutes a bucket attached to the wall would make a hissing sound, and brown sludge would course from the tube into the bucket. Presumably, the tube went down to her stomach. The brown sludge, being contained in tube and bucket, didn't convey a smell or any other hints as to what it might be.

Image via Wikipedia and a Creative Commons Attribution-Share Alike 3.0 Unported licenseAnother tube was in her nose, making a faint, continuous hissing noise. It also had a bit of a brown stain, just on the tips that sat inside her nose. It ran from her nose to another wall outlet, just next to the sludge bucket.

The third tube ran out from under her blanket, across her exposed thigh and over the side of the bed. It ran into a large, thick plastic bag filled with something that looked like urine, but with white flecks forming a cloudy layer at the bottom of the bag. That tube also had spots of brown sludge, but not exclusively, as the oral tube did.

She seemed to produce a lot of brown sludge. A bedside commode had a bit in it, and that one did have an odor, a faintly sweet but strongly fecal smell. More powerful was another bit of sludge on a shelf by the window. In between flowers in various stages of wilt; between cards, some with the neat hand of an older person, some in the large scrawl of a grandchild; next to pictures of someone who must be her, but without tubes and beautiful; on that shelf was a small Styrofoam bowl filled something that looked like cooled beef consomme. It was brown, of course.

From that small bowl, a powerful scent flowed around the dying flowers, past the cards and toward the dying woman. The consomme wasn't beef, but vanilla.

People think of vanilla as subtle; it's synonymous with "bland." But not this vanilla. The hospital-grade vanilla flows thickly through the room, around the sludge bucket, the commode, the still-living body. It attaches itself to other smells, sometimes accenting them, hopefully but rarely overwhelming them. It shares every room filled with brown sludge and grief.

That pleasant scent, the one that defines bland, attaches itself to something else, becoming something else. It becomes part of the smells of dying, of suffering. It becomes cloying, suffocating, insufferable. Outside the woman's room, it may be subtle, but it hints of what is behind the door--tubes, brown sludge, sunken cheeks, uneven breaths.

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog, White Coat Underground. The blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.