Some of the commonest questions in medicine sound deceptively simple.“When is the baby due?” “How long have I got?”
People ask these questions as though there should be a clean answer. A date. A time. Something solid enough to write on a calendar.
Medicine, however, deals mostly in estimates.
Predicting Birth
When I first began practice, due dates were often based on the first day of the last menstrual period and an EDC wheel — Estimated Date of Confinement, a term which now sounds vaguely Dickensian.
The old teaching was forty weeks plus or minus two.
Nowadays, ultrasound has made dating pregnancies far more accurate, particularly early on. In Canada, almost every pregnant woman now has ultrasound confirmation. Even the drugstore tests can give quite accurate predictions, based on hormone levels in urine.
Before modern testing, pregnancy diagnosis depended on much softer evidence.
Two missed periods.Nausea.Breast changes.Fainting spells.Changes in the colour of the cervix.
And then there was the famous “rabbit test.” You may know the expression “the rabbit died” without understanding its history. The woman’s urine was injected into a rabbit, and changes in the rabbit’s ovaries indicated pregnancy. Contrary to popular belief, the rabbit did not live or die depending on the result. The rabbit died either way.
But despite all our technology and chemistry, babies still arrive largely on their own schedule. There are many factors that can cause premature labour, and we largely intervene if labour hasn’t started two weeks after the due date.
The closer to the time of birth, the more accurate our predictions are. Once labour truly starts, when the cervical dilation is at 4 cm, we start looking for progression in hours rather than days.
There are good scientific reasons to intervene during labour for the health of the baby and the mother. And some might add, there are many interventions that are done for convenience as well.
Predicting Death
Death also has its own rhythms. At a distance, prediction is imprecise. Statistics may tell us that without chemotherapy a patient may survive six months, while treatment may extend life to two to five years. But statistics describe populations, not individuals.
We have methods for predicting the rate of deterioration, and the expectations of death, such as the Palliative Performance Scale (PPSv2) developed by Victoria Hospice which measures functional decline in 10% increments from 100% (healthy) to 0% (death) .
We also had a non-scientific, gut-reaction way of assessing patients in my practice, which we found to be surprisingly accurate. We asked : “ will he be alive in one year? ” To my knowledge, this has never been written up.
As with labour, the closer we get, the more reliable the signs become.
In the final days or hours of life, certain physical changes appear repeatedly: decreasing consciousness, mottling of the skin, irregular breathing patterns such as Cheyne–Stokes respiration, reduced intake of food and fluids, and longer pauses between breaths.
Then comes the vigil.
Families gather. Someone holds a hand. People begin watching each breath, unconsciously counting the seconds until the next one comes. Or does not.
It is one of the oldest human experiences.
Some patients far outlive expectations. Others deteriorate with shocking speed.
Families often struggle with this uncertainty. They want exact answers because exact answers feel safer than ambiguity. Yet medicine frequently cannot provide them honestly.
Can People Choose When to Die?
There is a common belief that some people can “wait” for death. The dying parent who survives until the distant daughter arrives at bedside.
The husband who dies moments after his wife finally leaves the room to get coffee.
Are these events meaningful? Coincidence? Selective memory? No one knows with certainty.
If people truly possessed conscious control over death, one might reasonably ask why they would not simply choose to continue living. Yet dying does seem to involve complex interactions between physiology, consciousness, emotion, and perhaps something we do not fully understand.
As any palliative care nurse will tell you, that ” last hydromorphone injection”, that last time the patient was turned can feel like death was hastened, even when that is not likely the case.
Experienced nurses and physicians will quietly tell you they have seen things that statistics alone cannot explain.
Full Moons and Folklore
Ask nurses about full moons and you will often get a smile.
Labour wards are said to become busier.
Emergency rooms are more chaotic.
Deaths are somehow more frequent.
Science generally fails to support these beliefs, but folklore persists stubbornly in medicine.
Perhaps because medicine is still, despite everything, partly storytelling.
Human beings search constantly for meaning and patterns.
Birth and death invite that instinct.
Treatment Is Not Always About Time
Another misunderstanding arises around cancer treatments and other serious interventions.
People often assume treatment is offered solely to prolong life. Sometimes it is. But often the goal is equally about preserving quality of life or preventing catastrophic symptoms.
Chemotherapy, radiation, or surgery may reduce the risk of bowel obstruction, fractures, bleeding, pain, or neurological complications even when cure is impossible.
Medicine is frequently a cost-benefit calculation, though that phrase sounds colder than the reality. The important part is not merely the decision itself, but clear communication surrounding it.
Patients deserve honesty about burdens, risks, probabilities, and hoped-for benefits.
In Canada, we now have the ability to intervene medically at the time of death, just as we do at the beginning of life. In the broad picture, the reasoning behind this is similar to the protocols we have during pregnancy, labour and delivery: for the wellbeing of the individual. When a person qualifies for MAiD, they can choose the time and place of their death.
I feel some slight trepidation that we might see more people who choose MAiD if we do not, as a society, provide the best level of care possible. Adequate housing, support for people with disabilities or mental health issues cost a lot more, but offering death as a way out seems wrong. We have work to do.
Bookends
After decades of practice, I remain struck by how similar the beginning and the end can be.
Both involve waiting.
Both involve uncertainty.
Both gather families into rooms where time suddenly feels strangely different.
At births and deaths alike, people stop looking at watches in the ordinary way.
Minutes stretch.
Hours collapse.
Everyone waits for something irreversible to happen.
Medicine has become very sophisticated.
We can estimate due dates with impressive accuracy. We can generate survival curves from enormous databases.
Yet the exact timing of arrival and departure still often surprises us.
Perhaps that is as it should be.
In the end, people rarely remember whether the prediction was exactly right.
They remember who was with them while they waited.