Doctors are trained to prevent death, but not deal with death

It was a dimly lit room, up on the sixth floor.  I am not sure why they would not fix the light in that corridor. Even during the day, I would find this area poorly lit.

Maybe it was not the light but the grim atmosphere of oncology floor. Some of the patients there had terminal illnesses but they would still act like they had decades to live. You would be surprised how you find bravery at unexpected places. Maybe they were not really brave but pretending to be.  I could never find the difference.

How do you find such strength? Maybe they are hopeful that they would get better, maybe they will get few more years to wonder this road. Hope keeps us going … I guess. Their optimism was like a breeze in the garden, which surrounds you in a subtle way. Those were the times you want to forget the statistics and all that prognostic data and just reassure them. You want to tell them that survival numbers are just numbers which mean nothing.

He was a resident of the sixth floor. He had mesothelioma, suffering with pain, not the kind of pain which can be cured by medications. He was leaving his family for good. For some it is a passage from one phase to another, for some it is the end of the line. No matter what they believe, we all cross over. He worked in an asbestos factory most of his life which eventually caused his cancer. Once I asked him sitting down next to his bed, has he ever thought about suing the company he worked for?  He said no, he was supposed to die one day anyway … so be it.

I offered to increase his medications to improve pain.  He said, “the kind of pain I have, you do not have the medications for it yet.” I think he was right. His son requested us to keep him comfortable. He wanted him not to suffer. In the end he requested to be released home, saying,  “I would rather die with my loved ones; I have had enough of these hospitals.”

And I think this is where hospice plays a very significant role. As much as we are trained to prevent death, we are not trained to deal with it. One of my professors said “death is just a phase, one to another.” He lost his wife to ovarian cancer. I learned a lot from him about end of life issues. He said, “sometimes we love our loved ones so much that we are not willing to let go of them for our own selfish reasons.”

I try to tell my patient families to think from the patient’s perspective rather than their own. Who would like to be lying in bed with all kind of tubes sticking out?

There are fellowships available in hospice medicine and palliative care. They teach and train principles which embraces compassion, integrity and ethical views to take care of dying patients. There is a misunderstanding that patients with cancer can only be a part of hospice. Actually, patients with terminal diseases of any kind, such as advanced dementia and gravely ill patients, can be enrolled in these programs.  We should realize their need and the great service they provide.

S. Irfan Ali is a hospitalist who blogs at Human Factor in Medicine and Life.

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  • http://www.drjoe.net.au Dr Joe

    This is very true. Regardless of medicine everyone will die at some stage. Doctors are so focused on saving lives that we often fail to help people prepare for (inevitable) death. Often people want support that medicine is not providing

  • Molly Ciliberti, RN

    I think we all want to die a good death with dignity and in a safe place (preferably) home surrounded by those we love whether human or kitties or dogs. We hope to have some choice in the matter and would like to be given the opportunity to say good bye. It shouldn’t be considered a loss if the patient has a good death; it is a win for dignity.