A duty to guide patients through the process of death

As healthcare providers we are focused on life.  We are committed to healing.  We measure success by lives saved.  Unfortunately, many diseases remain incurable.  Some diagnoses do carry with them a death sentence in spite of the best that modern medicine has to offer.  Even in theses extremely devastating cases, We can still make a huge difference in the lives of our patients in the way in which we help them handle their own death.

Too often, treatments are prescribed which may have the effect of only prolonging suffering.  In some experimental chemotherapies, treatment may raise survival only a few percentage points.  As caregivers, we become so focused on changing the inevitable outcome that we often forget about one of the more important reasons we are treating our patients–to ease pain and suffering.  In the case of terminally ill patients, we can help shepherd them through the process of death.  Too often, however, we as healthcare providers are ill-equipped to tackle this task.

In the New York Times, author Abby Goodnough chronicles the hospice care death of Martha Keochareon who happened to also be a nurse.  As described in the Times piece, Ms. Keochareon, during her final days, heroically wanted to help other nurses understand how to care for the dying.  She reached out to her former nursing school and asked if there were students who needed to do a case study for class.  She volunteered to have them come to the house and learn about hospice care–what she taught them was so much more powerful.  The students began to learn what is most important to the terminally ill patient.  Ms. Keochareon taught them the importance of a gentle touch, of listening, and most significantly, taught them how to truly care for a patient facing inevitable death.   Too little time is spent understanding death and dying.  The selfless act of Ms. Keochareon opened the eyes of young nursing students–in effect, the time they spent with her made them better caregivers.

As a whole, medical education for both physicians and nurses lacks formal training in dealing with death and dying.  There is little standardized palliative care training in the residency curriculums of most programs in the US today.  Although some programs do provide a palliative care experience, many do not.  Learning from a palliative care expert and from experiences with terminally ill patients can be a career changing experience.  No matter what specialty a healthcare provider ultimately decides to focus on, all of us must deal with death and dying in one way or another.  How we deal with death, may impact our patients in ways that are just as significant as performing a life saving operation or providing other life saving therapies.  When patients enter into the phase of their disease where death is inevitable, quality of life, quality of interpersonal interactions and quality of companionship often become incredibly important.

As a resident at the University of Virginia, I had some exposure to an inpatient hospice unit.  Although it was often sad to see patients slip away, my experience there made a huge impact on my development as a physician.  In my residency experience, I had the benefit of watching the interactions and care provided by experienced hospice nurses and physicians.  The thing that affected me the most was the concern in the eyes of the caregivers–the connection that each of them made with their patients.  Gentle touch–carefully timed smiles–and non verbal communication through caring glances seemed to make enormous impacts.

Ms. Keochareon’s inspirational story can teach all of us something about the process of dying.  To learn, we just have to open ourselves up to our patients and carefully listen and observe.  Even in her death, she intended to give to others.  She opened the eyes of young, impressionable nursing students.  I suspect that those students are better for having known her–even if just for a little while.  Rightly so, we are all trained to focus on the cure and to strive to make our patients well.  However, we must not forget about patients when they approach the other end of the spectrum.  It is our duty to guide our patients as comfortably and gracefully through the process of death and dying as well.  As healthcare providers, we must all work to perfect the “art” of caring–even at the very end of life’s journey.

Kevin R. Campbell is a cardiac electrophysiologist who blogs at his self-titled site, Dr. Kevin R. Campbell, MD.

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