I can often visualize the impact of my words as soon as they leave my mouth, the heavy weight sinking into the mind and body of my patient as they sit in the stark white hospital bed.
It usually isn’t the first time they’ve heard the sentiment. After all, we tell them countless times in different phrases we use as physicians, expecting them to understand, but none quite as precise or permanent.
“You’re in multiorgan system failure.”
“Your heart can’t handle the stress of your illness.”
“Your chances of making it through this are very slim.”
“We’ve done all we can do.”
“There are no more options.”
I’m not sure how this practice started, cloaking the process of dying, masking the acknowledgment of the end. I suppose it’s because we believed it was easier than facing the truth, even though we all understand death is a part of our human experience.
We might do it because we believe it’s easier for us to get through the interaction, easier for us to go home to our families, and easier for us to go to sleep at night. We might do it because we think it’ll be easier on them to not have to deal with the information and easier on the family members in the room.
I disagree with that line of thinking. By talking about death and dying in roundabout terms and not facing this inescapable process head-on, we’re robbing our patients of the ability to exercise their last shred of autonomy. We might not be doing it intentionally, but when we decide how much the patient knows by shrouding our information in colloquialisms, we’re no longer practicing patient-centered care. We’re taking away their opportunity to call family, spend time with their loved ones, or to even smoke their last cigarette.
So I tell them. I tell them in plain, simple, easy-to-understand terms. I say the words they know are true but have denied until that point because no one has said them out loud.
Sometimes there is simple acknowledgment; sometimes, there is fear, sometimes despair, and sometimes shock. There are usually tears shed on both sides as the weight hits us, and we are forced to recognize the inevitability of death.
But, perhaps most importantly, they get to decide how they deal with that information; they get to decide how to handle the end of their life in the most meaningful way. Not us.
It is the epitome of patient-centered care to provide our patients with an understandable explanation of what is occurring at the end of their life, and it does not get more simple than those two heavy words.
Cali Clark is an internal medicine resident.
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