Monday, May 5, 2008

On Discussing Death

I don't know when it happened. The day that I realized that I had certain abilities. A premonition...a feeling....about when my patients were about to die. It happened slowly. But as time goes on I have become more aware. The way people look....the things that they say....the disease processes that they suffer from. Somehow it all comes together and I know. Sometimes its hours, sometimes it days, and sometimes weeks. And I tell them...for better or worse. How could I not?

I remember the first time. It was when I was in residency. My grandmother was in her nineties and had dementia. Over months she had become progressively ill. She had seen her doctor and was diagnosed with cancer. My mother called me the week before to tell me that things weren't going well. She wasn't in pain but she had lost her interest in doing things. I was in the middle of my second year of residency and was on an easy rotation. No call....no weekends...I was well rested and happy. I had warned my residency director that a family member was sick and that I may have to take some time off.

The next time I heard from my mother was a Thursday night. She was sitting in my Grandmother's room. As I strained to listen I could here her breath in the background. Each breadth was long and deep followed by a pause. I remember the certainty in my voice as relayed instructions...."Mom she's got less then a day. It's time to call every one and tell them to come tonight....she doesn't have long."

My mother got on the phone and called her sister....who booked a flight from New York. I jumped in the car and started the 6 hour drive home. I promised my family that I would drive safely and take my time. The last thing they wanted was to have me get in a car accident on the way home. It took awhile but I made it in time.

As I walked into my Grandmother's room a crowd had gathered. Children and granchildren...we were all there. In fact I was the last. I walked directly to my grandmothers bed and took her into my arms. She was unconscious.....her breadthing shallow. I placed my lips gently to her ear and whispered..... "grandma I'm here, we're all here......you can go now". I gently rested her back on the pillow.

I walked over to the windows and opened the curtains. The sun gently made its way into the room bringing much needed light. As we waited I grabbed the rickety tape recorder that was lying on the table next to the bed. We put in her favorite tape.....the soundtrack to an old movie...I believe it was My Fair Lady. And then she left us. Such a quiet ending for such a lively and rambunctious women. A survivor of the great depression. Her mother died of influenza. Her father, an alcaholic, abandoned her in an orphanage which became her home till adulthood. Yet she endured....even today she endures.

So I often explain to patients that physicians don't like to prognosticate on when a patient is going to die. I tell them that every physician has a story about telling someone that they are going to die in a few days and then having them live much longer. And then I tell them that I am not that kind of physician. And I tell them that even though there oncologist/pulmonologist/cardiologist won't give them a prediction that I will not hide my opinion.

Some say that this is not fair. That somehoew by telling someone they are going to die I am in some way hastening the event. Or that I am squelching their hope.

To them I reply that I can't argue that they are wrong. But in my opinion I prepare my patients for life. I prepare them for aging, and for surgery. And yes....sometimes I even prepare them for death.

Wouldn't you want that kind of dignified treatment from your physician?

1 comment:

Kyle said...

interesting thoughts. why, though, are you so defensive of your care decisions? and a bit closed minded to other ways?