Wednesday, October 3, 2012

Let Sleeping Dogs Lie

I'm sorry!

I really am!  No one deserves breast cancer.  Especially the kind that spreads to your liver, lungs and brain.  The fact that you lived to your eighth decade doesn't detract from the sadness.  You deserve to live.  I can't blame you for not being ready to go.

I apologize that our meeting was so abrupt.  I was consulted to see you in the nursing home to address various issues.  I swept in the door, and introduced myself to you and your daughter. I explained what the word "palliative" means, and why I was asked to see you.  Although I saw a full hospice consult in the hospital chart, you both stared at me blankly as if this was the first time you heard of such things.

I asked if you were in pain.  I asked about your breathing as I watched your chest move back and forth laboriously, and your dreadfully weak body sink into the gigantic hospital bed.  Finally, I tried to discuss prognosis. 

You mentioned how your oncologist said that "we can get it all".  You placed great hope in the upcoming brain radiation.  When I pushed further, you had vague ideas about seeing your grandson's wedding that was slated for next fall.

Your skin sallow, your breath heavy, there was absolutely no way you were going to be alive for that wedding.   I had doubts about the weekend.  When I started to express my concerns that your expectations were unrealistic, the conversation turned.  Your daughter shook her head and her glance shot arrows through my chest.  You became angry and shooed my out of the room.  I was asked not to return.

I thought of a million ways I could have done better.  I should have approached the situation differently.  I could have brought these subjects up over many visits and allowed you to come to conclusions on your own.

But for some reason, I felt a great sense of urgency.  Rounding the next morning in the nursing home, I found your bed empty.  You coded an hour after I saw you.  The ambulance came, life support was initiated, and now you lie half dead in the local ICU.  Your daughter is left to make the horrible decision of when to pull the plug, if ever at all.  You will not recover.

Some may think that I write this post to gloat; to say I told you so.  The truth is agonizingly more complex.  I wish I could do this one over.  I wish I could have left you in your mist of denial, and taken a more simple approach.  I could have held your hand, said I was sorry, and let sleeping dogs lie.  Your weren't going to listen to me anyway.

Now, I am stuck with the great possibility that your daughter will see my visit as the straw that broke the camel's back.  And you, your last memory before dying, will be of some young pompous doctor who walked into the room,

and told you he was giving up on you.


older + wiser said...

For every story like this (OK, maybe for every 100 stories like this), there is another family who welcomes a clear, realistic assessment of the situation.

We went through something similar with my father a few weeks ago: Robust, lucid, otherwise healthy patient deteriorated unexpectedly after a medically appropriate surgery, and the challenges were too much for him to surmount.

The doctors with whom we discussed the DNR order and ultimately the decision to discontinue life support were strangers to us. We were reeling. Everyone, including the surgeon, had expected Dad would sail through, and within less than 48 hours it was all turned upside down.

But you know what - we appreciated the honesty. We needed to hear the truth so we could make the best decision, which in this case was to turn off all the machines. The doctors and nurses were very kind and compassionate but they didn't sugarcoat it, and we were grateful for that.

It can be hard for families to see this when they're faced with a gut-wrenching decision and their emotions are in overdrive. Perhaps later they can start to see it differently and recognize that you were helping them let go of a loved one whose time had come. Then again, maybe not. All you can do is continue trying to do the right thing on behalf of the patient and family and hope that at least some of the time it will bear fruit.

Americans really, really need to have this conversation, and we depend on people like you to keep it honest and not get too discouraged by those who can't or won't confront it.

Anonymous said...

When my Dad, who previously had been very healthy all his life, suffered a heart attack, we were blown away. He was transferred to a much bigger hospital with a heart center. I guess it was 2 days after his heart attack they took him down for a cath. Never having to deal with death before my siblings and I discussed possible outcomes and we agreed that the worst news we would hear that day was that he would need some big open heart surgery. We Prayed that wouldn't be the news we got.

When the doctor came into the room to speak to us following the cath he said things like " We can't do anything because to much of the ventricle was destroyed during the heart attack"....But, what was he REALLY saying is what I wanted to know. I asked him point blank "Is he going to survive?" The Doc answered "No, he's not"...At least we now knew what we were dealing with...Funny how then we had all wished the news would have been that he would need a big heart surgery. He died approximately 24 hours later, instantly, from coronary rupture. I know the question I asked that Doc that day was the hardest question I ever asked anyone. I also know this Doc. was relieved one of us asked it.