A story about something we all have to face – death
- The Facts:
We all die. The story shared in this article raises some questions about how to handle terminally ill patients.
- Reflect On:
Instead of keeping patients alive 'at all costs' should doctors be trained to recognize when medical intervention is not going to be helpful to a terminally ill patient?
In our current society, death is something that is often feared. Because of this, it is often not talked about and it is generally considered an absolute last resort option, even if that means that suffering will take its place. It seems in our current medical system the ultimate goal is to keep the patient alive at all costs (spiritual, emotional, mental and yes — financial), even when the body naturally starts to shut down. In practice, modern medicine continue to do whatever it takes to keep that body alive. But what if we began to view death differently, and saw it as a natural part of the birth, life, death cycle and not something to be feared?
Patients suffering from diseases that are considered terminal are spending their final months, weeks, days in surgery and in hospital beds instead of at home with their loved ones and pets. All for that hope that something could save them. But what if the goal wasn’t to keep the patient alive at all costs, but to observe and listen to the body and let nature run its course, only intervening when there is a significant chance of success?
Of course its hard to imagine having to say goodbye to our loved ones who are sick. Perhaps we can even be a bit selfish at times (understandably so) because we are not ready to say goodbye. What’s important to realize here is that everybody dies and we cannot escape this fate no matter how much we try, or how much we try to intervene with modern medicine. The angel of death will still come knocking at each and every one of our doors.
Story On Death
The following was shared by the Huffington Post from a former fellow in gynecologic oncology, Kate McLean.
Her cancer had initially responded well to surgery and the first few rounds of chemotherapy, but then it quickly returned. We had tried several other chemotherapeutic regimens, but all had failed to stop the tumors in her abdomen from growing. She’d been admitted four times in the last six months with bowel obstructions from the cancer. Each time, we would try a new treatment and it would help for a little while, but then the same symptoms would resurface.
“Yes, I’m afraid so,” I told her. “Your CT scan shows that a tumor is blocking your intestine, which explains why you feel so bad. Nothing is getting through like it should.” I wondered whether I should tell her how serious her condition was becoming, or if she would ask me on her own.
“What about this new chemotherapy you’re recommending?” she asked. “Will it finally make the cancer go away for good? Or will we need to remove it surgically?”
I now faced a difficult dilemma. What should I tell her? My supervisor had clearly laid out his plan when he told me she was coming for admission. However, I knew that the available data on patients like her suggested that her chances of responding to the treatment were incredibly low. And the chemotherapy would likely make her feel even worse.
“I’m just the fellow — how about we review all this with our boss later today?” I responded, trying to keep any sign of internal struggle off my face. Throughout my fellowship, I’d had misgivings about operating and prescribing harsh drugs so close to the end of a patient’s life. But that was exactly what we were expected to do.
“You’re the one I see every morning when I’m here in the hospital,” she replied. “I want to know what you think.” She gave me a stern look. “You know how difficult that last round of chemo was for me ― I was in and out of the hospital for weeks.”
I took a deep breath and decided to be completely transparent.
“Honestly, I’m really conflicted,” I said. “I respect my boss’s judgment, but the studies I’ve read tell me that your cancer probably won’t shrink — at least not much — with any further chemo. And if we perform surgery to unblock things, since no chemo is likely to slow the growth of the cancer for long, you’ll probably just experience another blockage soon.”
I followed her somber gaze as it appeared to wander out the window, through the skyscrapers downtown, all the way to the ocean. I could see frothy whitecaps kicked up by the strong breeze.
“Some patients feel like it’s worth it to them to go through the discomfort of surgery and the side effects of chemo if there is any chance it might help,” I continued. “They want to try everything possible, because, in medicine, we’re never 100% sure what might happen. However, once treatments become less likely to help, other patients would rather prioritize different things, such as pain relief and time out of the hospital with their family.” I paused carefully. “You know I’ll support you either way.”
She turned back to me, suddenly focused again and nodding. “Why would anyone suggest a treatment that probably won’t help me?” she wondered out loud with no trace of bitterness.
“We want it to help,” I said, squelching the niggling, unpleasant thought in the back of my mind that our supervisor also got paid every time he ordered chemotherapy or performed surgery.
“But that doesn’t mean it will. You know that. I know that,” she said.
I could feel her hand start to quiver on the bed next to me, and soon her shoulders were shaking as well.
I scooted closer and held her while she cried. Peach fuzz, which was just starting to regrow on her bald head, softly brushed against my cheek.
“I want to go home,” she whispered in my ear.
“Of course,” I replied. “Let’s loop in the hospice nurse and get your nausea and pain under better control this morning, then try to get you out of here by tomorrow.”
I looked back at my team standing in the doorway and saw relief etched on their faces. This was what was best and we all knew it. We just hadn’t been trained on how to talk to patients about what happens when treatments fail ― about what happens when death is inevitable.
I later learned that our patient died peacefully at home, surrounded by those she loved.”
Something To Consider
Considering 80% of Americans would prefer to die at home and less than 20% actually do shows us that something is not in alignment here. This New Yorker article expands on this quandary. It suggests that terminally ill cancer patients who are put on life support machines or are sent to intensive care have a worse quality of life than those who are not. Their caregivers are also more likely to suffer from depression.
Interestingly enough, when physicians themselves are terminally ill, they are more likely than their patients to choose less aggressive treatments. When given the information regarding their prognosis and treatment options patients will choose to have less medical intervention than those who are placed on a default treatment path.
Supporting End Of Life
For those who are terminally ill but are terrified of death, there are various methods of support including death doulas. Generally speaking, it is said that the role of the death doula is to walk alongside the dying person and their family. This encompasses a very wide range of services that include: providing spiritual, psychological and social support, assisting with the creation of positive and empowering end-of-life plans, ideas to optimize physical comfort, and educating families on the new and progressive options for home wakes and natural burials. Often, these doulas go above and beyond expectations as they bring light to a phase of life that can be very dark for many.
Another option that has proven to be successful is the use of magic mushrooms to help those who are terminally ill to come to terms with their impending fate. Because if the one who is dying has accepted it and has a more positive attitude towards it, it will help loved ones come to peace with it as well.
It might be time for society as a whole to start opening up these discussions, reducing the stigma around, well, dying. After all, it is something that we cannot escape, regardless of how much we try. We might as well attempt to make peace with it.