From a piece by Ken Murray entitled “How Doctors Die

To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent. “How can anyone do that to their family members?” they’ll ask. I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.

From my friend Josh Freeman’s post “How People Die and How Should We

I have cared for many people who were dying but whose families wanted more done. People who already had advanced dementia and whose physical bodies falling apart. People whose heart and kidneys and lungs were failing, who couldn’t swallow and might choke on even a small amount of food, but whose families believed that if we didn’t do a surgical procedure to poke a hole directly into their stomach we would be starving them; who thought that if we didn’t plan to do cardiac resuscitation or given antibiotics for a possible pneumonia, that we would be killing them. Sometimes I am able to point out that death happens to everyone, and that having your heart just stop, or having pneumonia, or not being fed, are relatively easy, painless, and natural ways to die. Sometimes I am believed and sometimes not.

I made a home visit to a patient last week. She is over 90 years old and though bed bound is as sharp as a tack. I showed up at her apartment armed with a print-out of her health record and an agenda. I had noticed in her health records that we have no “Advanced Directives” in our file. This is important because she has outlived her husband and her children and has no one to make difficult decisions for her, should she become incapacitated. I showed up and apparently she was double booked, as a member of the clergy was there as well (I could tell from the Roman collar, which served the same purpose as my stethoscope). He was going to excuse himself but I asked him to stay. I went the expected routines of my visit (as I’m sure the minister did when he arrived). I then took a deep breath and said “I see from your medical record that we have not spoken about what should happen when your heart stops beating.” She went to reach for the burial information. I said:

“No, I mean in between the time your heart stops and the funeral happens. You see, we have to do everything unless you say not to do so in advance. The chances of us restarting your heart is very small (it’s over 90 years old, you know) so my advice is to let nature take its course. This fellow here (motioning to the minister) is the man to talk about what happens between now and then.”

We all had a nice, if brief, discussion and in the end she elected to sign a paper documenting her wishes.

To me, one of the great lessons of the Easter story is how it came to be when it is. It is a story of people fighting to get their ideas across, for no other reason than because they are convinced they are correct and the salvation of humanity was in the balance. I agree with Josh that stories of physicians fighting to do things to people because “they can’t come up with a reason not to” are representative of medicine (and by extension, humanity) at its worse. We as physicians may not know what the right answer is, but we can surely enlist the help of the patient, the family, and others such as the patient’s minister to get as close to right as we can.

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