Today I cried in class.

One of our lectures was more of a talk: a woman came in to tell the story of her daughter’s death several years ago at a very young age.  She had a cancer that rapidly became terminal, and the mother recounted the nights spent in the hospital (and later at home through hospice), the conversations they shared about what death means, and the grief that the rest of the family experienced when the girl finally died.  I have such respect for the mother, who was able to speak with such grace and clarity and honesty and no didactic glurge, about a topic that must have been so painful to her.  We’ve had patients speak to us before, but I’ve never seen my class so moved; there were many wet faces at the end.  For me, the moment came when the mother recalled a conversation she had with her daughter, where the daughter expressed her fear of dying because “I want to grow up to be a mommy and now I’ll never get to have my babies.”

Afterwards, in small group, we discussed the appropriate role of the physician at the end of life.  One of my classmates denounced the concept of the “good death” as a sentimental myth and insisted that as physicians, we had to keep pushing for a cure.

I have never wanted to hit someone so much in my life.

Yes, of course, as physicians we would never want to “give up” on a patient.  Especially on a child.  But why do we have to think of death as “giving up?” We cannot make people immortal, try as we might.  We can hook them up to more and more machines, pump them full of more drugs, but in the end, everybody dies.  I think the point of medicine is not to prolong life but to alleviate suffering.  And maybe I’m in the minority here, but I happen to think that hospice and palliative care are among the best things one can do in cases of terminal illness.

I’m not just speaking theoretically here.  I was very close to both my grandfathers, and I watched them both die, in very different circumstances.  My paternal grandfather, who had lived with us pretty much continuously since I was about a year old, was diagnosed with lung cancer when I was 12.  Chemo and radiation only made him feel ill, and once the cancer metastasized to his brain, our family decided to stop aggressive treatment and opted for hospice.  He was home with us for his final few months. It was difficult to see him deteriorate, and at 12 I probably did not understand most of what was going on with him. In spite of the emotional difficulty of seeing my grandfather regress into incontinence and incoherence, I think it is preferable to what happened when my mother’s father passed away two years ago.  My mother and aunt decided to be very aggressive in treating his symptoms, even though he made it clear that he did not want so-called heroic measures.  He was visibly upset with his situation: bed-ridden, nasogastric feeding, a machine to stick down his throat every so often to clear out mucus secretions.  It was clearly painful for him, physically and emotionally, and it didn’t make anything easier on the rest of us.

The point is, dealing with death is difficult, but you can’t just ignore it and hope it goes away.  It’s a reality that everyone has to face; physicians perhaps more frequently than most.  But it’s ultimately the families who have to deal with the grief and suffering that accompany such loss.  Obviously, hospice isn’t the right answer for everyone, but neither is the ICU.  That’s a choice everyone must make themselves.  And pushing them away from hospice just because the physician wants to be able to DO something is, I think, unnecessarily cruel.


5 thoughts on “Heavy

  1. This is a great post and I’m glad that you were so moved to write it. “Lectures” like the one you described are the reason to go to medical school, in my opinion. As you said previously, everything else we can learn from the internet.

    I had an eerily similar situation with my two grandfathers and, as a result, hold hospice in the same high regard. Perhaps your classmates will follow when they get some clinical experience and understand that there is nothing more noble than helping someone leave this life with dignity, grace, and peace.

  2. Ideally, the dying person (technically, any person) should do as much good as possible in the time he has left. It certainly can be hard to do that if he is lying in a hospital bed in great discomfort, even if the treatment extends his life. But the choice is up to the patient, so I don’t think it’s irresponsible of a doctor to present all the options fully and make a recommendation according to his own heart.

  3. Yes…

    My grandmother just died, and it was such a relief to us – because we knew it’s what she wanted. I thought about her in the ICU in the interim between her stroke on Monday and her death on Tuesday, and I thought – I wonder if the doctors and nurses treating her realize that this is “good” – that losing this patient wasn’t really losing.

  4. Katie: I agree, having a personal experience with the terminal illness of a loved one does, I think, make a HUGE difference. I have such respect for hospice workers, because I know I’d never be able to have that kind of strength and courage.

    William: Absolutely, everything depends on the patient’s wishes. My issue with what my classmate said was simply that, according to him (and to many other physicians), hospice shouldn’t even be presented as an option, because that would be “losing.” (As Chenoa says.) When it comes to end-of-life care, it’s not about ruining some kind of cure rate statistic on the doctor’s track record, which is what my classmate was implying.

    Chenoa: I’m so sorry for your loss, especially coming at such a difficult time in your own life. Hope that all comes right in the end.

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