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.