A wise person once told me there are only two things in life that are guaranteed. Life and death.
Out of the two, I think we have a problem with talking about one of them.
I love life as much as the next person but I think my views on death are quite different. I think there are major issues with the way we look at death. Both the general public and as doctors.
As a doctor I often get the feeling that death is seen as failure (and sometimes it is when we get avoidable things wrong). But most of the time it really isn’t. People age. Organs tire. Treatments don’t always work. It’s at this point that we have to take a step back and think about what we’re really trying to accomplish.
Our aim changes. There’s a branch of medicine that deals perfectly with this change: palliative medicine. It’s may not be everyones job to treat dying patients, but it’s everyones job and business to recognise when someone reaches this point and to do something about it.
I’ve been working in a hospice for 4 months (really not as depressing as you might be thinking) and no I didn’t spend 4 months trying to save someones life. What I did do was try to help a little. Sometimes that meant treating an infection and other times it was treating agitation at the end of life.
I’ve moved back to the hospital now and it really doesn’t take very long to come across patients who are at the end of life. Yes we can all recognise it but I really think we have big issues in being black and white about it and saying it.
I’m not saying it doesn’t get said. But I think there is often a delay in relaying what we can all see happening and communicating that to the patient and their families.
I think it’s a cultural thing. You go to medical school and you become a doctor to “save lives”. Then you’re faced with a patient with a condition you can’t cure. They may not be imminently dying but you know they will at some point. Your mantra of “save lives” suddenly becomes a bit redundant. I’ve seen a mix of reactions to this from avoidance to a feelings of hopelessness. The end result of this is things don’t always happened as quickly as they should.
If you’re patient is having a heart attack you don’t delay telling them and starting treatment if it’s appropriate. The same attitude should be applied to the dying patient.
It’s can be a difficult discussion but it’s just as important as telling someone about a heart attack. It isn’t always a failure or anyones fault. People die.
I was also one of those doctors who went around with the attitude of “I save lives” (or at least I was trying to). My effort for my patients hasn’t changed but my perspective on what I do has. I now like to think of what I do as “I try to help”. Whether my patients can be “cured” or not, I’m always trying to help them. It makes dealing with the “we’ve reached the end of what we can do to cure this illness” conversation easier and also stops death from being the enemy.
Because if I’ve learnt one thing from my 4 months at the hospice it’s this. We might not always be able to cure disease or avoid death but that doesn’t meant there still isn’t a hell of a lot we can do to give someone the time and dignity to live the time they have left in the way that they want to.
Until the next post,