The ways of death

A few days ago, I visited an old friend of almost six decades, who had recently lost his wife. By a cruel twist of fate, he had broken his leg a few days after his wife died. As I sat by his bedside in a spanking new hospital, he told us the harrowing tale of the last six months where he had tried all that was known to modern medicine. They had gone through what the medical professionals call " futile care", where the doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, fed through tubes and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it really buys is misery we would not inflict on a terrorist. Yet his wife, a kind, soft spoken, gentle soul had borne all the pain that modern medicine inflicts in the cause of finding a cure and had spent her time in and out of hospitals with cheerful grace. But towards the end the doctors had thrown in the towel, but would not admit it, ( for it is a truism that no doctor ever admits that he cannot cure the patient or that he may have misdiagnosed the disease) leaving the family to face the difficult and agonising choices alone.

I became curious as to how when doctors faced their own end how they prepared themselves. What did they do and when did they give up?  When did they say enough is enough. Ken Murray, a doctor himself, describes how doctors in general face the end and how doctors die?


Of course, like most of us, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right). Then how is it that these same doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.

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. But they are trained to do all they can to preserve human life if the patient so desires.

"To see how patients also play a role" says Ken, "imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not."

The system too plays its part. Unless the patient has specifically asked for certain actions not to be taken, the hospital cannot, for example, take a patient off the ventilator or administer certain medicines lest they be sued by the survivors or become embroiled in some litigation. The safest course then is to do all that is availble irrespecitive of costs or indeed reason.

But it seems that for all the time they spend fending off the deaths of others, doctors in general tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But when it is time to go, they tend to go gently.

So can we all. All we need to do is to draft a living will that states "If the time comes when I can no longer take part in decisions for my own future, let this declaration stand as the testament to my wishes. If there is no reasonable prospect of my recovery from physical illness or impairment in which I am suffering continual pain or am incapable of ever again living a rational existence and when I am no longer capable of being consulted regarding my wishes, I request that I be allowed to die with dignity and not be kept alive by artificial means. I request that they administer whatever drugs necessary to keep me comfortable during this period even if it may reduce the length of my life."

If there is a state of the art of end-of-life care, it is this: death with dignity.  There need to be no heroics, and we should all be able to go gentle into that good night.