On Death...

It’s the holidays so I felt like I would spread some holiday cheer by making my first post on death. Death is one of the unavoidable parts of life. In school, we are always talking about “quality of life” vs. “quantity of life.” It makes us ask the question, that comes up all the time in medicine, “are we playing god?” But don’t worry, I am not even going to attempt to answer that question – smarter people with more credentials and more experience are better suited for that. I am only here to talk about my experience with death.

I dealt with death directly this past spring with the passing of my grandmother. She lived a wonderful life, had 4 kids with her husband that she loved. However, the past few years of her life were riddled with hospital visits and a decreased quality of life. Modern medicine was able to keep her alive – and for that I am incredibly grateful. Due to these interventions I was able to experience a few more years with her. These years however, were not like the years before. I found myself talking to her on the phone answering the same question multiple times – again, I didn’t mind because I was still able to talk to her; a luxury I don’t have any more. As a future doctor, I have been thinking a lot recently about treating a patient / family like this in my future.

As a good doctor, you have to understand your limitations. Sometimes, it is necessary to let go, and allow the natural course of life take its progress. Ashes to ashes, dust to dust. Doctors need to realize when patients are ready and not push it. Then again, we also need to be ready when a patient is ready to let go but their family is not. I will take an example that I have recently experienced.

Hospice is a place where people go to die. By definition, you can only stay in hospice if you are terminally ill and are expected to die within 6 months. Some escape, most don’t. The average stay in hospice (at least where I went) is 14 days – 2 measly weeks. Like I said earlier, its where people go to die.

A woman I met at hospice was at the end stage of cancer. As the doctor’s so eloquently put it, they were giving her a garden hose of morphine to make her ride out easy keeping the morphine 1mg away from death. The look in her eyes clearly stated that she was ready to give up; she was spending the last of her days in a drugged haze saying good bye to her family. She knew it was time to go, and was getting prepared for it.  On the other hand, her family was not ready to let go. They insisted that every last measure was taken, every drug tested, every therapy tried, and every needle prick done – all in the name for a few more months of a narcotic high. Clearly not her decision.

For every woman like that, there is another completely opposite. For instance, another patient in hospice wanted to return to the hospital because they do not do heroic procedures at hospice. He wanted to be fed through his vein, have his ribs broken chest pounding CPR, and everything besides his liver being done by a machine all in the name of staying alive. In my opinion, this is not a good way to live. His family realizing this pushed, for him to sign DNR. To this day, he has denied it.

These are just my notes and my highly unrefined thoughts. I am sure that I will return to this in the near future and add on. I am writing this because two of my good friends are in the midst of losing a loved one. Death is a natural course of life and it reminds us we are mortal. In addition, and most importantly, it allows us to reflect make us decide how we want to LIVE our life. Happy holidays, and make sure you make this new year count. As a note, I hope that both of my friends have success with their family members – which ever path they want.