So much of what we learn in medical school is about diagnosis and treatment - we learn about all these conditions so that we can recognise and fix them. When we become junior doctors we put into practice what we learn, and our ability to execute the essential "core" of medicine - diagnosis and treatment - improves.
But what about death? We learnt almost nothing about it at medical school. There was never any teaching about what happens when people die, and it was barely talked about outside the context of statistics "one in three people will die within 5 years..." As junior doctors we are often called to certify people dead, or at times take part in people's deaths, whether they be emergency deaths or planned deaths. I don't know what it's like for other people, but those experiences for me were rather surreal. I didn't feel like I was an active participant, rather just watching the evolution of what happens to these patients.
Sometimes it felt like someone would turn a magic switch when the direction of treatment changed from active to palliative. It was go go go with all the tests and treatments, until someone said enough, let's stop. Then everyone would hold their breath while they waited for the patient to die, and it was sort of horrible. Death is horrible by nature, worsened by the pain suffered by the dying person and the anguish of those surviving. It was an uncomfortable experience.
At some point in my career, and I'm not sure exactly when that was, I realised that there was actually quite a lot we could do about death. One does not have to hold still, do nothing and wait for "nature to take its course", though of course it is difficult to change nature's course. Talking about death, early and copiously with people involved, demystifies the process and helps people to cope because they have some idea of what is to come. Death is bad enough without having to deal with the shock of the raw physical challenges of it. Being aware of all the common problems associated with death makes one better equipped to deal with them as a doctor, and being pro-active about the management of these problems actually makes a difference to the patient and their family. Even when hope is lost for the preservation of life, one can facilitate some closure for the family when the circumstances of the death are peaceful.
Finally, when there is nothing "doctorly" to do, spending time with the patient and family may be what makes more of a difference than any treatments. We may not always "care" in the traditional sense of caring for a loved one, but I believe we have a fundamental sense of "care" as human beings.
I am triggered to think about this as I've had a couple of memorable deaths this week. One was a middle aged man who had a terrible complication of the stroke treatment he had, leading to a massive bleed in the brain which made him unconscious. The other was a young woman who was dying of cancer on her birthday. In both cases I felt that time spent with the patient and family were cathartic for me and for them. I think innately we act in some way towards people because we want to be treated the same way when we are in the same situation. The humanistic qualities of a doctor are so very under-emphasised because they cannot be taught, but they are so essential. Not only do we need to provide good diagnosis and treatment, a fundamental part of our job is to provide a good death.
But what about death? We learnt almost nothing about it at medical school. There was never any teaching about what happens when people die, and it was barely talked about outside the context of statistics "one in three people will die within 5 years..." As junior doctors we are often called to certify people dead, or at times take part in people's deaths, whether they be emergency deaths or planned deaths. I don't know what it's like for other people, but those experiences for me were rather surreal. I didn't feel like I was an active participant, rather just watching the evolution of what happens to these patients.
Sometimes it felt like someone would turn a magic switch when the direction of treatment changed from active to palliative. It was go go go with all the tests and treatments, until someone said enough, let's stop. Then everyone would hold their breath while they waited for the patient to die, and it was sort of horrible. Death is horrible by nature, worsened by the pain suffered by the dying person and the anguish of those surviving. It was an uncomfortable experience.
At some point in my career, and I'm not sure exactly when that was, I realised that there was actually quite a lot we could do about death. One does not have to hold still, do nothing and wait for "nature to take its course", though of course it is difficult to change nature's course. Talking about death, early and copiously with people involved, demystifies the process and helps people to cope because they have some idea of what is to come. Death is bad enough without having to deal with the shock of the raw physical challenges of it. Being aware of all the common problems associated with death makes one better equipped to deal with them as a doctor, and being pro-active about the management of these problems actually makes a difference to the patient and their family. Even when hope is lost for the preservation of life, one can facilitate some closure for the family when the circumstances of the death are peaceful.
Finally, when there is nothing "doctorly" to do, spending time with the patient and family may be what makes more of a difference than any treatments. We may not always "care" in the traditional sense of caring for a loved one, but I believe we have a fundamental sense of "care" as human beings.
I am triggered to think about this as I've had a couple of memorable deaths this week. One was a middle aged man who had a terrible complication of the stroke treatment he had, leading to a massive bleed in the brain which made him unconscious. The other was a young woman who was dying of cancer on her birthday. In both cases I felt that time spent with the patient and family were cathartic for me and for them. I think innately we act in some way towards people because we want to be treated the same way when we are in the same situation. The humanistic qualities of a doctor are so very under-emphasised because they cannot be taught, but they are so essential. Not only do we need to provide good diagnosis and treatment, a fundamental part of our job is to provide a good death.
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