The following story, in line with yesterday’s post regarding end of life care, is an example of the individualization of care of which we must always be aware. The question of electing for Hospice is not merely one of choosing for more treatment or not in seemingly futile situations. It is a more complex and must take into account the human element of wanting to continue to live. I do caution that one story of prolonging life and the quality of that life doesn’t indicate an absolute possibility. The determination to live might be an important factor in the continuation in life in relationship to “terminal” illness.
By David A. Shaywitz
Published: September 19, 2000
After generations in denial, doctors and lawmakers are paying attention to the importance of allowing sick people a dignified death, and to the value of helping patients and their families let go and say good-bye. Aggressive medical intervention in terminal cases is increasingly considered an avoidable cruelty, inflicted on a suffering patient by someone — occasionally a doctor, but more often a family member — unable to acknowledge the inevitable.
As an intern, I see this almost every day, and I’m grateful that most physicians now go out of their way to emphasize to patients and their families the limitations of medical technology. Medical students attend lectures on caring for dying patients, and medical journals remind doctors of the importance of letting patients die with respect and, as far as possible, without pain.
But as an experience in my own family made clear, this newfound concern for a good death can be taken too far during a patient’s final days.
My uncle was diagnosed a year ago with metastatic cancer. Late one night last March, he became acutely short of breath and was rushed to the cancer center where he had been undergoing chemotherapy. My aunt called his doctor, who she said sounded irritated at being awakened at 4 a.m. to deal with a terminally ill patient suffering from a bacterial infection of the lungs. The doctor’s message was clear: What’s the point of treating it if he’s just going to die anyway — if not today, then tomorrow, or next week.
My aunt pleaded with the oncologist not to withdraw care, insisting that even through his extremely painful cancer therapy, her husband had savored life and the opportunity to spend more time with his family. The oncologist eventually relented, ordering antibiotics to treat the pneumonia that had developed in my uncle’s vulnerable lungs.
I have heard many conversations among physicians about incidences like this one — often with the doctors expressing frustration that yet another family seemed unwilling to accept a difficult diagnosis.
Remarkably, my uncle — always a fighter — rallied. After a couple of touch-and-go days, he recovered from the infection and was soon discharged from the hospital. Over the next several months, he went to work part time, attended his granddaughter’s school play, enjoyed a Father’s Day cake and celebrated his 44th wedding anniversary, mugging for the camera while my cousin snapped away. When he finally passed away in late June, I don’t think anyone would have questioned the quality of his last few months of life.
Doctors see a lot of death, and it is difficult for them not to become fatalistic. But if ”facilitating the transition” out of life is to be a skill for the new physician, this should include not only the avoidance of unnecessary treatment. It should also require the vigilance to extend life when that makes sense, always remembering how much living some patients can compress into an additional day, an extra week, an unanticipated month. I have the pictures to prove it.