Do or Die?
Like my colleagues all over the world, I was trained to never stop advocating for my patients, and to exhaust every option when it came to their health and survival. Yet as these options proliferate, are we physicians and caregivers taking our efforts too far, and unintentionally harming our terminally-ill patients in the process? That’s what recent research seems to suggest, as published in a powerful piece by AP medical writer Marilynn Marchione.
For the patient running out of options, our do-or-die culture seems to offer an endless supply of yet another experimental treatment, or one more drug trial. Yet its flip-side is the reality of precious hours spent in treatments that may never work, away from family members; or the endurance of horrific side-effects piled on top of an already devastating illness. Where is the tipping point, and do we physicians have an obligation to help our patients weigh these agonizing choices?
I look for cues in my patients to tell me when they are ready to shift the focus away from continuing the fight, and towards the creation of a safe space where they can prepare for the end of their life. That decision is exclusively and entirely theirs, of course, and I consider myself deeply privileged to be a part of it. I’ve treated people who’ve chosen to spend their final days half-way around the world, literally dragging themselves to one more treatment. And I’ve watched a Native American family chant around their grandfather’s hospital bed, drowning out the sound of heart monitors and breathing machines.
I’ve practiced medicine for over 35 years now, and will never cease to be humbled by the courage and dignity of my patients facing the unfathomable decision of when to say enough is enough.
As a nurse who works with reinsurance carriers I so often see patients for whom no md ever offers options such as no treatment. I do not mean you should not give hope, but so often these patients have no quality of life. Hospitals and mds who practice allopathic medicine fail to offer options so a patient can make plans while they are still able. After a while my cynicism takes over and I think they only offer treatment as a money making option for mds, hospitals and pharmaceutical companties.
We are here to live, to teach, and to learn.
All we really have is the journey of life, not our bodies, and certainly not the outward trappings.
When afflicted some of us will ask for help, some will beg, others will demand more and more, and yet others will give of themselves until the end. Each way is entirely appropriate. Thus to be presented options in a time of crisis is proper. To recieve intelligent professionally informed options, options which match our temperment as the patient, this is both rational and appropriate action by a care-giver.
As a man fortunate enough to have held the hand of two fiancees, each on their one-way journey while cancer held the other, please allow me to applaud Dr Glenn Rothfeld on his attitude toward his patients and their quality of life. As I learned from my dear friends, the experience of life, of sharing life – or of going it alone when it is such time – can not be judged right or wrong by any one but ourselves.
Again, we are here to live, to teach, and to learn.