I saw an article recently in which the author writes that doctors die differently from the rest of us. That certainly caught my attention, and while there are no studies to back up what he writes, he does seem to point to factors that all of us might want to consider.
Ken Murray, MD, in How Doctor’s Die, writes:
“It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they 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 they go gently.”
He continues,” Of course, 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…”
What made the article particularly relevant for me was the experience I had just gone through with my 93 ½ year old dad, who died July 4, 2011.
My dad (Sam) had been very clear with our family he did not want any medical extension of his life. He was clear he had lived a good and long life and was not afraid to die. He repeatedly told us “there is a time to leave the party,” and in the last year or two, he said we needed to accept that the time had come for him.
“Of course,” we responded. “We won’t do anything extraordinary to extend your life.”
Ah, and that’s where the issue got a bit sticky.
His health had been basically good. He had no heart issues, no cancer, no strokes, and, except for somewhat weak kidneys and an enlarged prostate, he had avoided the major life ‘killers.’
Sam had fallen three or four years earlier, and although his leg had been ‘nailed’ back together, he became increasingly less mobile, moving from a cane to a scooter to a walker, and ultimately to a wheel chair over a period of three years. Gradually, he also became less able to enjoy those things that previously brought him great pleasure (reading, chess, computer, and music).
We caught urine infections, dehydration, and other ‘minor’ issues early, and he saw his internist once a month, and his other doctors as necessary. The result of this care was that we were extending his life, even though he was quite ready and accepting of dying.
Then, one day in June 2011, he became quite confused, and we suspected a urinary infection. So off to the ER we went, where the doctor said he did have an infection and was dehydrated. He also suggested we hospitalize Sam to stabilize him as he feared there were other indications of problems.
Sam objected, and we agreed to leave the ER with the understanding we’d return if the antibiotics did not cure the infection.
We got a call a few days later that the infection had spread to his blood, and the recommendation was we take further action.
We called his internist about what to do and had a truly amazing discussion. His doctor said that we were at a decision point. We could hospitalize Sam and, most likely, successfully deal with the current medical issues. Or, we could keep him where he was, make him as comfortable as possible (Hospice was involved at this point), and treat this as the ‘concluding event’ in Sam’s life.
His internist said he knew Sam well, knew he wasn’t saying he wanted to die because of depression, delirium, etc., and knew Sam’s desire to ‘leave the party’ was a conscious, well thought out, and often expressed decision, desire.
His doctor said he’d support either decision we made.
Hospice said Sam was in critical condition. His 24/7 caregiver encouraged us to discuss the situation with Sam and to listen to what he was saying. Our family was in agreement Sam should make the decision whether to return to the hospital or simply be made comfortable until his body shut down.
When we talked with Sam, he was quite clear. “I’m ready,” he said. “It’s OK. Let me go.”
So we did. Three days later he took his last breath with family at his bedside and with a minimum of pain. With the help of his internist, we had finally understood that there had to be a ‘concluding event.’ We were fortunate enough everyone was in agreement, and we could follow Sam’s desires.
So why this post?
Because, in addition to directing you to Dr. Murray’s article, I wanted to share with folks what I discovered. Plus, I hope some of you will share with MillersTime readers your discoveries from your experiences with end of life issues. Obviously, no two situations are the same, and what follows is not meant to be advice for anyone.
For me, for us:
* How wonderful it was that we knew so clearly what Sam’s desires were.
* I discovered good, routine care often extends life, even when one is not meaning to extend that life.
* Our ability to have a 24/7 caregiver was immensely helpful to Sam and to all of us who were also taking care of him.
* How important it was for us to have family agreement about how we would handle the end of life events.
* How important it was to have a doctor who knew Sam, understood him, and was able to help us focus on Sam’s desires (as opposed to just keep Sam alive, with one more hospitalization).
* The concept of a ‘concluding event’ was important, once it was mentioned to us. We all hoped for (fantasized about) a smooth, painless passing in the middle of the night, which probably doesn’t happen very often.
* Hospice was particularly helpful, both in how we dealt with Sam’s end of life and also my mother’s end of life, three years earlier.
* That there is, as Sam so often said, “a time to leave the party,” and it is often difficult to know exactly when that time is and exactly what role family should play in that decision.
* For us, it was not possible to avoid playing a role in the ‘time to leave the party’ for Sam.
* Sometimes we mixed up our needs with Sam’s. But ultimately, it was Sam’s wishes that needed to be honored.
* Sam and Esty gave us a gift by having their wishes and all of their estate issues handled in advance.