How Doctors Die?
“How Doctors Die- it is not like the restof us, but it should be“was the provocative title of an essay published in 2011 by Ken Murray MD, Clinical Assistant Professor of Family Medicine at USC.1It attracted lot of debate in which a large number of healthcare professionals including those working in the Intensive Care Unit have participated. This was shared with me by Mr. Tom Lang a dear friend and Executive Committee Member of World Association of Medical Editors (WAME) after reading the chapter about the death of my mother in my autobiography “Plight of a Medical Editor”.
This essay is based on a few case histories related to the last moments of a few patients including doctors. Doctors, he says, “know the limits of modern medicine”, hence they do not ask for any heroic measures when it is their turn to leave this world. “Do not break the ribs in an attempt to resuscitate the patients with CPR (that is what happens if CPR is done right).” His advice to the doctors is not to bring in the cutting edge of technology to bear on grievously ill person near the end of life”. What usually happens is that “patients in critical condition are cut open, perforated with tubes, hooked up to machines and assaulted with drugs.”1
Medical care should not be administered which makes patients suffer inagony. This is one of the reasons that some physicians have stopped participating in hospital care. When the patient is serious, the family members wish the doctors to “do everything that is reasonable” but they themselves do not know what is reasonable. Many a time’s poor knowledge and misguided expectations lead to a lot of bad decisions by the healthcare professionals. Doctors must discuss with the patients and their family members “end of life choices”. Describing his own practice, Ken Murray says that in such a situation” I discuss the issue with the family members of the patient in layman’s terms that portrayed the downsides clearly. If the patients or family still insist on treatments which I consider is pointless or harmful, I offer to transfer their care to some other doctor or hospital”.
He narrates the case of an attorney from a famous political family who developed painful sore on her foot. He did everything which he could to keep her away from resorting to surgery. However, She went to another doctor “who decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This did not restore her circulation, the surgical wounds did not heal. Her feet became gangrenous and she endured bilateral leg amputations.” Doctors often resort to heroic interventions and procedures either to make money or because they are fearful of litigation and do whatever they are asked to avoid getting into trouble. There are reports that patients admitted in Hospice care often live longer than people with the same disease who are seeking active cures.
The last few days which my mother spent in an intensive care unit under lot of misery before her death, still haunts me. Despite the fact that I try to forget all that but that scene is often recreated and I have to spend sleepless nights. My mother often used to tell us that “do not take me to the hospital. There the doctors puncture the body with needles everywhere, do lot of un-necessary procedures and the patient dies without getting a sip of water.” She was a diabetic for almost twenty years, well under control but once she had an episode of hypoglycemia which proved to be the beginning of herjourney to the other world. She developed severe chest infection which could not be resolved despite potent antimicrobial agents and other medication, stopped eating and even taking fluids. She had to be hospitalized. I could see that her condition was deteriorating with the every passing day despite the fact that doctors were giving false assurances to other family members that she was recovering. I saw her in the ICU last time at about 5.00PM and told my family that it was all over,” hence let us make necessary arrangements”. She eventually passed away at about 6.30 PM. I myself feel guilty that we could not fulfil her last wish “to let her die peacefully at home.
Although most of the health care professionals try to prolong life with good intention, yet, my sincere advice to them would be to not to prolong misery and sufferings of a dying patient unnecessarily by doing overzealous procedures and interventions. Let the doctors minimize the agony of the patients and involve the family in patient management, tell them the truth so that the family gets ready for the bad news. As we all know that Death is an exit door through which we all have to pass sooner or later.Do not make the death more expensive. Patients used to die in the past, they die even today despite lot of advances in modern medicine but in the past patients use to die alone but now it also leads to economic death of the family, thanks to the greedy physicians and healthcare facilities infected with materialistic virus. Let the hospital administration educate its healthcare staff including doctors, nurses and technicians how to handle terminally ill patients and ensure that they earn death with dignity. Patients in the far flung rural areas or in small towns are blessed because in most cases the doctors and healthcare facilities there knowing their limitations in such situations advise the family to take their patient home, take care as much as they can and let them leave this world peacefully which is not the case in major cities where most often it is the greed and love for making more money which dictates the decisions by doctors and healthcare facilities. They must all remember that:
Sikandar Jab Gaya DunyaSayDonow Hath Khali Theysince Coffins have no pockets.