“The old man and the young woman sat across from one another stiffly perched on plastic chairs, staring down at the floor — doctor and patient. The tension in the room, exaggerated by the silence between them, was almost unbearable. Then the patient, stroking a trembling, emaciated hand across a hairless scalp, spoke haltingly, “Doctor, promise me I’m not going to die.”
According to a recent post in the New York Times by columnist Jane Brody, this type of interaction with a terminally-ill patient is not infrequent, and illuminates the fact that “many doctors are not equipped emotionally to handle such a difficult situation.” Brody goes on in her article to bring to light the possible abruptness or avoidance doctors may demonstrate when faced with their own sense of failure or helplessness. Further confusing and frustrating to the communication process—or lack of such—is when doctors know the patient is at the end of their life, but recommend additional and futile treatments because “they cannot connect with those patients on a human, suffering level and have nothing else to offer them.”
What Doctors Need to Learn About Death and Dying
Huffington Post – December 6, 2012
Karen M. Hyatt, MD
The article lists essential truths taught to every medical student entering training. These are the fundamentals of death and dying.
The first truth is that death is inevitable. Over the years we have come to think we might somehow beat the odds, escaping death’s grasp. With obvious advancements in technology and pharmacology, the average life expectancy is sometimes decades longer than that of most of our ancestors.
In Please Dance at My Funeral: A Celebration of Life, I write how many lament at a diagnosis or disease, “Why me? How did this happen to me? What did I do to deserve this?”
“Well-meaning friends and loved-ones may encourage that we can beat this thing. Concerned physicians and caregivers may contribute words of over-optimism.”
“How many times have we witnessed or heard of a patient…confessing ‘I’ve let you down?’ How can we take responsibility for disappointing our loved ones because we are experiencing this natural and final stage of our lives? We have to stop thinking that a disease is a punishment or that dying is a personal failure.”
The second truth is that death is a mystery. Yes, many times people will defy the odds and out live an estimated time imposed by an advancing disease. There are probably many more situations, however, that a life is taken far too young. “Death is the word that defines the ultimate experience of that which we have no knowledge or control. We are a culture of people, who by clutching our fear of dying squeeze the joy out of our living. Our discomfort comes from the sense of having no control over this expected event. By living more consciously, embracing the unknown, and mentally working through the inevitable, we can diminish the fear, and live our life more fully.”
The article lists the third truth as death makes life more precious. From Chapter Nine of Please Dance at My Funeral: A Celebration of Life: “Can the preparation we begin today, subscribing to greater awareness, forgiving, and making amends, allow us to come to our end without suffering? Is it possible, as our awareness expands, we might manifest that which we have painted in our minds for a fearless, pain-free, journey home?”
“Our lives are indeed journeys. This journey, as we know it, may end. It may continue in a way that goes on without the limitation of the body as its vehicle. Life is not about the ending; it is about the living. It is about living well. It is about our interaction with our world, and our relationships with all whom we come into contact during this journey. It is about the emotions felt, the risks taken, and the lessons learned.”
Dying provides an opportunity for transformation. Of this truth, the author emphasizes:
“In my ideal world doctors would be educated in the wisdom of all aspects of health, including the decline of physical health that ends in death…would be the guides who help us make reasonable choices, who see beyond our fears, and who possess the compassion and tools to ease our suffering. Doctors then would be the wisest members of our society, never deluded by the myth of immortality.”
Karen M. Hyatt, MD
Chapter Nine in Please Dance at My Funeral: A Celebration of Life is entitled Transformation. “We want to acknowledge that we were here, with a purpose, and that our life mattered. We want to be remembered for who we were, and what we did with our life. We are all here as witnesses for each other, to validate others, and to be validated. We want to leave memories of having loved. We want to live on through the memories of our loved ones. We want the legacy of our love, our values, and our ideals to resonate down through the lives we leave behind, to leave hearts touched in ways that are passed on—and remembered.”
“The final stage of our life should be considered as natural as birth. It is time to bring this understanding to a working concept that supports us now, even if we are young and healthy. When we reflect upon our life as a celebration of living, a celebration of accumulated wisdom and experiences, loves and relationships, we become mindful of our life in a perspective we have seldom allowed ourselves before.”
When we embrace these truths we are no longer living in fear of death, but living in fullness of life, communicating openly with loved ones our wishes for dying with dignity, and helping others face these truths, as well.
- A Look Back: Looking Ahead
- January 2013 Newsletter – The Next Journey