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Doing Death Better

Doing Death Better

In the national debate over health care, the way we die is the issue
that few want to confront. A Milwaukee cardiologist makes a plea for
Americans to face their worst fears and prepare for life's final
chapter.

By Bruce Wilson, Special to the Journal Sentinel

Posted: Oct. 26, 2009

We struggle so with death. It frightens us and drives us, causes us as
a culture to fight it with a vengeance.

Life is to be embraced. Yet death, whenever it comes to each of us, is
as natural as the rising of the sun. We spend so much money and
emotional turmoil staving off death, even for minutes or hours, beyond
all hope, often beyond reason.

In our culture, we have some work to do in coming to terms with death.

As a physician, and particularly as a cardiologist, I have had to deal
with death many times. Often in my business this comes quickly and
unexpectedly, and little has been discussed ahead of time to help in
this difficult moment.

My first experience with impending death, at least as a responsible
party, came on my first hospital rotation as a medical student. I was
assigned to a cancer ward at a university hospital. On my third day,
the team was making the morning rounds. There were two students, an
intern, a resident, an oncology fellow and an attending physician.

The patient was only 19. His name was Joe. He had a mop of dingy blond
hair and large, haunted eyes. He had been in the hospital for weeks to
receive an experimental treatment for metastatic (widespread) colon
cancer that had little effect on his far advanced disease. He lay
speechless in his bed each morning as the team came around and
discussed his statistics. He never said more than a syllable at a
time, and to my surprise the team seemed comfortable enough with that
as we stopped for only a few minutes each day. On top of having a
horrible and lethal disease, Joe was from a small town and must have
been intimidated by all the hustle and technology of a modern
university hospital.

On this warm day in June, one of the more senior doctors looked down
at Joe and told him that the treatments had finished and that he'd be
able to go home the next day. It was quiet. Somebody told Joe that
we'd get everything ready for his departure. That was it. I think
someone asked him if he had any questions. Of course Joe said nothing,
as usual. Those big eyes, and space. We walked out of the room. I was
at the end of the pack. Joe spoke to me then.

"What's going to happen to me?"

I was shocked just to hear his voice, and felt horribly unprepared to
respond. I told him that I didn't know all the details of his case and
his treatment, and that I would speak to the senior doctors to try to
get him some answers.

I went into the conference room where the others were discussing
something clinical and told the attending physician what had happened,
and that somebody needed to go spend some time with Joe.

He punted. "You seem to have a pretty good feel for these things - you
go talk to him." It was absurd. A new third-year medical student three
days into his first rotation being asked to speak to a dying patient
about whom he knew almost nothing, not to mention knowing little about
anything else, either.

I did go into Joe's room, and talked to him at length about his fears
and about his impending death. It took all I had to look him in the
eye. On my way out of the hospital later that day, I felt as if I had
to get out and be somewhere private as I was holding back a flood of
emotion.

I bumped into his mother on her way in, who asked me if it was really
OK to take him home the next day. I held on. I got a block away from
the hospital and was sobbing my eyes out while walking a mile to my
car. I'm sure the people passing me wondered if I had lost my own
brother.

Back then, there was no training in helping the dying patient, or more
importantly, their families. People are trying now, but there's so
much more to be done. This is in part because medical science over the
past 100 years or so has developed treatments and technologies so
fast.

Generations of physicians like me have falsely been brought along
thinking there's always something more we can do. As doctors, we often
view death as our failure, a thought that remains subconscious because
it's too disturbing to have right out on the table. We have given this
notion to our patients and to society as a whole, as well. Many a
family member has pleaded at the bedside of their dying relative,
"There must be something you can do!" They've seen it so many times on
TV.

Over time I would find myself as the medical director for a hospice,
where I gained education in areas where I had only the guidance of my
heart and my experience.

I know now how to manage and direct these conversations. They are
often hard, but they are critical, and they are professionally
rewarding. There is often nothing we can do for the patient in terms
of technology. Our equipment wears out. Everything stops. But the time
around someone's death will be remembered by the loved ones for the
rest of their lives.

First, we need as a culture to view death as a natural end to a cycle.
Mankind has been walking this Earth for about 200,000 years. Our 75
years or so on this big ball is but a speck on that timeline. Death is
often viewed as a moment, and one to be feared. We should learn that
death can be viewed as a chapter, and one in which spiritual and
emotional growth can occur both for the patient as well as the family
and friends left behind.

Hospice refers to a way of delivering this type of care in the last
chapter, when no more technology is appropriate. It helps get the
patient into the frame of mind of making the proper internal
adjustments for things to be right. Comfort measures and attention to
psychological issues for all involved is of utmost importance.

Hospice care can occur in a hospital, in another facility, or in the
home. It's a philosophy, not a place. Palliative care is really the
same thing. It's a way of scripting the last chapter. We wish to avoid
panic and fear while holding death at bay.

My own mother is slowly dying of progressive dementia. Her mother died
of it while I was in medical school. The day I got into med school my
mother told me that if she were ever to find herself without her
mental faculties that I should give her the "black pill."

All of her advance directives and power of attorney forms were filled
out years ago. Yours should be, too, regardless of your age. And far
more important than the legal documents is the discussion with the
people you love and who love you about what your wishes would be. And
it's OK to change your mind from time to time, depending on what's
going on in your own personal universe.

But talk about death. Share gratitude with the people who are most
important to you, and tell them your thoughts. We can avoid much of
the fear and prevent people from being put, often by the medical
professionals who seem to view death as the enemy as well, into
positions of responsibility and decision making that will haunt them
forever, well after you're gone.

It's a chapter. Work with it. Write your own script. Don't fear it any
more than you'd fear birth, or puberty, or retirement. Take part in it
with the important people around you. If you are one of the ones who
are gone in a split second, you won't have suffered, but your loved
ones will. Spend some time while you're around letting people know how
much they mean to you and what you would want in case you can't speak
for yourself.

And then we have to tackle what to do with my mom, who made it
perfectly clear a thousand times over.
__________________

Physician Bruce Wilson is the former director of acute cardiac care at
the University of Minnesota Hospitals and former director of the
University of Pittsburgh Heart Institute. He served as chairman of
cardiology and continuing medical education at Columbia Hospital in
Milwaukee. He currently has a consultative practice in cardiology in
the Milwaukee area.

Find this article at:
http://www.jsonline.com/features/health/65918152.html

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