Don’t Let The Patient Die

(Martha Calihan is a Board-Certified Integrative and Holistic Medicine Physician, and a Certified Functional Medicine Practitioner. A practicing physician for over 30 years, she has helped many patients and families through the process of preparing to say goodbye to a loved one. She is the author of the book, “A Death Lived“.)

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“Don’t let the patient die.” The spoken and unspoken mantra in medical training. It’s us against death; keep going to the bitter end. There is one more thing to try, one last thing to do.

We can, but should we? This became the question that haunted me in the early stages of my career as a family physician. Over and over again I thought, “Just because we can, doesn’t always mean we should.”

Where was the quality of life for some of these people spending their last weeks and days tethered to machines, no longer being able to communicate or even spend time with their loved ones? And how much physical and emotional pain were we causing them?

This clearly was not the conventional way of thinking in medicine, but it was mine. How, I wondered, was I to reconcile these opposing views?

I realized it begins long before the final crisis. Before a patient is in the last days of their illness and their life, conversations need to be had to address the issues of end-of-life care. We need to be able to talk about the fact that life ends in death … that death is an expected event that we will all experience.

Ours is a death-phobic culture, one where we use euphemisms for the word and talk in hushed whispers, if at all, about an impending death.

Often, I have had one spouse in the hospital bed saying, “Don’t tell my spouse I am dying,” and the other spouse in the hall outside the door saying, “Don’t tell my spouse he is dying.” WHY? Are we so unable to face reality that we are willing to forego the possibility of the incredible gifts that can be found in sharing that most precious of time, the time left, with the one we love in full, open, and honest conversation?

We need to be honest about death, and about the extent to which our medical interventions are likely to help, to change things. When we have options that can really help a patient improve and survive, great. But when we don’t, when the choices left are not likely to change the outcome, I believe it is only fair to be honest about it with the patient. Their choice might be to continue everything, or it might be to stop treatment and spend their time with comfort as their goal.

We, as physicians, have to be ready to accept that and to support them in their decisions.

It is my belief, and was my experience, that the entire process is made less difficult by having the end-of-life conversations early and often. Have the conversations with your family, your decision-makers, long before it is a time of crisis, when emotions are less intense and you can have enhanced perspective. Talk about the what-ifs — what you think you would choose, what seems would be important to you in your waning days and weeks. Having the initial conversation before you have to helps normalize the subject and makes it less hard to have the next one … and the next. And when you need to make real decisions, the practice runs can prove to be helpful beyond words.

That was my experience with my husband’s final illness and death. At first, it was hard … really hard. But it got less hard to talk about it as time went on, and he (and we) were able to have the death experience he chose. He chose when to end medical treatment, when to come home.

He died with his family by his side, and each of us had the full knowledge and understanding of the choices he had made. I could not have asked for a better, although excruciatingly sad, process.

“Don’t let the patient die”… is that the right thing or the wrong thing for a given patient? It is time for physicians to think that through more completely and allow, perhaps, a different answer.

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Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s right to choose. For more information, go to www.finalexitnetwork.org.

Payments and donations are tax deductible to the full extent allowed by law. Final Exit Network is a 501(c)3 nonprofit organization.