Monday, November 17, 2008

Fight or Die

MICU rounds. A dozen or so doctors - interns, residents, fellows, pharmacists and the attending – are all in agreement that it would be better to not intubate the patient with advanced, aggressive, metastatic brain cancer. He can die now or after a couple of weeks or so of ICU hell. The resident has had some preliminary talks with the family and they are open to the option.

Just as the team gets ready to enter the patient’s room, the oncologist shows up. The resident updates him and is taken off guard as the oncologist says something to the effect of, “don’t worry, I will take care of this,” and goes alone into the room. He sits down with the family and, using the finest unintelligible jargon, explains to them that the patient has no chance for survival, but they can still give their permission to do everything. He lays it out in plain terms – they can give up if they want, or they can fight. The resident, a caring young woman who perhaps thought that she was poised to do just a tiny bit of a good deed in this dark world, watches in quiet dismay from the doorway as the family rehearses their chant of “fight, fight, fight!” Now she would get to practice her intubation skills.

From my perspective, there is nothing particularly praiseworthy about wanting to fight as death approaches. When Ted Kennedy received his cancer diagnosis, the media was full of praise for him as a fighter. In our popular culture people die when they give up fighting, but this is not really true. Everyone dies. Sometimes things can happen faster when a person gives up, but then there are plenty (really) of patients who are praying for death. Death often does not seem to be in any rush to respond.

What about accepting death as a part of life and embracing it with dignity? We cannot accommodate that in our culture. Punishment must be related to guilt. “They must have done something wrong, or else why did they die? I am a good person, so surely I will live.” This seems to be a common subtext. An ocean of resources down the drain. Nothing for the person on the street while in good health, but millions of dollars on the verge of death. No questions asked. Or is it really all about teaching and experimentation? A little bit of both maybe? Somewhere someone is getting rich. Death is starting to feel a little insecure I think though…

3 comments:

Jay, aka: Happy To Be Here said...

Thank you for every single post you write. I appreciate your willingness to break the code of silence, which is the gulf between patient and healthcare professional. I have a chronic illness that makes me a "frequent flyer" in the medical world and too many times, I wish I could get my doc to just "say IT," whatever IT may be (and to say it in layman's terms, no less). Your unique perspective is a welcome dose of reality. I'm a big fan.

Leo Levy said...

Thank you so much for your encouragement. It really means alot for me that you, with a patients perspective, can relate to and appreciate my efforts. I must be doing something right.

dethmama said...

Way to go, Leo... you can preach to my choir anytime!