"How a doctor reacts to a patient’s death (and thus, maybe this whole reflection) is pretty unimportant."
I love the essay but not sure i agree with this statement. unimportant relative to ?
If a doctor does not grieve, does not feel any o these emotions that says a LOT to me. It matters to my patients that i feel those things for their family member
Three years now after my wife passed and my thoughts wander into was there something more I could have done? Could I have forced her to understand self care from her trach as she was learning to live with the device. And a tiny voice in the back of my mind says I could not have done more. Still I often reflect without answer. But perhaps someday I might know.
It’s wonderful that you have made the effort of writing about this woman’s passing amidst the horrors of ‘21st century healthcare’ where there is no ‘care’ left in healthcare anymore.
Given that you would have witnessed or been a part of several of your patients dying , has it changed your own views of life and death, your practice of medicine and ‘patient care’ and has it resulted in the ‘guilt’ aspect coming down?
You are not alone in feeling these emotions and I appreciate you sharing. Sometime I think we as healthcare practitioners forget we are human and experiencing emotions comes with that. And since we frequently witness those at the end of life it would be inhuman to not go through a wide range of emotions. Thanks again, your Reflections remind me that we are treating people not just patients.
You know, I can't help but think we can do "21st century medicine" better, that this should not be a reference to how industrialized, mechanistic, and bureaucratic our medical system is. However, it is definitional. We can do better.
We have to seize the means of production, including in medicine. It's the only way out. The core reason why things are this way is that the underlying profit motive of our society is pretty much its only driving force and the only value it holds sacred.
My mother died at 39 of systemic scleroderma. Even as a child, it was important to me to know that her doctor cried when she died. Years later, the same doctor cancelled my medical bill to him in order to get me out of working a dead-end job and into teaching college. His goodness and mercy has inspired me all of my life. Thank you for modeling the same concern and dedication to your patients.
What is curious to me how the cause of death might have affected your thoughts and feelings on the death of a long time patient. And yet that is not mentioned once. Is it not relevant?
If she has died unexpectedly from an MVA, a heart attack, a stroke, a fall, an allergic reaction, an accidental poisoning/overdose, a diabetic event or a suicide wouldn't each of those causes affect your thoughts in different ways?
It also strikes me that how we think about "unexpectability" might be an important reflection point.
Not making it 24 hours to the next day's breakfast, is about a 8 micromort event for an "average" 66 year old (if I remember my tables). That's a reverse lottery ticket.
66 even with all of the medical issues still seems young, perhaps because my wife and I are in that cohort. Even when my grandmother died a few months shy of her 99th birthday that was "unexpected" - or at least it was to her -- she lived independently and the night before (a stroke) she had wrapped a birthday present for a great grandchild and laid out a dress to wear to the party the next day.
Thinking about daily, annual, five-year, ten year, and 20 year mortality rates (all cause and specific cause) might be a good thing for physicians and patients to incorporate into sensible medicine.
Isn't it in fact, "the fine print" in all lives. So many joys, even as a doctor patient relationship
and all relationships of care giving, on every level.
The bond is close as both of you have a connection of dependency of some measure.
One of us will always out live another, and hold those memories tight.
We just hope we can give then happiness, and good memories in the end.
This reminds me of one experience when I was a young nurse in an orthopaedic office so so many years ago. We did not experience many deaths in ortho patients, one attraction for me.
We did have a very long term patient that came in regularly with knee pain, she eventually had total knees, and a total hip. One thing that stood out for us when we saw her name on the list coming in, we had to try our very best to make her happy because she was perpetually unhappy. Of course, it was the pain, and the struggle for her. We never saw that woman in a really good mood but one time upon knowing she was coming in at 1:00 pm, I zipped over to the local store and picked up some flowers to give to her when she came in. Just so she knew we loved her.
Suddenly one Monday that over the week-end, long after the flowers, she was struck by a car (SE DC streets) and rushed to the hospital. They were unable to save her. When we learned of this we were crushed. Our most grumpy patient!!! I know she did not deserve to leave this world like this.
Thank you for sharing this. My mom died of COPD. She had many wonderful doctors. She was a patient that while suffering always was able to brighten a doctors day. Her Doctor, that’s what she called him, Dr Domby. He can’t start to imagine what he meant to her. She grew to love him as a family member. In doing so our family grew to love Dr Domby as well. Just so you doctors and nurses know, there is a special place in the hearts of our families for those of you who care. We love you and we appreciate you.
One of the most touching eulogies I’ve witnessed was by a doctor who had cared for the deceased for over 30 years. They were both young when they met and went through the ups and downs of life together. Doc spoke about his warning to her to not get pregnant, his fear when she did anyway, and his joy of watching her experience motherhood,. Doc shared how her cystic fibrosis pushed all the limits of medicine and he was amazed she lived to see her 28 year old son marry. Doc laughed and cried through his eulogy and his humanity restored some of my faith lost to cynicism of ‘the system’.
This seems to me to recognize the feelings (sorrow, guilt and relief) that caregivers feel after seeing their loved ones die after years of slowly going downhill due to chronic diseases. As you watch a vibrant person decline, especially when the diseases affect their cognitive functions, you feel relief when they pass on that they are no longer having to fight, but at the same time the caregiver feels sorrow for the loss of their loved one. The caregiver also feels guilt remembering every time they were late in giving medicine or made other mistakes in the care of their loved one. I especially liked your noting the horrors of the 21st century healthcare in the final weeks of death.
I hope that this compassion you have for your patient, family and self could spread wide and far in medicine. I bet your patients and their families are very fortunate to have you caring for them. This is almost the story of my mom's passing. She had battled a lot (oral cancer, malnutrition as a result, a non-healing surgical back wound from an MRSA staph infection post back surgery). It was a long road. And when she died of a heart attack alone, her health was the best it had been in years. I do believe that the poor concern for the tentative balance she lived in without saliva and the challenges of nutrition are what lead to her death when she had a.knee arthroscopy and she decompensated post-op and went into AFib and heart failure. A cardiac workup showed no evidence of clogged arteries that would have suggested she was ripe for a heart attack. But who knows in all honesty except it was her time. She died quickly. She was found in a comfortable position that indicated she knew she wasn't well but she didn't struggle. In the end, despite all the millions and millions of dollars of healthcare, not one doctor reached out. Her ceramic arts teacher did! Who also mentioned her creative fire was out. So it's those comments that give solace. She is now no longer encumbered by her physical body that had broken down and affected her ability to be free. I appreciate what it seems you do for your patients and families by being in your process and feeling what you do. It's remarkable in this day and age and how crazy and busy and impersonal medicine, for me, seems to have become.
As a NICU nurse, I have had many days where "doing our best" just wasn't enough to save a tiny life. I have had the same reactions as you - second guessing if there was something we could have done sooner/better, did we miss some small tell-tale sign that the infant was going to decompensate? Relief that the infant will be spared a life full of dr visits and (in many cases) severe deficits which is quickly followed by guilt that you even felt the relief. Overwhelming compassion, sorrow and heartbreak for the parents as they struggle to say goodbye to this tiny life. I have cried with parents at the bedside and in hallways, bathrooms or on my ride home from work. Each death has left an indelible print on my heart.
"How a doctor reacts to a patient’s death (and thus, maybe this whole reflection) is pretty unimportant."
I love the essay but not sure i agree with this statement. unimportant relative to ?
If a doctor does not grieve, does not feel any o these emotions that says a LOT to me. It matters to my patients that i feel those things for their family member
Three years now after my wife passed and my thoughts wander into was there something more I could have done? Could I have forced her to understand self care from her trach as she was learning to live with the device. And a tiny voice in the back of my mind says I could not have done more. Still I often reflect without answer. But perhaps someday I might know.
It’s wonderful that you have made the effort of writing about this woman’s passing amidst the horrors of ‘21st century healthcare’ where there is no ‘care’ left in healthcare anymore.
Given that you would have witnessed or been a part of several of your patients dying , has it changed your own views of life and death, your practice of medicine and ‘patient care’ and has it resulted in the ‘guilt’ aspect coming down?
You are not alone in feeling these emotions and I appreciate you sharing. Sometime I think we as healthcare practitioners forget we are human and experiencing emotions comes with that. And since we frequently witness those at the end of life it would be inhuman to not go through a wide range of emotions. Thanks again, your Reflections remind me that we are treating people not just patients.
I've been thinking about the idea of mourning a lot lately, even wrote a bit about it myself.
Somewhere I can read?
Sure, this is my most recent piece although I also wrote earlier about coming to terms with the fact that you're going to die:
https://tvphilosophy.substack.com/p/ghosts-and-dying-with-dignity
You know, I can't help but think we can do "21st century medicine" better, that this should not be a reference to how industrialized, mechanistic, and bureaucratic our medical system is. However, it is definitional. We can do better.
We have to seize the means of production, including in medicine. It's the only way out. The core reason why things are this way is that the underlying profit motive of our society is pretty much its only driving force and the only value it holds sacred.
My mother died at 39 of systemic scleroderma. Even as a child, it was important to me to know that her doctor cried when she died. Years later, the same doctor cancelled my medical bill to him in order to get me out of working a dead-end job and into teaching college. His goodness and mercy has inspired me all of my life. Thank you for modeling the same concern and dedication to your patients.
What is curious to me how the cause of death might have affected your thoughts and feelings on the death of a long time patient. And yet that is not mentioned once. Is it not relevant?
If she has died unexpectedly from an MVA, a heart attack, a stroke, a fall, an allergic reaction, an accidental poisoning/overdose, a diabetic event or a suicide wouldn't each of those causes affect your thoughts in different ways?
It also strikes me that how we think about "unexpectability" might be an important reflection point.
Not making it 24 hours to the next day's breakfast, is about a 8 micromort event for an "average" 66 year old (if I remember my tables). That's a reverse lottery ticket.
66 even with all of the medical issues still seems young, perhaps because my wife and I are in that cohort. Even when my grandmother died a few months shy of her 99th birthday that was "unexpected" - or at least it was to her -- she lived independently and the night before (a stroke) she had wrapped a birthday present for a great grandchild and laid out a dress to wear to the party the next day.
Thinking about daily, annual, five-year, ten year, and 20 year mortality rates (all cause and specific cause) might be a good thing for physicians and patients to incorporate into sensible medicine.
Thank you for sharing your reflections.
The cause of death IS so important. Probably gets most the guilt aspect. Was this something I conceivably could have prevented?
Thanks so much for reading and commenting.
Adam
Thank you for writing this out Adam.
Isn't it in fact, "the fine print" in all lives. So many joys, even as a doctor patient relationship
and all relationships of care giving, on every level.
The bond is close as both of you have a connection of dependency of some measure.
One of us will always out live another, and hold those memories tight.
We just hope we can give then happiness, and good memories in the end.
This reminds me of one experience when I was a young nurse in an orthopaedic office so so many years ago. We did not experience many deaths in ortho patients, one attraction for me.
We did have a very long term patient that came in regularly with knee pain, she eventually had total knees, and a total hip. One thing that stood out for us when we saw her name on the list coming in, we had to try our very best to make her happy because she was perpetually unhappy. Of course, it was the pain, and the struggle for her. We never saw that woman in a really good mood but one time upon knowing she was coming in at 1:00 pm, I zipped over to the local store and picked up some flowers to give to her when she came in. Just so she knew we loved her.
Suddenly one Monday that over the week-end, long after the flowers, she was struck by a car (SE DC streets) and rushed to the hospital. They were unable to save her. When we learned of this we were crushed. Our most grumpy patient!!! I know she did not deserve to leave this world like this.
Thank you for sharing this. My mom died of COPD. She had many wonderful doctors. She was a patient that while suffering always was able to brighten a doctors day. Her Doctor, that’s what she called him, Dr Domby. He can’t start to imagine what he meant to her. She grew to love him as a family member. In doing so our family grew to love Dr Domby as well. Just so you doctors and nurses know, there is a special place in the hearts of our families for those of you who care. We love you and we appreciate you.
Thanks so much Linda.
Adam
One of the most touching eulogies I’ve witnessed was by a doctor who had cared for the deceased for over 30 years. They were both young when they met and went through the ups and downs of life together. Doc spoke about his warning to her to not get pregnant, his fear when she did anyway, and his joy of watching her experience motherhood,. Doc shared how her cystic fibrosis pushed all the limits of medicine and he was amazed she lived to see her 28 year old son marry. Doc laughed and cried through his eulogy and his humanity restored some of my faith lost to cynicism of ‘the system’.
This seems to me to recognize the feelings (sorrow, guilt and relief) that caregivers feel after seeing their loved ones die after years of slowly going downhill due to chronic diseases. As you watch a vibrant person decline, especially when the diseases affect their cognitive functions, you feel relief when they pass on that they are no longer having to fight, but at the same time the caregiver feels sorrow for the loss of their loved one. The caregiver also feels guilt remembering every time they were late in giving medicine or made other mistakes in the care of their loved one. I especially liked your noting the horrors of the 21st century healthcare in the final weeks of death.
I hope that this compassion you have for your patient, family and self could spread wide and far in medicine. I bet your patients and their families are very fortunate to have you caring for them. This is almost the story of my mom's passing. She had battled a lot (oral cancer, malnutrition as a result, a non-healing surgical back wound from an MRSA staph infection post back surgery). It was a long road. And when she died of a heart attack alone, her health was the best it had been in years. I do believe that the poor concern for the tentative balance she lived in without saliva and the challenges of nutrition are what lead to her death when she had a.knee arthroscopy and she decompensated post-op and went into AFib and heart failure. A cardiac workup showed no evidence of clogged arteries that would have suggested she was ripe for a heart attack. But who knows in all honesty except it was her time. She died quickly. She was found in a comfortable position that indicated she knew she wasn't well but she didn't struggle. In the end, despite all the millions and millions of dollars of healthcare, not one doctor reached out. Her ceramic arts teacher did! Who also mentioned her creative fire was out. So it's those comments that give solace. She is now no longer encumbered by her physical body that had broken down and affected her ability to be free. I appreciate what it seems you do for your patients and families by being in your process and feeling what you do. It's remarkable in this day and age and how crazy and busy and impersonal medicine, for me, seems to have become.
I am so sorry for your loss. A beautiful story. As a (hobby) potter, I am not at all surprised that the ceramics teacher reached out!
Yes, the heart centered in the moment people...they know how to be in the human experience...
As a NICU nurse, I have had many days where "doing our best" just wasn't enough to save a tiny life. I have had the same reactions as you - second guessing if there was something we could have done sooner/better, did we miss some small tell-tale sign that the infant was going to decompensate? Relief that the infant will be spared a life full of dr visits and (in many cases) severe deficits which is quickly followed by guilt that you even felt the relief. Overwhelming compassion, sorrow and heartbreak for the parents as they struggle to say goodbye to this tiny life. I have cried with parents at the bedside and in hallways, bathrooms or on my ride home from work. Each death has left an indelible print on my heart.
Thanks for doing your incredible work... and for caring.