What matters most in the end? Chances are the answer looks somewhat different for everyone. In our experience, people simply want to know that they’ve lived a good life and that they will die pain-free in the place they call home – surrounded by the people they love.
What if you’ve been struggling with a serious illness and curative measures are no longer of benefit to you? Will you be prepared to discuss with your family and your physician what you would like to do to make the best of the time you have left? Is your physician equipped to have these conversations with you when the time comes?
According to writer and renowned surgeon, Atul Gawande, doctors often struggle with how to talk with patients about death and dying. In a recent Frontline documentary about his book, Being Mortal, Gawande examines these struggles and the extremely complex emotional choices patients and their families experience when faced with death.
Prompted by his own feelings of discomfort and inability to deal with his patient’s circumstances when treatment wasn’t working, Gawande set out to explore the reasons behind the difficulty doctors face when having end-of-life conversations and what others are doing differently. He followed three patients diagnosed with terminal illnesses and filmed the conversations between the patient and physician.
According to Gawande, “[Many doctors are] walking a fine line on pulling the patient through to recovery and recognizing when it’s time to let go and allow the patient to pass with comfort and dignity.” In other words, they’re taught to fix patients. The most challenging “unfixables” are aging and dying, and when doctors realize they can’t control either, anxiety and fear ensues. Facing death makes both the doctor and the patient think about what more they can do to prolong life regardless of what they may be sacrificing along the way.
“It’s a charge to get to know the patient and their desires and fears about their management during a critical illness,” states Gawande. And, the earlier the conversation takes place the better. He encourages doctors not to wait until a crisis comes, which is often too late. Beginning the conversation earlier allows the patient the opportunity to think about and decide how they want to live out their last days.
Talking about decisions at the end of life is so difficult that there are physicians that specialize in “Palliative Care.” They help other physicians with their technique when broaching the conversation. Delivering bad news is always a challenge. According to Dr. Kathy Selvaggi, it’s just as much about listening as it is about talking. It’s very important for the physician to ask the patient about their understanding is of the disease. And if the doctor has to deliver news about a terminal condition, it may have to repeated several times and delivered in pieces.
Gawande states, “In medicine when we’re up against unfixable problems we’re often unready to accept they’re unfixable. But, I learned that it matters to people how their stories come to a close. The questions that we ask one another, just as human beings, are important…”
- What are your fears and worries for the future?
- What are your priorities if time becomes short?
- What are you willing to sacrifice and what are you not willing to sacrifice?
Answers to these questions will reveal what matters most to us in the end and how we’ll go about making the best of the time we have left.
Atul Gawande MD, MPH, is an American surgeon, author, and public health researcher. He is a general and endocrine surgeon at Brigham and Women’s Hospital, professor in both the Department of Health Policy and Management at the Harvard School of Public Health and the Department of Surgery at Harvard Medical School. In his latest book Being Mortal, he examines his profession’s ultimate limitations and failures – in his own practices as well as others’ – as life draws to a close. And he discovers how we can do better.