Saturday, 9 January 2010

Death

Yesterday I visited two patients around the age of 90 who both spoke to me of being ready for death. They were not suffering unbearably, but their faculties were failing and they were finding their lives irksome. On returning home I read a book review in the BMJ discussing death, which suggests that we need to accept it in order to live a fully human life. Somehow it gives life its worth - for immortality would be intolerable. And I am currently reading a theological book which describes how one of the purposes of religion is to let us step outside our mundane existence and come to terms with suffering and death. As I am now nearer the end of my life than the beginning, I wonder whether part of my value to patients is to present and interpret this sort of truth to them. I certainly feel that this is a more worthwhile use of my time than doing bean-counting audits.

One of those two patients was a charming and courteous Welsh gentleman living in a residential home. I found it a joy to talk to him, and as I left I said "you're the nicest Welshman I know". "You don't know very many" he replied.

11 comments:

Anonymous said...

When theses patients are admitted to hospital by the out-of-hours service with, say, pneumonia how are we hospital doctors supposed to know what their wishes are if they are too ill to tell us?

Eileen said...

If I weren't such a coward I would have a tattoo across my chest with a DNR for certain circumstances - I really don't want to be kept alive just to be a vegetable. And later on, I would like the option of a dignified exit.

Isabelle said...

Immortality might indeed be intolerable but I do feel that a life about twice as long - a capable life, I mean, only slowing down at about 160 - would be a better idea. I say this as I approach 60...

Eileen said...

Isabelle - I, too, am approaching 60 (hence the later on aspect of exiting) but I really don't think I want another 100 years of the world as it is even if I were to remain capable and live in a wonderful area of northern Italy!

I really meant to comment on the acceptance of death, though. Death must be part of life - as it used to be when people tended to die at home, not in the sanitised anonymity of a hospital. Our attitude to our journey towards death from birth has become warped I think: consider the distress we see on the part of many mothers as their children first go to school, then leave school, leave home. Each of these is a step we take in that journey and I have always seen them as the completion of a step I have taken (successfully, I hope) in preparing my children for their turn in life. That is a form of immortality, is it not?
Another, albeit slightly different, aspect concerning death is the denial of where our food comes from - if you want to eat meat, then animals must be killed. And here, where I live, most of the meat I get at the butcher had a very nice life halfway up a mountain before being slaughtered for my consumptiom. If we want to eat meat then we should allow the animals a decent level of comfort first!
But death and taxes are inescapable - we might as well accept them and make the best of it. When my time comes to go I want to feel I didn't waste my time here - so I'll get on with it.

Eileen said...

You might be interested if you haven't seen it: Voice of Reason at shadesofgreynursing.blogspot.com wrote a series of posts on death and dying in December 2009 which link to your post on "Death".

Fuddled Medic said...

Death and time are friends of ours, they both help to make us appreciate what life we have been given and that we need to make the most of it

Dr Andrew Brown said...

Thanks everyone for your comments.

Anonymous: I'm sure it can be difficult. Asking relatives may help. And don't forget that your treatment may not affect the outcome much.

Isabelle: perhaps you would feel different at 90?

Eileen: my thoughts on euthanasia are (a) it's a primarily a problem of public safety, and (b) it shouldn't be doctors who administer the "treatment". I like your comments on acceptance, it's all about "letting go".

Fuddled Medic: I'm sure you're right.
"Give me your arm, old toad,
Help me down Cemetery Road."

StorytellERdoc said...

Great post. Very respectable and compassionate to accept finality of life. Many people fear this and it is simply part of the cycle that we must embrace and prepare for.

Well done on how you handled your patients!

Eileen said...

Me again! Dr B: I didn't necessarily mean euthanasia (although I have little problem with the Dignitas concept) but nor do I want to be taken to hospital when I am terminally ill anyway and be aggressively medicated/treated just to give me a short time longer. My mother died at home, in no pain and with no fear, of advanced cardiac failure. Had the ambulance arrived 15 minutes earlier she would have been rushed to A&E and cannulated and all the rest of it. Not dignified and, in the longterm, not changing the outcome. She did not want to live housebound and dependent on anyone and had made the choice NOT to take her medication. She had had 79 years of a full life - 11 had been as the result of a successful resus whilst on holiday in Germany followed by a triple bypass. She died the way she wanted - after having been out to work at the coffee bar she ran for the WRVS earlier that day (it was to be closed shortly after).

Dr Andrew Brown said...

StorytellERdoc: thanks for your kind comments.

Eileen: I'm very happy with the idea of not treating people aggressively when their quality of life is poor. But as Anonymous said, it can be difficult for doctors who don't know the patient to get things right.

Edwin said...

is there any term called immortality..if yes show me one..every life is followed by death irrespective of his/her wishes..