Should moving towards the end of life begin a conversation?
Being Mortal
Dying is an inevitable part of life. In the manner that we celebrate and discuss the process of birth, why we can’t discuss the process of death? Even for medical professionals, who have seen people going through the process of dying more than anyone else, they are not completely comfortable talking about it with patients or patients’ families.
When a patient has reached an advanced stage of illness when it is clear that the patient needs palliative care, how does a doctor convey this message to his or her family? And is the family open to accepting the fact that the patient may or may not be able to go back home, back to how they were before becoming ill?
The answer to this is palliative care, which concentrates on providing comfort and improving the quality of life in the advanced stages of incurable illness. It certainly does not mean that a patient or his caregiver has given up the hope, or that the patient will not be provided with any medical help. Palliative care helps in making the transition from life to death a comfortable and dynamic phase, where relationships still flourish, where patients can are helped with maintaining dignity and independence, to the last moments.
How Doctors Tell Patients They’re Dying
This powerful video takes us through the last days of a critically ill patient and his wife, and the wife’s conversation with a physician with training in palliative (end-of-life) care. Dr. Zara Cooper, an emergency surgeon, shares that most patients are in denial that they are nearing death. A senior palliative care physician, Dr. Kathy Selvaggi, is also brought in as the patient’s condition worsens. The couple has many plans for the future, although when the doctor talked about the end of life and hospice care, the wife said that she knew that “it” was coming but she wasn’t able to accept the fact.
According to Dr. Selvaggi, the conversations around the end of life should not be waiting for the last week of someone’s life.
Medical Soft Skills Training: Delivering Bad News to Patients
This video highlights how a physician can deliver bad news to a patient, although he/she has to adapt the conversation to accommodate various external and internal factors.
There is a step by step protocol published by The Western Journal of Medicine, which can be read here.
Watch this moving video “Man sings to 93-year-old dying wife”
This viral video is about a couple who have been married for 73 years, with the wife making peace with her final days. We can see and feel the profound connection of this couple and the poignant goodbye occurring in front of our eyes. When we encounter patients in the hospital, ill with family around we don’t necessarily appreciate these profound connections.
Breaking Bad News to Patients
Dr. Mikkael Sekeres shares his experience of informing a patient, who is in his mid-30s with Down syndrome, and his mother, about the patient having cancer and the future course of action.
The End-of-Life Nursing Education Consortium (ELNEC) project by American Association of Colleges of Nursing is a national education initiative to improve palliative care. The project provides undergraduate and graduates nursing faculty, Continuing Education providers, staff development educators, specialty nurses in pediatrics, oncology, critical care and geriatrics, and other nurses with training in palliative care so they may teach this essential information to nursing students and practicing nurses.
We certainly need more institutes and courses providing training in palliative care. Although there have been extensive innovations and advancements in the medical sector, there is a growing necessity to formulate strategies for clinicians to handle these complex medical situations with greater care and awareness. Being helpful in these situations requires not only good communication skills but also emotional awareness. Although rehearsing is a good option very often these complex issues and the relationships encountered present themselves in unpredictable manners. At that point, the humanity of the clinician is the most helpful tool to rely on.
About the Author
Dr Gavril Hercz
Dr. Gavril Hercz is a nephrologist at Humber River Hospital and Associate Professor of Medicine, University of Toronto. He completed his psychoanalytic training at the Toronto Psychoanalytic Institute and is a member of the Canadian Psychoanalytic Society. His major area of interest is the impact of physical illness on patients, families, and caregivers.
Being Mortal Dying is an inevitable part of life. In the manner that we celebrate and discuss the process of birth, why we can’t discuss the process of death? Even [...]
