This one, too, is about healthcare--about hospice care. The title of this post is one of the question's the sisters of one of his patients apparently asked him. What was the patient's condition?
The septic shock had left her with heart and respiratory failure as well as dry gangrene of her foot, which would have to be amputated. She had a large, open abdominal wound with leaking bowel contents, which would require twice-a-day cleaning and dressing for weeks in order to heal. She would not be able to eat. She would need a tracheotomy. Her kidneys were gone, and she would have to spend three days a week on a dialysis machine for the rest of her life.So, back to the question, "Is she dying?”
I didn’t know how to answer the question. I wasn’t even sure what the word “dying” meant anymore.It used to be a simple question when I was young!
For that matter, less than a decade ago, when one of my favorite uncles was diagnosed with an advanced case of cancer, the oncologists at India's leading hospital advised the family to take him home. They may not have uttered the "d" word, but the message was clear.
But, things have changed now; Gawande writes:
medical science has rendered obsolete centuries of experience, tradition, and language about our mortality, and created a new difficulty for mankind: how to die.Perhaps I am in the minority who have pondered way too much about our own death. Even by the time I turned 30, I had given explicit instructions to my (then) family on what they ought to do if I developed serious health complications. If I were to die today, I am confident that it will be in peace. But then this is the view when I am healthy when the end of life does not seem to be that near. But, what if tomorrow I am told I have probably about six months left; would that change my perspective? I hope not. Because, of what Gawande writes here:
Two-thirds of the terminal-cancer patients in the Coping with Cancer study reported having had no discussion with their doctors about their goals for end-of-life care, despite being, on average, just four months from death. But the third who did were far less likely to undergo cardiopulmonary resuscitation or be put on a ventilator or end up in an intensive-care unit. Two-thirds enrolled in hospice. These patients suffered less, were physically more capable, and were better able, for a longer period, to interact with others. Moreover, six months after the patients died their family members were much less likely to experience persistent major depression. In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation, and to spare their family anguish.
Can mere discussions really do so much?Yes.
But, when I reached the end of the essay, I choked up and became emotional. Pain, suffering, and death are simply awful.
It is amazing that even when we are fully aware of the very short lives we have, we manage to make life unpleasant for others. I don't have to wonder what Kafka might say; he did address it in a very short story titled "The Next Village."
The following poem by John Updike, might be a an appropriate ending to this lengthy post on death.
Requiem
It came to me the other day:
Were I to die, no one would say,
"Oh, what a shame! So young, so full
Of promise — depths unplumbable!"
Instead, a shrug and tearless eyes
Will greet my overdue demise;
The wide response will be, I know,
"I thought he died a while ago."
For life's a shabby subterfuge,
And death is real, and dark, and huge.
The shock of it will register
Nowhere but where it will occur.
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