As a cancer survivor and a caregiver of an 86yr old with dementia, I find myself attracted to discussions about quality of life, death, healthcare etc. So when I discovered a book written by a physician titled Final Exam- a Surgeon's reflection on Mortality... I was intrigued. I read it in a day. It has relevance to anyone who has been in a hospital, faced the process of "terminal illness" with a family or friend, and/or wondered about it for themselves. And aren't we all terminal at some point? So this is good food for thought... from someone who is on the front lines of our healthcare attitudes..
Dr. Chen is a modern physician who has 15 years under her belt as a surgeon specializing in transplants. That puts her up close and personal with death. And yet, her point is that for all of the training in med school, all of the hands-on experience, and all the talk about death, physicians and their patients rarely TALK about end-of-life. And in this avoidance both physician and patient are LESS comforted. Not more. The physicians psyche is bent on extending life. As she says, there is NO protocol which says to a surgeon facing a hopeless dead end... to sit on their hands. Do nothing. Wait and see.
There are many reasons for the problem.In the Handbook on Mortality, the authors write. "Perhaps the classification as "dying"is really more like height than it is like gender. Some people are clearly "tall " or "short," but many are "in between. Likewise, some people are clearly "dying" or "fully healthy," but many are "in between." In fact, most of us will die without having a period when we could readily be recognized as "dying" or "terminally ill." The new reality is that most of us will die from complications of a serious chronic illness that we will "live with" for years. There will only occassionally be a transition from that "living with" to a time of "dying from."
The question: When is enough.... enough ? is something she and her fellow physicians struggle with. Their training says keep going. The system says keep going. But patients, and the families suggest otherwise. And, when asked what they would want for themselves if diagnosed with a terminal illness, the overwhelming majority of physicians would choose to limit or withdraw life-sustaining therapy. ... Fully a third of the fully trained attending physicians felt they had acted against their conscience in providing care to the terminally ill... offering mechanical ventilation, CPR, dialysis, artifican nutrition, even as they believed those treatments to be "very burdensome."
This is a timely book for all of us baby boomers who are going to grapple with our own mortalitiy and under the best of circumstances will get to decide when "enough is enough." One of the physicians in the book suggests that the more terminal the patient the greater the need for a physician who will sit on their hands...but not their heart. We do need to change healthcare in this country. And one of the biggest paradigm changes would be to shift from extending life...to simply sharing the process of life...to the end.
