Doctor, Am I Going to Die?

Every time I co-staff the Medical-Psychiatry inpatient unit, our interdisciplinary team encounters a patient whose plight is not just medical, not just psychiatric, but fraught with complicated social and health care system pitfalls. More than occasionally it becomes necessary for doctors, nurses, occupational therapists, physical therapists, family members, and everyone else involved with the patient must learn to sit in the chair, listen, and simply share the sorrow when the patient asks, “Doctor, am I going to die?”. Often the challenges these patients face are in the context of terminal illness. Sometimes they need to make decisions that are critical to what our modern society nowadays considers vital to preparing for a “death with dignity”.  So when primary mental illness and brain cancers produce delusions and delirium that interfere with that goal, what then?

What if the patient doesn’t want to know about the nature of the disease which will eventually kill him? What if he doesn’t want to know or can’t understand any of the details about risks and benefits of conventional treatments and those that are being offered as part of randomized, placebo-controlled trials?

We must somehow tolerate this sorrow and be with someone suffering near the end of life. They are afraid and so are we. We must be willing to interrupt the hurried and problem-focused way we conduct rounds on the unit. We have to sit quietly with them, holding hands, witness their tears and wonder ever and again about the propriety of crying with them. And we again become aware of a time most of us never lived through in the history of medical practice–an era when, more often than not, holding the hand of the suffering fellow human being was all a doctor had to give. And we remember this gift again and again.

I’ll always remember what I learned from a brilliant and sensitive internist who co-staffed the Medical-Psychiatry Unit with me many years ago. During one of these pivotal and painful moments with the family of a patient diagnosed with a terminal illness, Dr. George Lawry told them about what direction physicians could take. He framed it as two lists: “The list of things doctors can do to your loved one is long because medical science has advanced so much in the last few decades. Though the list is long, they might not be the kindest things to do. On the other hand, the list of things we can do for your loved one is relatively short, but they may be kinder.”

Though I can’t say it half so well as George, I have learned to say something like it over the years, not just because I respect him as a doctor and a teacher…but because I believe in it.

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Comments

  1. Very nice (difficult situation handled with kindness)!

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