This piece was published [see url below] by a primary care colleague much concerned with the state of health [insurance] reform. Although he does not comment upon it explicitly in the piece, Doctor Lillis’ comments point out to each of us that the “death panel” hysteria perpetrated by a very foolish group of politicians early this year has very clearly done the American people harm. Doctor Lillis is correct: we are each dying. And to disallow the conversations – by calling them death panels – between patient – family – and physician is a profound disservice. AJ Layon (Accessed 8 October, 2010).
Everyone is dying, so why are so few talking about it ?
Don’t be afraid to talk about death
Date published: 10/3/2010
YOU ARE DYING. If you are reading this column, I can guarantee that you are dying. For that matter, I am dying, my wife is dying and, after my son is born next month, he will begin the process of dying.
How’s that for morbid? I do apologize for jolting you to attention this Sunday morning, but sometimes reality needs to be confronted.
Aging is an inevitable series of biological changes that occur on the genetic level that follow a fairly predictable progression from birth through maturity, to advanced age and death. And that’s if you die of natural causes.
I spend my days preventing and fighting heart disease, cancer and all manner of illnesses that can cut the progression short for my patients. But there are motor vehicle crashes, natural disasters and bear attacks lurking as well.
Our life expectancy – with all of our medical advances and in the absence of a premature illness or accident – seems to be pegged at around the age of 85. While some scientists are working on “longevity” research to see if they can push that a little further, it is going to be fruitless unless they start meddling on the level of DNA.
So, death and taxes are inevitable. For the latter problem, we can hire an accountant. But what about the former problem?
Last month I was invited by Gloria Lloyd, the bereavement programs educator at Mary Washington Hospice, to her weekly writing group. Through the writing group Lloyd moderates, family members can share their innermost feelings regarding a loved one lost. Some in the group lost a spouse, others a parent or child. But all shared their insight, grief and emotions surrounding the essentially universal experience: death.
I was moved. Tears flow easily when surrounded by loss, but also in the presence of the awe-inspiring selflessness of the group’s moderator and participants. The support offered in this group, and groups like it, provides an amazing service to those grieving a loss.
Grief is normal. Grief is painful. But grief is temporary, and having the fellowship of others who have experienced the same allows us to carry on for another day in our process of awaiting death.
A BIG QUESTION
If you have not read it, I highly recommend Dr. Atul Gawande’s essay “Letting Go” in the Aug. 2 New Yorker magazine (http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande?currentPage=all). Dr. Gawande is a brilliant writer and a surgeon at one of the Harvard hospitals in Boston.
In an amazing piece, he essentially asks the question: Which matters more–the quality or quantity of life? He asks the question because each and every one of us should have our own unique answer.
As physicians, sometimes we lose sight of the answer to this question. Perhaps because we forgot to ask our patient? The question rarely is asked in the middle of fighting a cancer with chemotherapy, or facing complicated surgery, or in the frenetic environment of the intensive-care unit.
Doctors sometimes focus solely on trying to achieve a cure, rather than asking your thoughts on how you would like to die.
Simply asking the question “How would you like to die?” seems grotesquely out of place for your physician, does it not? I am not proposing that doctors should ask this question the way you would ask, “Would you like fries with that?” Rather, this conversation is best handled with care and during times of good health.
Forethought prior to any health crisis allows for the careful consideration each of us should undertake to prepare for the inevitable.
BODY AND SOUL
Serendipity also points me to a recent research article in the August 2010 edition of the New England Journal of Medicine (http://www.nejm.org/doi/full/10.1056/NEJMoa1000678), the premier medical journal in the world.
Researchers in four hospitals identified patients newly diagnosed with lung cancer that was advanced at the time of diagnosis and had spread to other parts of the body. Once identified, patients were randomly assigned to one of two groups:
Standard oncologic care (surgery, radiation and chemotherapy)
Standard oncologic care in addition to palliative care.
Palliative care can be defined as care focused on improving the quality of life for those diagnosed with serious illness and includes pain management and caring for the emotional needs of the patient and his family.
The results are astonishing. Patients receiving palliative care in addition to standard care lived longer. And not because they had more care–they less frequently chose aggressive care (surgeries, intensive-care units), yet still had longer survival times.
I see this as a result of caring for one’s soul, not just the body.
Thinking about death need not be morbid. I choose to enjoy every day of my life and cherish the present rather than worry about the future. Many turn to their faith for comfort that they will move on to a better place. Some see death as an end to suffering.
Rather than harboring a fear of dying, or somehow expecting that death will skip you, I urge you to ask yourself and share your answer with family and friends: “How can I die well?”
Dr. Christopher Lillis is an internist with Chancellor Internal Medicine in Fredericksburg. He can be reached at firstname.lastname@example.org