It's something we all must think
about sooner or later. It's more inevitable than clothes
piling up on the bedroom chair and it's something doctors
certainly spend a great deal of time dealing with. Indeed,
the very nature of a physician's job makes death an
almost quotidian workplace reality. Surely those morbidity/mortality
— "M and M" — rounds give doctors plenty of
chances to ponder death. But does a doctor's experience
and medical training help him or her cope with death
better than some greenhorn med student or John Q Public?
To get an answer to this burning
question, we asked a physician, a med student and a
musician to speak candidly — and anonymously about
death. Here's what they had to say.
DYING
WELL
"I think the predominant view is that death is the worst
outcome you can have," opines Dr A, a family physician.
"I think it can be a very good thing. We undermine the
idea of people having a good death."
A study in the July issue of
Academic Medicine echoes his views and trumpets
the value of "good deaths" for both patients and physicians.
The article warns of the horrors of "overtreated deaths,"
where family members often pressure caregivers to aggressively
treat patients with one foot in the grave. The problem
with these overtreated deaths, write the authors, is
that they often prevent a patient from reaching any
sort of emotional closure.
When asked if his views about death
or illness change if it's someone he loves on that stretcher,
Dr A admits it makes a difference — though not
in the way many outside the profession would expect.
"Being in family medicine, I ideally try to think of
the whole body experience regarding disease or illness,"
says Dr A, "but it's hard as a doctor not to take that
step back regarding whatever is going on and look more
solely at the biological aspect of it. My instinct is
still for information gathering and diagnosis, even
when it's a personal thing.
MED
STUDENTS' VIEWS
"Death is the end of life on earth, but your spirit
continues on," says MC, a med student. "I don't see
it as a bad thing." She's quick to point out that her
relative comfort with death is a byproduct of her devout
Catholic faith. But for med students who haven't shaken
off their fear of death, there's a fascinating program
at the Harvard Medical School Center for Palliative
Care where future doctors learn from the dying. Students
are paired with terminally ill patients who they're
expected to interview and spend time with.
An article on the program in the
September 29th New England Journal of Medicine quotes
one med student as saying, "I'll always remember [the
end-of-life patient] as an amazing teacher — a
gift to me in terms of my life. Since I know that she
is ready [to die] and has found acceptance and completion,
it makes it easier for me to accept."
A
LAYMAN'S VIEW
JT, a jazz guitarist, who's lanky, bearded and something
of a modern-day beatnik, ponders our questions about
death and illness. His responses are strikingly similar
to what one would expect to hear from a physician.
"Death is a part of life. I don't
fear it," says JT philosophically. "I'd say I fear pain
more than I fear death." When he mentions the AIDS-related
death of his uncle several years ago, he looks away
and his voice flattens. "I just kind of accepted it.
It was expected, it would have been different if it
was sudden."
Dr A, JT and MC all share their
views on why we get sick. "I don't think you get sick
to be punished — it happens to good and bad people
— it makes no difference," says MC. JT adds "illness
isn't anyone's fault — it's just that life's like
that." Dr A thinks he has a pretty good idea why we
get very ill and accepts his own mortality, "I don't
go to the doctor. I ignore my health like everyone else."
Additional reporting by Peter Woodford.
Christina Cheung is a fourth year medical student at
Queen's University.
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