Saturday, April 11, 2020

"Bugle Notes" - On Death and Dying

 Death is inevitable. How we die, though, we can and should have more control over. We are most fortunate in this country to have Palliative Care and Hospice programs. These individuals are “angels on earth” as far as I am concerned. They enable our patients, friends, those dear to us to have that control while being cared for with compassion and dignity. I am so appreciative of the hard work they do. Yet, our healthcare system overall is not doing as well in this arena.  

In today’s aging, over medicalized, technological environment with increasingly challenging patient/family expectations, the concept of dying with dignity has become too uncommon. The highest expenditure of costs on patient care occur in the last two months of a person’s life and all too often for futile reasons. Atul Gwande’s book, “On Being Mortal”, provides great insight into the current state and the high costs, not only financially, but also emotionally on every person involved.

 In 30 years as an Internal Medicine Specialist, I cared for more dying patients than I can remember.  Some patient’s death, though, you never forget because of the circumstances surrounding it and the impact it had on you personally.

 I cared for her husband and her while in the Army years ago. She was dying of pulmonary fibrosis. She was a woman of strong faith with a loving, supportive family. Her desire was to die in her home, family surrounding her, with grace and dignity. I had developed a very close relationship with them both. They were wonderful people. They had become my friends.

One night, I received a phone call from her husband - she was near death and could I come by to see her? I drove to their house where I met him and the three daughters who had flown in from other states to be with their mother. By the time I arrived, she had died. I remember standing at the bedside with the family as the husband prayed. Afterwards he thanked me for the care I had provided her. 

That day was the birthday of the youngest daughter. They had plans to celebrate it with cake and champagne. Then a most remarkable thing happened. The daughter poured a glass for each of us and led us outside to the patio. The night was clear and the stars were shining. She lifted her glass to the night sky and thanked God for her mother’s life and the blessing she had been to her, the family, and so many others. We toasted her and then we celebrated her birthday, tears of sadness now mixed with tears of joy. Their mother, my patient, my friend, had her wish fulfilled.

Moments like this are a reminder of the privilege we have to be so intimately involved in the lives of our patients. It is a humbling experience during these sacred moments because of this privilege and the relationships that result from it. What you do so well every day in the care of others, is hard work, very hard work. It is important work. Thank you for caring, serving and loving so well.

Andy Lamb, MD

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