Posted by: sayamika, the killer bunny | 2009 August 16

End-of-life care and death squads

During my undergraduate medical training, we had a section on end-of-life care, also known as palliative care. This section was led by a sensitive and caring physician, who had himself been to the brink of death.

He talked to us about such broad concepts as medical futility, acceptance, “total pain,” and oneness.

We were a group of medical students, mostly in our early 20’s. We believed that the function of medicine was to save lives. The people we couldn’t save would represent our failures. His talk frightened and embarrassed us.

We were terrified on our actual first visit to see his patients.

In a palliative care ward, I expected to see old people, crying people, sad people, people in wretched pain, people drugged to unconsciousness, people who were depressed and suicidal, people vomiting and retching. I was expecting to see the people medicine was giving up on.

My professor introduced me to a young man of 23 in a hospital gown. This young man smiled and shook my hand. His mother and grandmother were present, in street clothes. They were smiling as well.

This young man explained to me that he had had cancer as a young child, had been successfully treated, and had been many years cancer free. He now had lymphoma, and had had it for five or six years. He had exhausted several treatments, but secondary lymphomas, he explained, were harder to cure than ones with no known cause.

He was in the palliative care ward because he had chosen not to have surgery for a complication of his lymphoma, and this had been expected to end his life. They had tried a new drug, however, which had worked for the time being, “So, actually, I’m going home today for a while. We’ll see where things go from here.”

I was surprised: I know this isn’t the usual outcome. But what surprised me more was how serene and accepting he and his family were.

My professor had some thoughts about this young man. His life was in order. He knew the end was coming. Every day for him was a gift, and he was pleased to have it to spend with his mother and grandmother. He had expressed regrets- having been too ill to date and have a proper girlfriend was chief among them- but he chose not to dwell on this as he neared the end.

The professor was an sweet man, with many theories. He said the human animal had the capability to find peace and acceptance almost anywhere. He told one story to illustrate: Once, he was at a concert downtown. The music was exceptionally fine, the audience was entirely in tune with the musicians. The hall was suffused with light. At one point, the entire audience was singing, and my professor said he felt a profound sense of oneness, a tingling to his fingertips.

And that was when he realised they were singing about Saturday night being Alright for Fighting…

Death squads? Oh, I must have missed those. End-of-life care is one of the most important parts of primary care medicine. Do they really think if they take out end-of-life care wording, people will stop dying?

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