Stopping treatment

"If I have to go, then I have to go."

He looked well yesterday. In ICU, but he was sitting up, alert and able to communicate and articulate clearly. Today he seemed drowsy, struggled to talk, and well... had an aura of death around him. I was surprised and saddened at how rapidly he deteriorated.

The decision was made yesterday. He has had long standing diabetes, with amputations, and chronic kidney failure for which he's on dialysis. Recently, he had a pleural effusion, which was investigated and was diagnosed as mesothelioma. The consultant discussed with him the poor prognosis of mesothelioma, and the option of stopping haemodialysis. The registrar started crossing out everything in the long list of medications he's on except the painkillers. Indeed, there is no point managing blood pressure and diabetes when death is in sight.

"He has suffered enough," the doctor said to us. To the patient he said, "we will do everything in our capacity to keep your comfortable during this process."

"How long do I have?" he asked.

A week, two weeks? Will you die during my two week rotation on this unit? I know the decision is sensible. According to patient information sources, death from renal failure is relatively peaceful and painless. At least you have sufficient warning to settle your affairs. Nevertheless, death and suffering are so ugly it brings tears to my eyes. I wanted to say, I'm sorry, how do you feel? What's it like, preparing for death? What will happen to you when you die? Of course, we stood behind the doctors and asked none of those questions.

We walk out of the room. Everyone seems to have left the heaviness inside the room, and left unscathed. "It's sad isn't it?" I said to the other student, and I'm not sure if he hears because he starts talking about a different topic. Are doctors encouraged to be untouched by suffering? Who are you supposed to confide in?


tablecolor said...

Thanks for sharing. Even though I work (and train) in oncology and deal with deaths much more frequently, this still tugs my heart deeply every now and then. I've had my share of tales when i was a med student and fresh doc too, and it's refreshing to read your accounts :)

Winnie said...

thanks joe, I'll scroll through your tales sometime :) I guess there's always that delicate balance between caring/understanding suffering, and not being so emotionally involved that you can't do the job properly..


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