Sunday, April 1, 2012

How Doctors Die

“How Doctors Die - It’s Not Like the Rest of Us But It Should Be”

That’s the title of an article our niece Carrie sent us a link to shortly before Chuck’s Tanta died. Written by Ken Murray, MD, it was timely then and, most likely, will be timely many more times during our lives.

One of the things which required the most explanation as we began telling family and friends why Chuck’s Tanta was entering hospice care, was that she was not going to have a biopsy and there would be no treatment for her cancer.

Tanta had the same primary care physician for decades. His colleague had been her mother’s doctor back in the 1980s. Tanta and we met with each doctor about a week apart. At the second appointment her primary confirmed the diagnosis of liver cancer. He explained that the size of the mass and the progression of the disease was quite clear from the CT-Scan. He told us that they had seen nodules on both of her lungs, which they believed was likely a recurrence of the lung cancer Tanta had beaten successfully many years before. Now it seemed that the lung cancer had metastasized to the the liver. But even if it were an intrahepatic cholangiocarcinoma the options and outcome would be the same. A biopsy was not necessary because it didn’t matter which kind of cancer it was. It was untreatable.

We live in a time when treatment, often aggressive treatment, is the norm. The CT-Scan had been done in Boston at one of the finest hospitals around. Both of Tanta’s doctors were affiliated with that hospital. We all went into those appointments expecting to come away with a treatment plan. Instead, two experienced, compassionate doctors were very frank and honest with Tanta, while also being gentle and respectful. Initially the news that there was no treatment which would not do more harm than good was startling. But in short order we all came to understand the wisdom of their advice.

Tanta was given the truth. It was a gift. Tanta also gave us a gift long ago by spelling out, in no uncertain terms, her desire to spend her final days at home. Because of both of these gifts she did not spend her last weeks being shuttled to doctors and hospitals for unnecessary treatments. Instead she stayed in her own home where family, friends, neighbors and rabbis from her temple could stop in for a visit. She had round the clock care and, as she put it, she didn’t have to wait twenty minutes after she rang a bell for someone to respond to her needs. And the brilliant hospice staff was in regularly to tend to her physical, emotional and spiritual needs - but always on her terms, not theirs. Tanta died peacefully and, most importantly, she died with dignity.

Not everyone is able to die this way. Dr. Murray’s article spells out very clearly why we all need to think ahead and understand all of our options. The resources and options are increasing - not just for treatment of disease but for hospice and palliative care. We have choices.

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