Medicine From The Trenches

Experiences from medical school, residency and beyond.

My Patients Do Not Die Alone…

Introduction
One of the duties of a physician is to attend to those, who are near death, who are dying and who will die in your care. From the time of the first patient that I pronounced as a newly minted MD to the present, I consider my presence at the end of my patients’ life one of my sacred duties as a modern practitioner of medicine.
My first experience with death as a physician
The second-year resident had paged me to let me know that a patient was coming out the TCV (Thoracic, Cardiac and Vascular Surgery Intensive Care Unit) into my care as the resident covering the Thoracic floor. She said that she would write transfer and floor orders but as this patient was dying, all I would have do is to pronounce and fill out the “Death Pack”. She said that she didn’t think he would last very long and would be no “trouble” for me.
As soon as the floor notified me that the patient had arrived, I ran down the stairs to see what I could do for this patient. He was a 38-year-old man who had a massive dissecting thoracic aortic aneurysm that was inoperable. He was not conscious but I could see that his breathing was shallow and slowing.
“Does he have any family that need to be notified?” I asked the nurses. They said that they were sure that he had no relatives. I looked at his chart and found no family contacts. I headed back up to my call room to fetch my surgery journals. Since my father’s death (before I started medical school), I will not allow anyone to die alone. I would be present in this moment with this patient.
I settled into a blue chair next to his bedside and moved close. I looked at his peaceful yet young face with curly blonde hair and a very neatly trimmed mustache. “I am not going to leave you,” I said. “It’s OK to leave because you must but I am here if you need anything,” I said to him as the nurse looked at me quizzically. I said a prayer of thanks for being able to be with this very young man in the final hours of his life. I didn’t know him, other than what was on his chart but I knew him as a human being.
I decided in the moments that I sat with this patient that sitting with my patients in death, being present with my patients in death, is something that I would do for those under my care. I would be thankful for the privilege of being present as a soul that might connect with another soul beginning a journey.
Death and being a physician
We can read many articles and texts on how to handle the death process from the standpoint of being a physician. In some manner, every physician finds a strategy to deal with the death of a patient that is under their care. Some attempt to look at death as an opponent that must be conquered while others look at death as a part of life.
As a physician who is a life-long Christian and a person of faith, death is neither an enemy nor part of life. Death is a transition into eternal life for my patient, my belief since childhood. The physical body is left behind but the soul soars and continues eternally. As a physician, my vocation challenges me to make sure that the physical body, in terms of health, is optimized but death of the physical body happens no matter what we, as physicians do.
In the Christian doctrine
“Jesus said to her, “Your brother will rise again.” Martha said to him, “I know that he will rise again in the resurrection on the last day.” Jesus said to her, “I am the resurrection and the life. Whoever believes in me, though he die, yet shall he live, and everyone who lives and believes in me shall never die. Do you believe this?” – John 11:23-26
Many of your patients (and their families) will be Christians and will have heard the above Biblical passage many times. Still, in most cases, the death of a loved one will be very difficult evoking anger, sadness and a host of other emotions. Additionally, other faiths have explanations of death and its place in the life experience.
No matter the faith (or non-faith) of my patient, I try to assure them that I will make my patient as comfortable as possible. If family are present, I encourage them to speak with their loved one even if there is no answer. I encourage family members to touch, embrace and hold their loved one. If no family, I can do this easily.
Many of my fellow surgeons
Many of my fellow surgeons are very uncomfortable with spiritual aspects of patient care and the spiritually of their patients. From my Introduction to the Practice of Medicine in medical school to my present practice, I was never uncomfortable with sharing the spirituality of my patients or their families. For me, this sharing has been an honor. My practice partners tend to dismiss spiritual matters in favor of surgical matters but for me, spirituality and surgery are intimately connected.
I have often shared my belief that patients who are spiritually connected and comfortable have better outcomes in all aspects of their care. As I have aged in my practice, I have become more, rather than less spiritual. As a medical student, I was encouraged to ask patients about spiritual beliefs and discuss them if necessary. One of my fellow surgeons said that he would rather have “brain surgery” than discuss “religion” with a patient. I simply asked, “Why not?”
“Why are you infinitely comfortable with your hands in a patient’s abdomen but you are uncomfortable with discussing spirituality?” As I have gained more life experiences, I tend to see that when I may not be able to treat illness with a scalpel, I can give care spiritually and that’s all right with me surgeon or not which is why I can be found sitting at the bedside of a patient who is dying.

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4 September, 2015 - Posted by | practice of medicine |

4 Comments »

  1. This is a beautiful post. I remember being by my father’s bedside in hospital at the age of 5 when he was dying and I know he felt great comfort in having his family by his side in his last moments. Thank you for sharing your experiences. I am very encouraged by your thoughtfulness towards your patients and your spiritual approach.

    Comment by Malaika | 5 September, 2015 | Reply

    • To Malaika:
      I am encouraged by your view on life as you enter medicine. You are the future of medicine and I know it will be in good hands if you are there. Thank-you.

      Comment by drnjbmd | 5 September, 2015 | Reply

      • Thank you! I really appreciate your confidence in me.

        Comment by Malaika | 5 September, 2015

  2. This is a very beautiful post. I remember being by my father’s bedside in hospital at the age of 5 when he was dying and I know he had great comfort in having his family around him in his last moments. Thank you for sharing your experiences. I am very encouraged by your thoughtfulness towards your patients and by your spiritual approach.

    Comment by Malaika | 5 September, 2015 | Reply


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