By now we have said our goodbyes to 2010 and are looking to what achievements, joys, and challenges 2011 will bring. I am continuously reminded that the issues and perhaps struggles we face in the future not only pertain to the economics of medicine and health care but also to the emotional aspects inextricably linked to our practice.
A young woman I know recently lost her valiantly-fought battle with cancer. She faced one of those excruciatingly difficult situations many patients face: being prepared for the end of life when the hope for curative treatment slips away. It brought to mind an article by Dr. Atul Gawande appropriately titled Letting Go. This article addresses in a most compelling way how to care for our patients when our aggressive array of treatments will offer little, if any, benefit. How do we ensure the best quality of life for our patients with the time they have remaining? And how do we help our patients and their families to be at peace with the decision to no longer pursue curative or aggressive treatment?
These are surprisingly difficult questions, to say the least, because it is so ingrained in us to do everything possible to stymie the inevitable—death. And generally speaking, the stigma of death often makes us uncomfortable and willing to do something—anything—to thwart it just a little longer. As we know, many treatments we can offer for either advanced cancer or its complications thereof may ultimately leave our patients feeling worse, not better, and potentially keep them from accomplishing the goals they may have in their final days.
I was recently reflecting upon a discussion about end of life care in which I had taken part: While aggressive measures would have undeniably brought with them an immense component of suffering, the decision the patient made during the course of that discussion to pursue comfort measures in the final hours of life for some reason led me to feel awkward…uncomfortable. I contemplated why I would have such feelings. Then it occurred to me that it was all about courage: the patient had shown ten-fold the courage to face the end of life than I had been able to muster to even have the discussion about whether to pursue aggressive measures, knowing full well that aggressive measures would bring no quality of life to her. Courage.
Sadly, cancer will take the upper hand from time to time in the year ahead. My hope for us all is to have within our own constitution that same courage our patients possess, and may we use that courage to help assure them the best possible end of life experience that we can provide and help them and their families to achieve their goals and priorities.
As always, your thoughts and comments are welcome.
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