There’s more to a good death than moving my bowels

Dr Dhruv Khullar wrote this week in the New York Times about an old man in an emergency department. Amid the chaos, the doctor greeted a thin, older man whose prostate cancer had grown through several chemotherapy regimens: 

“His spine is full of tumor and he’s been vomiting everything he eats or drinks for weeks. He can’t move the left side of his body after a recent stroke.”

The two men talked. Fifty years after the patient emigrated from Greece, he was alone — in a crowded emergency room, on a Friday night, his wife dead, his two sons overseas, a nurse visiting him once a week at home to help him with some medicines and make sure the various tubes coming out of his body aren’t infected. The man smiled a charming, crooked smile. “It hasn’t been the best month of my life.”

The doctor then asked when the patient last moved his bowels, and was told:

“Son, I’m dying. I’m alone. One day you’ll learn there’s more to a good death than how often I move my bowels.”

The doctor wrote:

“I am better at many things than I was when I started my journey to become a physician more than a decade ago. But I am not sure that understanding patients as people — and placing them in the context of their long, messy, beautiful lives — is one of them …

As we acquire new and more technical skills, we begin to devalue what we had before we started: understanding, empathy, imagination. We see patients dressed in hospital gowns and non-skid socks — not jeans and baseball caps — and train our eyes to see asymmetries, rashes and blood vessels, while un-training them to see insecurities, joys and frustrations… a more robust, more holistic understanding requires a deeper appreciation of “Who is this person I’m speaking with?”

Dr Khullar wrote about the small but growing body of research in Britain which has found that allowing patients to tell their life stories has benefits for both patients and caregivers.

It can help older patients and other residents of long-term care facilities gain insight into their current needs and priorities, and allow doctors to develop closer relationships with patients by more clearly seeing “the person behind the patient.”

How much more effective would we be as diagnosticians, prognosticators and healers if we had a more longitudinal understanding of the patient in front of us?

If we saw not just the shrunken, elderly Greek man on the emergency room stretcher in front of us, but also the proud teenager flying across the Atlantic to start a new life half a century ago?

Read the whole story here.


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