As an inevitable role of this profession, we come to numb ourselves from a reality that surrounds all humans whether big or small, white or black, rich or poor, straight or gay, the reality that we will all come to our deathbed. We forget that families actually don’t realize death on a day-to-day basis so how is it really when we appraise patients and relatives of their eventual demise.
A 46 year old man who came in for a gastroscopy for symptoms of bleeding in the stools and abdominal distension. He was admitted for around 4 days already. We discovered a mass in his stomach that seemingly looks cancerous and there are masses in his liver on imaging. He has Stage 4 Gastric Cancer pending biopsy results.
Suddenly, a day after his gastroscopy, he complained of dyspnea. We never really knew what the cause of his dyspnea was but we did put a mechanical ventilator to help him breathe. We had several causes and tried to address each of the causes one-by-one prioritizing the easier ones to treat. He turned out good. His family talked to him and he was actually up and about although intubated. A few hours later, he suddenly succumbs into arrest and a code was called. After 30 grueling minutes of trying to revive him, it was obvious that death was inevitable.
The family begged us to do more but we do know our limits. The sudden course of events had not given them enough time to process everything but this profession had taught us when it was necessary to stop and lay out the bitter truth. At the end of the day, terminal illnesses like cancer will meet their time. None of the invasive procedures that we do can actually help cure him but only attempt to extend his life for a while.
Death, as a reality of everyone in this world, is a bad news that physicians usually shy away from but is expected to come from us. Like a judge who brings a criminal sentence, we bring bad news amongst all the lives we try to save. There are the people whom we will save but there are those where our management will fail.
Keeping it simple and straightforward is much appreciated. Make them understand that life can end and that all men will turn back to dust. After all, although medicine was made to cure people of diseases, it actually only bridges the gap between life and death.