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A better death

This blog is written by Dr Harmeen Kaur, a medical intern at Peninsula Health.

I don’t have any answers for you today; all I have are questions.  Questions about what it means to die in a hospital and whether we, as medical professionals, can do anything differently. 

I used to have such a romanticised notion of death – to be in your own bed at peace with the world, surrounded by friends and family, all affairs in order. That is what they show on television, right? (unless you’re a Game of Thrones fan!).    

I’m no longer this naïve. Now I know that end-of-life can be very different for different people and for most it happens suddenly: one day you are well and the next day someone is telling you or your family that their time is up.

Today I am going to tell you (briefly, I promise!) a story. Earlier this year, I was called by a nurse to review a patient and soon as I walked in the door I could not believe my eyes. We were ready for this man (let’s call him Andy) to go home but somehow, he is now drowsy and struggling to breathe. I know he has end-stage lung disease and an infection has been making it worse for the past few days but surely, we think, he should be getting better by now. His wife and daughter are standing in a corner, staring at him with concern in their eyes.  I do a quick assessment of the situation, start my patient on some initial treatment and go up and talk to the family. And all I can think about is that this man is not likely to make it. Then it hits me—I am about to have my first end-of-life conversation with a family.  I stand with them and explain the situation. I use terms like ‘high chance of deterioration’ and ‘unlikely to improve’. Then I finally ask them whether they have talked about end-of-life decisions as a family; whether they know Andy’s wishes.  Their response is quite immediate: they report that he wouldn’t want any heroic measures but he would like to die peacefully in his own bed.

This is where I diverge from the story and ask you, the reader, what is an appropriate response to this? For Andy, his death is imminent if therapy is withdrawn and we don’t have the resources (including time) to set home palliation up for him. He probably won’t survive the transport. Later that afternoon Andy had passed away.

Most people used to die at home but now it seems that despite their wishes they end up dying in hospital.  On the one hand, we want to make them comfortable, but on the other hand we take away their autonomy at a time they need to feel most empowered.  We sometimes affect patients’ opportunity to have a good death (whatever that may mean to them). However, maybe the medicalisation of death is the new normal and the newer generations won’t wish to die at home. Or maybe, the system must adapt to try to accommodate these issues in another way.

There are many issues that I raise in this short post and I don’t intend to address them, let alone resolve them, in this short space.  However, I think that we should all turn our minds to these questions and look to each other, as well as our colleagues in hospices and nursing homes, who grapple with these issues every day in our search for a ‘better’ death. 

Dr Harmeen Kaur