“There’s nothing more we can do.”
These words are often spoken by a physician just before transitioning a patient to hospice and palliative care and are regrettably uttered only days, if not hours, before the person dies. These words leave no room for hope; they make a transition to comfort care a much-feared and often avoided final destination.
Yet here’s the reality: More can always be done. More important, patients know exactly the “more” that they want. The real question is: Why don’t we ask?
“If I had a magic wand, what is it you would wish for today?” This is a question I ask of my patients receiving hospice and palliative care.
No one has ever asked that I rid them of their disease. Rather, I have been met with immediate replies of “make my anxiety go away” or “let me travel to see my family” and “let me go home and sit in my garden.”
These are the things that people say, over and over again, when they are given the opportunity to answer. The real test for physicians, then, is being willing to meet the challenge of discovering our patient’s true wishes, the fulfillment of which may push us well outside our own professional comfort zone.
Sometimes, it is actually the medical team’s best-intended professional wisdom that stands in the way of having patients’ wishes fulfilled. The patient who taught me that, whom I’ll call Ms. Weatherby, was a remarkable 57-year-old with a horrible collection of diseases, which had conspired to stop her lungs from working. [...]
Physicians mostly assume that life support is such an uncomfortable level of medical intervention that no one would ever choose it if they knew no chance for recovery existed and certain death in the hospital would be their only future. Ms. Weatherby challenged that, not in that she thought she would leave the hospital or even the I.C.U. — she knew she wouldn’t. But she defied everyone’s assumptions that life would be too unpleasant and painful in such a setting to be worth living at all. She radiated gratitude.[...]
The only time doctors are left with “nothing more we can do” is when we fail to ask.
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ReplyDeletein the criminal justice system, too, these words are often heard. they also have severe consequences
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