How Doctors Die: It’s Not Like the Rest of Us, But It Should Be

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How doctors die, a rewarding and enriching article published in late 2011 by Ken Murray, MD, Clinical Assistant Professor of Family Medicine at USC on  Zocalo Public Square  brought into the spotlight how doctors prefer to die. The writer gave us a glimpse of how physicians and physicians in training would prefer to go when death bid them in. Doctors want to die in utterly different ways from the rest of us. Apparently, this may be an unfamiliar subject of discussion, but there is something unusual about doctors’ death that seems to  pose more challenge when you try to figure it out. Of course doctors die just as everybody else do die, after all death is inevitable but they seem to die in totally different ways from how the rest of us die. They rather choose to die without health care when diagnosed with deadly diseases that might possibly not offer them any chance of recovery than trying them out at all.

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For almost all the time of their lifetime, they spend fighting off the deaths of others, these great minds seem to be fairly at peace and  above the fray when faced with death themselves. What’s more unusual about them is how they administer care to patients and desire to earn a little care themselves when they ought to need care. They are quite aware of the possible outcome, they know the choices, and they generally have access to any sort of medical care they could want. But they choose to go gradually when death swing by particularly when they are sick with sicknesses that will make them to show no signs of quality of life or chance of recovery. To most of them, they really don’t want to stress their family members, themselves or their friends going through painful medical care when they will die eventually. They want their well wishers and themselves to be saved from the stress of embarking on medical care that will only nurse them to death.

Absolutely, doctors like every other person don’t wish to die; they want to live as long as long possible. However, they are quite aware of the point or level beyond which modern medicine does not or may not extend or pass. And they are pretty aware the meaning of death to know what all people are deeply afraid of: dying in pain, and dying alone. They’ve discussed this with their families. They want to be completely certain that when the time creeps in, that no brave measures will be put in place–that they will never go through such bold measures when they reach the end of their lives. Things like allowing an individual to break their ribs with CPR in a bid to revive them back from the edges of death  because yes, that what is put in place when CPR is being carried out. Due to their immerse knowledge which they have in modern medicine, they seem to want t less intervention than most patients seem to want. Patients often think that some medical interventions like CPR does work, and that they can be brought back from dead and have a lovely happy life. In reality, it doesn’t happen. Guess what most doctors want? They prefer to die at home, with the people who love them unless they have a reversible cause and the outlook was good.

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Nearly all medical professionals have experienced what is known as “futile medical care”, the continued provision of medical care or treatment to a patient when there is no reasonable hope of a cure or benefit being performed on patients. That’s when doctors employ the latest stage of technology to bear on a severally ill person just a few steps away from the grave. The patient according to the writer, will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this health care takes place in the Intensive Care Unit milking a cost of tens of thousands of dollars a day.  What all the money spent end up buying is simply a physical and mental distress, anguish, discomfort, as a matter of fact the list is inexhaustible. All inflicting as much pain and suffering we wouldn’t even inflict on a terrorist. Ken Murray  went further to narrate how it is almost impossible to count on one hand the number of times his fellow physicians have told him, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” and said they mean it when they say it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them.He said that he has even seen it as a tattoo.

According to him, administering medical care that makes patients to be racked in pains is agonizing and distressing. Since thee ethics of Physicians demand they rally round information without disclosing any of their personal feelings, yet in private, among fellow doctors, they’ll  give rein to the opinion. He revealed that sometimes they could ask“How can anyone do that to their family members?”. He  suggested that it could be one of the many reasons most physicians have greater rates of alcohol abuse and depression than professionals in most other fields. Ken Murray mentioned that it’s one reason he dumped taking part in hospital care for the last 10 years of his practice as of the time he wrote the article ‘How Doctors Want To Die’.

It’s hard to look ahead, but patients, doctors, and the system seem to be the reason why doctors administer so much care that they wouldn’t want for themselves.  Doctors know much about the difference between prolonging life and prolonging death.’ It sounds exaggerated and likely to be untrue, but it’s true, and it’s a fine line. So much of modern medical care offer can prolong death as well as pains.

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Patients of course play a role in the reasons doctors administer so much care. Picture a situation in which a patient is no longer responsive and had been admitted to an emergency room. This is usually the case and no one has prepared for this situation and as result comes with shock and fear on the part of  the patient’s family members. They find themselves caught up in confusing mass of choices. When doctors crop up the question do you want “everything” done, the only reply is yes. Ant that is where the unpleasant experience starts out. More often than not, a family in actuality means “do everything,” but often they just mean “do everything that’s fair-minded.” Naturally, the mix up is that they are probably not aware of what’s fair-minded, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is open to reason or not.

The above example is a common one. Adding to the trouble are impracticable expectations of what doctors can achieve. In most cases, people believe CPR as an ultimate measure to save life when in real sense of it, the outcomes are often below par. The Doctor explained how he had hundreds of people brought to him in the emergency room after getting CPR. He said exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital. If a patient suffers from serious illness, old age, or a terminal disease, the chances of a successful result from CPR are extremely tiny while the chances of suffering are overwhelming. Inadequate understanding and misguided expectations lead to a lot of bad decisions.

Yet of course it’s not only the patients that make bad decisions. Physicians play an enabling role as well. The problem is that even doctors who don’t like to administer futile care must look for a way to address the desires of patients and families.  Especially in such scenario as the emergency room brimming with the grieving, worrying and anxious family members are and they barely know the doctor. Setting up trust and confidence under such scenario is a highly delicate thing. People are ready to imagine the doctor is acting out of base motives, trying to save time, or money, or effort, particularly if the doctor is advising against further treatment.

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While all doctors face the same kind of pressure, some doctors are stronger communicators than others, just as some doctors are more adamant.  According Ken Murray, whenever he was faced with circumstances involving end-of-life choices, he chose the approach of laying out only the options that he thought were sensible (as  he would in any situation) as early in the process as possible. When patients or families brought up irrational choices, he would discuss the issue in layman’s terms that explained the negative aspect of it despite it is regarded as good or desirable. If patients or families still insisted on treatments he considered pointless or harmful, he would offer to transfer their care to another doctor or hospital.

Because he can’t be too forceful on them all the time, despite some of those transfers still haunt him. He recounts one of the patients of whom he was most fond was an attorney from a popular political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, he did everything he could to keep her from resorting to surgery. Still, she sought out outside experts with whom he had no relationship. Not knowing as much about her as he did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.

It’s easy to blame both doctors and patients in such stories, however in many ways both parties are simply victims of a bigger system that supports immoderate treatment. Still in some regrettable cases, doctors subject patients to excessive treatment and do whatever they can basically for fee-for-service model to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting into problems.

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Ken Murray mentioned that even  when the right preparations have been made, the system can still swallow people up. One of his patients was a man named Jack, a 78-year-old who had been sick for years and undergone about 15 major surgical procedures. He talked to him that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to revive him and put him on life support in the ICU. This was Jack’s worst nightmare. When Ken Murray arrived at the hospital and took over Jack’s care, he spoke to his wife and to hospital staff, bringing in his office notes with his care preferences. Then he turned off the life support machines and sat with him. He died two hours later.

Despite all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. Ken Murray later said that one of the nurses even reported him to the authorities as a possible homicide for switching off of Jack’s support machines. It yielded to nothing as Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. Nonetheless, the prospect of a police investigation is scary for any physician. Ken Murray could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. He would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of excessive treatment.

Another story he cited was one with his cousin Torch which happened several years ago. Torch was born at home by the light of a flashlight–or torch and he had a seizure that resulted in being the cause of his lung cancer that had gone to his brain. Ken who is younger than Torch organised for him to see different specialists, and they both learned that with forceful treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live maybe four months or so. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with Ken.

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They spent the next eight months doing a bunch of things that he enjoyed, having fun together like they hadn’t had in decades. They explored Disneyland, which was his first time. They’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat Ken’s cooking. He even gained a little of weight, eating his favorite foods instead of foods which the hospital offers. He didn’t have any severe pain, and he remained lively and cheerful. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.

Another story about Charlie, a highly respected orthopedist who discovered a lump in his stomach was laid bare. He had a surgeon check out  the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival chances–from 5 percent to 15 percent–albeit with a poor quality of life. Charlie was not interested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

Doctors who had cracked ribs before would say how unpleasant it was. The sound of a cracking rib is haunting, and it happens, especially with the patients who do CPR in A&E. It doesn’t happen every time, but it often does, and it’s not very nice. Some go through anguish performing CPR on elderly, terminally ill patients.

Some emotional doctors would even be doing the CPR with tears coming down sometimes, and saying, ‘I’m sorry, I’m sorry, goodbye.’ Because I knew it very likely was not going to be successful. It just seemed a terrible way to end someone’s life. But they rather prefer to die calmly to remaining calmed by their serene expression until death swing by. Doctors still don’t get excessive treatment themselves. They see the negative aspect of this constantly. Nearly anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.