“There is a dignity in dying that doctors should not dare to deny.
For death begins with Life’s first breath”
The above statement by an unknown author has always impressed me for its profound simplicity and dramatic accuracy, and deserves much more than passing notice. Like the clergyman, the physician is expected to play a pivotal role in the life of the dying patient and the family, especially during the period of “the final journey” and beyond. Unfortunately this does not often happen because doctors are very rarely trained to recognize and deal with end-of-life issues.
Dr. Ira Byock in his excellently written book,
Dying Well, summarized this in the following manner:
“The medical profession most commonly approaches dying as if it were solely a
problematic medical event. From the first day in medical school, doctors are taught
to approach patients by defining a set of medical problems to be solved. People come
to doctors with "problems". For each case a problem list must be developed through
which both physical and psycho-social problems can be addressed”.
Dealing with dying is much more than just a consideration of the etiology of a collection of symptoms and signs, diagnosing the problem and providing a treatment plan. This is what physicians are trained to do and are generally confident in executing. Rather, it is a very personal experience that requires a very special and individual approach tailored to meet the needs of the patient and the family. The physician is uniquely placed to facilitate and ease the pain and uncertainty of the situation. By being available to answer questions, being honest and caring and above all, being especially sensitive to the fears and the anxieties of all concerned, he will go a long way in assisting everyone to cope with this daunting and terrifying period.
In my own personal experience, after actively practicing medicine for almost half a century, no aspect has given me as much satisfaction as the successful occasions when I was able to help my patient and the family cross over in peace, faith, dignity and acceptance. Because of my Psychiatric background, I was perhaps better equipped to understand, recognize and possibly identify cues from the patient and to deal with them. But I believe I was able to achieve greater success when I learned to accommodate the strict objective, scientific training I received in medical school with a personal subjective, faith-based viewing of life and death as a continuum, controlled by the hand of the Almighty.
As I have stated previously,
I believe life is a precious expression of a greater plan in which our time spent on earth is but a short segment of a journey which began in eternity and will continue to eternity. Because of this, I see the process of dying, not as the end of the journey, but merely a stage along the path, and as such I view my role as a physician as doing my best to facilitate the change.
Sri Chinmoy Kumar Ghose, the great Indian spiritual teacher and philosopher who recently died, described this concept exquisitely in the following quotation:
"Death is not the end.
Death can never be the end.
Death is the road.
Life is the traveler.
The Soul is the Guide."
As I see it, the approach to dealing with death and the dying patient is essentially eclectic, encompassing a variety of approaches from many sources including the attitude and expectations of the patient and family, the immediate and long term prognosis, society’s mores and the extent of religious and social support available. The physician’s role is crucial, not only in providing honest and accurate information concerning the prognosis and treatment options, but equally important, in assessing the real needs of the individual and providing understanding and strength without resorting to denial or lying. He must be available to prepare and to guide his patient through the difficult passage, to ease the pain and above all, to offer hope and reassurance.
It is generally assumed that patients would prefer not to hear the real truth, but rather be given hope of recovery even when the situation is hopeless. This is a mistake, for by encouraging this we rob the patient and the family of the opportunity of coming to terms without lingering regrets. I prefer to choose the approach of Rev. Forrest Church who before he died in 2006 wrote:
"Many people who are dying have an opportunity—but sometimes don't have
the imagination to seize. And that is to turn my life…into a prayer, to embrace life,
to accept my past and just say 'yes' to it. Not to let the future haunt me, but to be
in the moment, aware of the miracle, which is life itself, which would not exist if
death was not one of its hinges."
Events occur during this period for which we have no real explanation, but which seem to point to other influences actively manifesting itself. Anyone who has worked in this field will attest to occurences experienced by the dying patient which had profound effects on them. These paranormal episodes, often referred to as Near death experiences, have been extensively researched by several people, including Dr. Raymond Moody, MD who has written extensively on the subject.
In my own experience dealing with terminally ill patients, I have encountered many such incidents when my patients will report encounters which have profoundly affected them. These have ranged from visitations from deceased family members, to stange phenomena like brilliant lights, or Holy people, such as Jesus or Mary. They have invariably left the patient peaceful, calmer and more accepting and have served to reassure the family. While it would be easy to ascribe these occurences to subjective or hallucinatory causes resulting from the disturbed mind, I prefer to think of them as yet another example of the involvement of a higher power.
Too often we allow feelings of anger, petty rivalry, suspicion or revenge to cloud our thinking and prevent us from sharing and expressing our true feelings at this important time. This is a real shame, for by doing this we cheat ourselves and the patient, and set in motion negative feelings which stay with us long after the event. This is wrong! Instead we should strive to correct these feelings and remove these obstacles and make every effort to come to terms with ourselves, so that as the journey ends, so would our bitterness.
In the end, if we really believe in the continuity of life, we must agree with the words of the great Irish poet and author, Arthur Joyce Cary when he wrote:
“Look at life as a gift from God.
Now he wants it back, I have no right to complain.”
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