July 29, 2011

Day 4 – “In Search of a Good Death”

Filed under: Med School and the MSTP — sanguinemare @ 12:20 am
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Today’s topics covered: the US health care system, the Hippocratic Oath vs. the Physician’s Charter, the (social) history of disease, and death and dying.   My focus today will be on the last one, the title of which I have borrowed for the title of this post.

In this class, the professor wanted us to participate in an exercise/focus group.  He gave us 10 minutes to think about someone we’d known who has passed away, and say what was/would make the circumstances surrounding the death good or bad.  Here were some things that were shared today:


  • Someone’s grandpa died when they were a teen due to a heart attack.  The good things were that it was quick and at home where he was in a familiar place with family around.
  • Able to make peace with God/family, etc before death
  • Someone’s grandma stayed in a hospice her last days, which helped take off a lot of pressure and stress for the family.
  • Having an honorable/respectable death (ie army)
  • Knowing that you’re leaving a legacy, or that you accomplished something


  •  The doctor tried really hard to keep someone’s family member alive longer, which could be good, but they were in pain for a long time, which was really tough.
  • Dying at a young age
  • Having dementia (Alzheimer’s) before death – being “gone” before death
  • Being along at the end of your life
  • Dying unexpectedly.  One example related to this was having a false expectation of how long the patient would live due to what the doctor said.  The doctor had said they’d live for 6 months to a year, and the patient died within 4 months.  Another person’s friend’s dad got shot in the head.  Very unexpected and traumatizing.
  • Death due to overmedication – the patient was given too much medicine and lost awareness/recognition of people during their last days, which shortened the amount of time the family could spend time with them.
  • Someone’s grandpa is currently declining, and they are having to deal with a lot of  unexpected medical bills
  • Feeling like you are being a burden on the family
  • Dying and leaving behind bickering siblings over inheritance
  • Not knowing what the deceased family member wanted done after death
  • One person had a bad experience with the doctor being very bad at informing the family about the death.
  • Taking your own life.  One person’s grandpa basically did that by not eating (through tubes) because that was the only thing he could control.

I was pretty surprised so many people shared their experiences.  And that there was so many people who have had to deal with death personally.  After the first couple of people, the examples just rolled right after another for the whole 10 minutes.  That probably would not have happened in my undergrad courses – people didn’t care about the classes that much to participate.  This is something I’ve noticed about medical school, at least so far.  People actually pay attention in class and are invested in it.  They participate.  (They also come to class like 30min early and stuff, which is kind of crazy, but oh well).  Returning to the topic on hand…

The people who used the focus-group method in a study came up with 6 “themes” on what makes a death “good”/”bad”:

1. Pain and symptom management – self-evident, but not always done well
2. Clear decision-making – dependent on having had prior discussions with the family/medical team about what to do in case of death.  Communication is key)
3. Preparation for death –  communication of the trajectory of illness, the potential options of treatment/location of care, ideally done with interdisciplinary teams.
4. Completion – having the “individual life review” and gaining closure.
5. Contribution to Others – a purpose to life
6. Affirmation of the whole person

Interestingly enough, a study showed that physicians apparently have a difficult time coming up with all the themes during a similar kind of focus-group setting.  Our professor was actually impressed at how “theme-rich”  we were (as vs. “theme-poor” like the physicians,) especially given how short a time we had.  He said he’d always wanted to do this experiment, because he wondered if physicians were theme-poor because medical school selects for people who tend to be that way, or if it is somehow squeezed out of people during the process of medical school (which would not be encouraging if it were true – it would imply/affirm that jadedness is an inevitable result of medical school).  I guess we at least proved that our class was not selected for theme-poor people during admissions, haha.

Death and dying, as mentioned yesterday, is not something that is often thought about at our age.  We tend to think it’s something far off in the future, and barring the few accidents that may cost a peer their lives or the passing of grandparents, the concept is nebulous, at best.  But as doctors, this will be something that is important to consider.  How to deal with the patient who has just been told about their potentially shortened life, how to come to grips with it yourself, how to approach the situation and what treatment to give.  Is quality of life more important, or is prolonging life, even if it might cause more pain?  “Suffering occurs when the intactness of being is threatened.”  People may thus be suffering, even in the absence of pain. How do you help ease the situation, and what preparation needs to be done so that in the event of death, everyone will know what to do?  How do you break the news to the family?

While on the subject of death and dying, I’ve been hearing a song on the radio a lot since I’ve gotten here (not unusual, considering this radio station plays like 5 songs on repeat).  It’s called If I Die Young, by The Band Perry.  The bridge always gets me thinking:

A penny for my thoughts, oh no
I’ll sell them for a dollar
They’re worth so much more
After I’m a goner
And maybe then you’ll hear the words  I been singin’
Funny when you’re dead how people start listenin’…

It’s pretty sad how true this is in modern society.  I just read an article this afternoon about a young girl named Rachel who was trying to raise $300 by her 9th birthday to donate to an organization to bring clean water to developing nations.  She was $80 short of her goal, but a terrible vehicle accident caused her to be seriously injured, and proved fatal.  After people heard about the accident, thousands of donations poured in, and many laud her selflessness.  But why did so few people respond to her heartfelt call when she was still alive and well?  Why do we go about our lives taking so many things for granted, thinking “oh, we can do that later, talk to that person later?”

We need to start appreciating each other more, appreciating life.  Let’s start listening now.


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