Saving Death

It is not the false hope that they live on forever. But the true hope that patients will live with dignity and that death can be saved.

J. C. Salwitz, 2012

Icame across this line while reading an article on the internet one evening during my palliative care elective rotation and found that it described palliative medicine so aptly. Saving death. How ironic, but reflecting on the cases I saw during my elective, there is no better way to describe what the team does on a daily basis.

Mr. Lim was a Chinese gentleman in his late 70s, diagnosed with metastatic prostate cancer, and had been with the team for the past month. During morning rounds he always appeared distant, staring into space, never saying more than what was being asked. One evening I decided to pull up a chair and speak to him. He spoke openly about his diagnosis, his fall, his pain, and then he started crying. He began sharing with me about his partner, his stepson, his gradual decline in function, the severe pain in his back and knees, and his home to which he longed to return before he passed on. He used to be a man who enjoyed living an independent life, going for walks in the park and enjoying coffee breaks with his friends at the coffee shop below his home, the very same few steps that led to his fall and admission. He was a simple man who wanted simple things in life, but there he was that evening in tears, frustrated with the pain and loss of function, saddened by the abandonment of his partner and the overwhelming feeling of loneliness. He felt useless and hopeless, to the point of expressing a wish to end his life.

He was a man in great pain. Not only was there physical pain, he was also suffering from great emotional pain. The doctors treated his pain aggressively. The social worker spent a long time counseling him. The team sought to resolve his physical pain in the hope that he could regain some of his previous function through physiotherapy so that we could help fulfill his last wish of returning home. Helping him soothe his emotional pain proved much more of a struggle. Our comforting words sounded so empty offered to this man who was confronting the specter of death and decline. At the end we found that just sitting with him and allowing him to talk freely and to cry proved most therapeutic in helping him cope emotionally.

As a fourth year medical student I've honestly not had many experiences seeing patients break down in front of me, being in so much physical and emotional pain. My natural response was to offer him a tissue, to comfort him. This I learned was not appropriate and would have signaled my discomfort with his tears and stopped his emotional and possibly therapeutic crying. Medical school teaches us so well about the physiology of pain and the pharmacology of analgesics but not how to sit with a hurting patient. This to me was a totally strange and new experience. Perhaps all that Mr. Lim needed was just for someone to sit by his bedside to listen. I can only hope and pray that his wishes are fulfilled and, even if he does not manage to go home, I hope that he manages to find peace within himself in the end before he leaves this world.

In my short exposure to palliative care, I have realized that while it is our mission to save lives, we often forget that death is inevitable. There are many who can help us to live well but few who would help us to die well. Those of you who practice the field of palliative care do much to soothe the pain of those who are dying, to help them to “die well.” This to me is “saving death.”