Abstract
I have discussed responses to the question, “What kind of work do you do?” with my hospice colleagues. They agree that when informed that you are a hospice doctor, most people do not say, “That's great! Please tell me more about it!” The usual response is “Oh! That must be very difficult and depressing work.” I usually do not continue the dialog beyond saying, “Actually, it's very rewarding work.”
Dying and the end of life are not popular topics. The majority of physicians I have encountered over many years experience some difficulty discussing alcohol abuse, drug addiction, sex, and dying with patients. If health care providers shy away from these discussions perhaps I am naïve in expecting regular folks to embrace these kinds of discussions. I suspect morticians and proctologists would also be in the “discussion avoided” category.
Perhaps ordinary people (civilians, as we call them) are uncomfortable exploring topics such as death and dying unless they are presented in a soothing and comforting manner as promoted by the mortuary industry. People purchase “life” insurance, not “death” insurance. It is easier to buy it and get that ugly topic out of the way, isn't it? I wonder if people just don't know the right questions to ask. I guess I should ask people who inquire about my work: “Would you like to know more?”
I wonder if maybe it's me who avoids particular end-of-life and dying topics with my family because it's uncomfortable for me. God knows that I have spoken gently to many patients and families about dying and the value of palliative care at life's end.
I know that when I developed progressive Stage IV chronic renal failure and shared the diagnosis with my three sons, they immediately elected to fly across the country to see old Dad. Possibly to say goodbye and to catch me breathing (we call it “closure”). I jokingly asked them if they would be willing to donate a spare kidney to me, although at age 80 I probably wouldn't qualify for a renal transplant.
When I asked my nephrologist about my life expectancy, she avoided any timeframe estimate. She talked about dialysis and said that, with my laboratory values, I would probably die of something else. Sweet. Never was hospice mentioned and I told her that if I started dialysis and found the quality of life poor (as I had seen in my hospice experience), I might just climb into the bathtub and cut my shunt. She did a reserved, uncomfortable gasp.
I look forward to the visits from my boys and expect they will be surprised not to see me marinating or circling the drain, or whatever is the current euphemism for slow dying. I am sure we have a lot to discuss and, although I no longer practice, maybe I will ask them if they have an interest in learning about “Dad's work.”