Throughout my time with hospice, I have learned a lot about patient care as well as about death and dying. One of the most important things that I have learned is the concept of “a good death,” which is the most important thing to understand as a hospice volunteer as well as a patient-oriented physician. While I was aware that everyone wants a good death, I didn’t fully comprehend the numerous elements that factor into one before I started this program.
One of the most essential aspects to a patient experiencing a good death is for them to understand their mortality and the impermanence of life. This is outlined in “The Lesson of Impermanence,” when Dr. Sunita Puri writes: “…understanding death as inevitable is necessary to appreciate the meaning and beauty of life.” This appreciation for life that Puri writes about is crucial to a patient being able to face their own mortality. If a patient is unable to recognize the unpredictability and impermanence of life, they will be unwilling to accept their own mortality, leading them to experience an unpleasant death. This idea is especially relevant in the book When Breath Becomes Air by Paul Kalanithi. According to his wife, Dr. Lucy Kalanithi, his reason for writing the book was to help people understand the unpredictability of life as well as their own mortality, both of which he was forced to face at age 36 when he was diagnosed with metastatic lung cancer. He wanted to help people understand these things earlier, so they are well-equipped to experience a proper death.
In prompt 1.1, I learned that a good physician is one that knows when to push, but also is aware of when to withdraw curative treatment and focus instead on the comfort of the patient. This attitude is something that is necessary for a doctor to have, because it influences whether or not the patient is able to experience a good death. It’s a doctor’s job to help a patient in any way he can, so sometimes a last-ditch, one-in-a-million effort to save a patient seems like the right idea. However, sometimes the physical and emotional toll this route takes on a patient causes them to spend their last moments in pain, instead of being with their family or doing what they love, which is why fighting death with an iron fist is not always the right approach. This is because, in addition to an awareness of mortality, the patient must be well-prepared for their death, as we learned in prompt 3.2. A good death is a well-prepared one, which can not occur in the middle of intensive curative treatment, especially if it is not expected or anticipated. It is often difficult for doctors to recognize when to withdraw treatment, but it is essential to the comfort of the patient for them to do so. It is important for a person’s last moments to be painless, which often won’t occur if they are in the middle of curative treatment.
Another aspect that is essential to a person’s experience of a good death is living their last few months or weeks surrounded by those that care about them. Companionship is a natural human need that is necessary, especially in difficult times such as the end of a person’s life. This is why the work I did volunteering with Helen, my patient, was so meaningful to me. Although I was only able to visit with Helen once, I could see her light up when the nurse came in to tell her she had a visitor. I was also able to provide comfort to Nancy in her last few weeks in the form of companionship, which I hope was able to help her experience a good death.