Do as I Say, Not as I Do
Training untrained eyes to see when death is approaching takes more than time.
It takes exposure and an intention to illuminate that which has a tendency to be kept in the shadows.
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John seems vibrant and healthy (so long as you don't look at his blood under a microscope). Other than the chemotherapy-induced alopecia, John appears so well that he could easily be mistaken for his bone marrow donor. It isn't until our team steps outside his room that I learn our attending physician holds a different perspective.
Dr. Maddux turns to our team as we re-form our huddle in the hallway.
"He's going to die," he says, as matter-of-factly as if he were naming the items on John's breakfast tray.
What? Too stunned to utter the question aloud, I wonder what I missed. I did not see or hear John say or do anything that gives any indication he is dying.
His bloodwork shows otherwise, and two days later Dr. Maddux is right. John dies.
Our team never told him what we knew was coming. We never spoke about him again. We never discussed what happened to him. We never talked about what it was like for us. My emotional response to death remained restricted to embarrassment for my own lack of knowledge.
As my clinical training progressed, I became increasingly inured to the daily emotional and physical traumas my colleagues and I witnessed. I had no idea I was actually becoming part of the affliction. When I realized a person was going to die, my trained response was concern for my professional self-image. At the time, no possibility existed that would have allowed me to consider a now obvious alternative: people are mortal. Instead, if a person died on my watch, the only plausible conclusion was that I must be an incompetent doctor. I am not proud of what I am going to admit to next. Because death was and continues to be seen as a nonviable outcome (pun not intended) when seeking healthcare, I and my colleagues have unconsciously learned to do things, all within the accepted realm of treatment options, to postpone the inevitable so the death would not be considered the result of a lack of skill, competency or care. As a result, many suffered greatly for this misplaced focus, perhaps none more than Jake and his family.
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