Dealing with Life, Death, and Human Suffering

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Introduction:

Physicians assist patients with many challenges—giving birth to a child, overcoming an addiction, managing a chronic condition.  One of the most difficult challenges for many health care providers is providing care for patients who are dying or suffering.  Accomplishing this goal may be more difficult in our society than others because medicine in the United States for many years has been equated with curing disease, leaving many medical professionals with a sense of hopelessness that they can no longer “do anything” for patients when they are unable to provide a cure.  Dealing with these emotions may be especially challenging for medical students.

Reactions to these types of scenarios vary widely.  Some feel numb and detached from their patients while others may become sad and distraught.  Some desire to support the patient and family as much as possible while others prefer to avoid too much contact.

Medical professionals may fill the role of helping others through the end of their lives and must develop the skills to do so compassionately, while maintaining our own emotional and spiritual well-being.

Strategies:

• Remember that there will be times when it’s more important to care than to cure.
• Caring for a patient is a process—dealing with suffering and illness takes time but what you do on a daily basis may have great value to your patient.
• When patients who you are caring for on the wards die, talk to other members of your team (interns, residents, etc.) about what happened and support each other.
• Grieve when you are able to (depending on the urgency of the situation) and when you feel that you need to.  Some prefer to grieve with the patient’s family and friends while others usually chose to express such emotions in privacy.
• Some members of healthcare teams attend the funeral of patients they’ve cared for.  It can provide some personal closure and offer an opportunity to empathize and support family members.
• Read books to help inspire you.  Some recommendations are “The Good Death” by Marilyn Webb;  “Tuesdays with Morrie” by Mitch Albom, and “Dying Well” by Dr. Ira Byock.
• Take time to renew yourself, such as watching a funny movie, spending time with a loved one or going to the beach.
• If religion or spirituality is important to you, pray for your patients.
• Particular scenarios that especially trouble you may be due to your own experiences with family members or friends who have been in similar situations.  You may have unresolved grief that you need to deal with.
• Don’t be afraid to seek professional help if needed, especially if you become depressed (see Recognizing Depression).
• Remind yourself about the preciousness of life.  The dying can often teach us how to live.  Try to live each moment to the fullest as much as they do.
• When a cure is no longer possible and a patient’s passing is imminent, find your victories in helping them achieve a painless or “good” death.  Avoid focusing on death as a defeat.  Instead find solace in providing good palliative care.

People to Talk To:

Note:  Confidential counseling services are provided for medical students through the Counseling and Student Development Center (956-7927).

In times of a mental health crisis, individuals may call 832-3100 to access the Crisis Line of Hawaii, staffed 24/7.  If you believe you are a danger to yourself or to others, please call 911 or go to the nearest ER for assistance.

Suggested Reading:

• The Good Death: The New American Search to Reshape the End of Life by Marilyn Webb.  This book discusses ethical issues surrounding death and dying as well as the hospice movement.
• Tuesdays with Morrie by Mitch Albom.  This popular narrative is of one man’s approach to his life and final days, seen through discourse with a former student.
• Dying Well by Dr. Ira Byock.  This book, written by an experienced palliative care physician and advocate for improved end-of-life care, contains stories of how patients go through the dying process with dignity and how their hospice team helped them along the way.

Final Thoughts:

“We are faced with a situation that the classroom cannot prepare you for.  It is so important to recognize this and not be afraid to take time to get your thoughts and emotions together.  No one will ever fault you for being compassionate and feeling badly for your patient.  It is a normal and necessary process to go through on the way to becoming a physician.”

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