An excellent New Yorker expository piece entitled:
Dying words .
In summary, in telling a person they are about to die there are general considerations:
1) There is no right way
2) There are many wrong ways
3) Find a quiet, comfortable, private place where the patient, family and doctor can sit quietly without interruptions.
4) Try to have an idealised script to deliver news so that nothing is forgotten.
5) Avoid bluntly delivering information and just leaving the patient.
6) Involve the patient in the process, to a level they are comfortable with.
7) Explain the details of the disease at an appropriate level.
6) Explain your terminology esp. palliative vs curative, remission.
8) Put prognosis (the course of the disease), into context. Bare statistics do not tell the full story and do not say much about the particular patient.
9) Explain the objectives of palliative treatment
10) In discussing treatment options, always remember to inform the patient of side-effects, and especially side-effects that may be specifically relevant to the patient.
11) Management involves physical AND emotional issues amongst others. Refer to the concept: ars moriendi - the art of dying.
12) Consider advanced or end of life directives to cater for situations where the patient is not competent to consent i.e. ask the patient what they'd like to do in certain eventualities such as the worst-case scenario.
13) Ask the patient what their expectations are. A patient and their family's expectations of death may differ considerably to the actual event. They may need to be prepared.
14) Try to answer patient's questions in as straightforward a manner as posible, avoiding jargon. Try to avoid skirting the truth.
15) Don't discuss the patient with other family or friends without the patient's involvement or consent.
Conclusion: Palliative care operates on many levels alleviating some of the suffering, maximising quality of life and the economic costs associated with terminal illness ( Generally, greater proportion of health care costs are consumed in the last few weeks of life than for any other period). It is worth the investment..
In addition, some other stuff of note:
1) No matter how carefully you discuss the situation with the patient, they will only retain a minority of it, so write the salient points down, or record them on tape.
2) Sometimes the doctor also does not want to let go of the patient and may view death as a failure on their own part.
Seminal works:
On Death and Dying, Elisabeth Kübler-Ross
How We Die, Sherwin Nuland
The Journal of Clinical Oncology, March 2002.
Organisations:
Open Society Institute - Project on death in America
Robert Wood Johnson Foundation - Palliative care centre
Significant people in the field:
Diane Meier
Kathleen Foley
It's odd, Jerome Groopman, who wrote the article has a considerable media presence which lead me to an automatic distrust probably because of the quick fix tv gods such as Dr Phil. from Oprah. Note to self: " I must not make assumptions". Two of his books were the premise for the series Gideon's Crossing, he regularly writes for the New Yorker and holds esteemed positions within the medical community.
"I like too many things and get all confused and hung-up running from one falling star to another till i drop. This is the night, what it does to you. I had nothing to offer anybody except my own confusion."
Jack Kerouac, On the Road
This year's Andrew Olle media lecture was delivered by Lachlan Murdoch. He tried so hard to cater his speech to an Australian audience but between the accent and the uncomfortable use of aussie slang just didn't carry it off. It was merely another platform for the News Corp thrust into the popularist media.
One defence Murdoch, senior, junior or otherwise uses in expanding the popularist media, is that if you don't present issues in an accessible way, accessible to everyone, then you are elitist and narrow-minded. This therefore must require a "dumbing down" of issues to make them accessible. Surely this understates the complexity of world affairs and actually diminishes or trivialises their importance. Life just isn't that simple. Ofcourse in Murdoch's defence, they do produce worthy publications e.g. The Australian.
Anyway, the selection of Lachlan Murdoch as this year's speaker actually diminished the memory of Andrew Olle. There was nothing novel or respect-worthy contained in Murdoch junior's speech. It was merely a justification for current practice and their continuing practice, a softener for arguing that the tabloid media has intrinsic news and analytical value.
And no matter how he justifies the benefits of a commercial media, it is right and necessary to question what dictates news policy, the almighty dollar or altruistic principle (provided that the principle is not the dollar). It is entirely reasonable to suspect the motives of any organisation whose main motive is to generate profit, especially when their objective is purported to be one of serving the public at large.
I was watching The American President . And while idealistically I wonder whether a US president ever lived up to such ideals; we certainly hear of the statesmanship of previous presidents, Roosevelt, Lincoln, Washington, Jefferson; in their time were they as great as we now think they were? Surely they're not as dispiriting as today's examples. There was a particular speech towards the end of the film that stated that the two interests of the corrupt opposition leader, regarding problems, were "making you afraid of it and telling you who's to blame for it." This seems to reflect the order of political scoundrel that exists today. Suddenly leaders don't seem to be interested in building the identity of the constituencies they represent, they just merely seem to attack their opposite numbers, or to seek to find an appopriate nemesis to blame. And any promotion is based purely on an event rather than what it was about the constitutuency that made that great event possible. They don't state "this is how great you are" but "this is how great you could be if that was you". It's rather unempowering in a way...
To seemingly counter this, it's one of the aspects i enjoy about film. It grants us the luxury to imagine ourselves as we'd like to be (even if some films indicate how we can be at our worst). It gives us something to aim for.
Camus, The Plague, Penguin Modern Classics, 1967, p236:
"Then they had resumed their silent vigil. From time to time Mme Rieux stole a glance at her son and, whenver he caught her doing this, he smiled... then once more the quiet breathing of the night.
'Bernard?'
'Yes?'
'Not too tired?'
'No.'
At that moment he knew what his mother was thinking, and that she loved him. But he knew, too, that to love someone means relatively little; or, rather, that love is never strong enough to find the words befitting it. Thus he and his mother would always love each other silently"..
Happy Birthday Mum....