The Sudden Death
The sudden death of a patient is devastating to doctors. It is beyond sad, or depressing - it is a viscious slap across the mouth, a painful screaming, a well-placed sledgehammer blow to the abdomen. Some oncologists, especially those instilled with empathy, may even consider such deaths as a failure on their part. This is ironic, because cancer patients usually don’t suffer sudden death like victims of a heart attack. They certainly can die from such events as strokes or pulmonary emboli, but typically they pass away after a predictable decline in function. The slow inevitable loss of a loved one, however, is no less tolerable than a sudden death and in some ways is crueler since it prolongs the sorrow of caregivers and relatives. I don’t care what has been published - in my world, where patients fight for their lives each day, there is no such thing as a good death.
With all the unhappy outcomes oncologists have to deal with both professionally and personally though, nothing brings them to their knees faster than a treatment-related death. By this I refer to a patient dying not from their cancer but from a complication of chemotherapy - usually an infection leading to failure of one or more vital organs. I write this today because over the weekend a patient of mine with metastatic cancer developed pneumonia after his first chemotherapy treatment, and rapidly went into septic shock. He now lies helplessly in the intensive care unit, and I would be a fool if I thought he was going to survive this blow. The buzzing swarm of “what-ifs” now torments me as I try to counsel his family.
Such a loss makes me think, even at the risk of sounding pretentious, of how Lt. General Lloyd Fredendall might have felt after the battle of Kasserine Pass in 1943. The unexpected loss of either patients or soldiers is a tragedy. It must not, however, weaken the will to fight on. Unless doctors can look to future struggles with a thoughtful determination to succeed, they may not get sacked, as Fredendall was by Eisenhower, but they will have nothing to be proud of when they look in the mirror.
I’m so sorry. My condolences to you and his family.
Comment by Ali — May 10, 2005 @ 6:00 am
Chemo is always a gamble, I know. But I don’t know how any doctor can not feel horrible. I’ve learned a lot about how oncologists deal with a difficult job from reading your posts, but I still don’t understand how you face again and again the heartbreak of so much of what you do.
But as a person who you guys have saved, I’m glad you do it. And grateful for the compassion and empathy that you do it with.
Comment by Maureen McHugh — May 10, 2005 @ 4:00 pm
I really don’t have much to offer beyond my prayers for your patient, his family — and you.
Comment by Judy — May 10, 2005 @ 5:45 pm
Dr. Cheerful - You can be proud when you look in the mirror each day, whether you win or lose the cancer fight with a patient, because you try, and you do so with compassion. You’re a hero.
Comment by Feisty — May 10, 2005 @ 11:22 pm
Name me no names for my disease,
With uninforming breath;
I tell you I am none of these,
But homesick unto death.
~Witter Bynner, “The Patient to the Doctors”
I think his flight just came in…..
Comment by MDWannaB — May 11, 2005 @ 3:27 am
As a fellow oncologist, I’m intrigued that you suggest that there’s no such thing as a good death. Acknowledging that death is a natural part of life, and that it is inevitable in certain situations, seems to me as being particularly important for counselling of patients and family. Fighting in such situations is all very well, but if it gets in the way of readjustment of expectations, it may not serve the individual well. Finally, a question - which do you think would be preferred, a death in hospital, with tubes and drains in-situ, surrounded by strangers, or an anticipated death at home, surrounded by family? Too many people die in the former situation.
Comment by splicemix — May 13, 2005 @ 8:50 pm
I’m sorry for your patient and for you.
That you’ve chosen to remain empathetic, to allow yourself to be hurt and saddened by each case, rather than to shut off and numb yourself to it as I think so many doctors faced with frequent death do, just further proves what I’d already known from reading your site: you’re a good doctor and a good person. Thank you.
Comment by Eliza — May 14, 2005 @ 6:13 pm
Dr. C - Don’t forget that death is inevitable for us all, and don’t believe the lie that you are a failure when a patient dies. You don’t REALLY hold the power of life and death, though you do have tools to utitlize in hopes of preventing an untimely death. Do your work, love your patients, and keep on going.
Comment by Feisty — May 15, 2005 @ 4:37 am
My mother-in-law lived to 89, had myelodysplastic disorder, thought initially to be CML; she got so close to death so many times, it was like calling “Wolf,” to the point that when she actually did die, we were rather nonchalant in dropping her off at the ER AGAIN with shortness of breath. My point? Death comes on its own terms, no matters what any of us do. Professionals like you who dedicate your career to cheating Death for a little more time are true angels, but Death always wins in the end. It is your caring feelings that the family will remember forever, not the ultimate death of this patient, so bless you…
Comment by Amy — May 18, 2005 @ 1:19 am