Aug. 17, 2004 - 18:59 MDT

THE WONDERING JEW

Seen That

Yesterday's entry about hospice care was in the front of the paper. Today's entry is about an article buried back in another section of today's paper - but apropos nevertheless.

An article by Jane Brody in todays Well Being column, in part:

Do doctors abandon patients who are dying ?

"The letter that appears in this column was written by the husband of a woman whose oncologist had cared for for nearly seven years, and then abandoned her, her husband writes, in the final weeks of her life. A copy of the letter was sent to Dr. Diane Meier, director of palliative care at Mount Sinai Medical center."

"Dear Doctor: I'm writing to you in reference to my wife, who died on May 29, 2004. I wish to make clear from the outset that I am not impugning your medical competence but am seeking to bring to your attention what, in my opinion, constitutes a grave breach of the moral contract you entered into with her."

"As you know, my wife was diagnosed with lung cancer in 1997 and was treated successfully by you for almost seven years. During that time, she developed a relationship of confidence with you which, given her many unhappy past experiences with doctors, was both encouraging and surprising."

"And yet, at the end, to her (and my) profound disappointment, you failed her. When you realized that you could do no more to reverse her progressive disease and that death had become inevitable, you abandoned her. You evaded her telephone calls you waited 10 days before informing her of the April 2004 CAT scan results; you pulled away. The empathy you had displayed was replaced by what she experienced as indifference. And, sadly, your behavior dovetailed perfectly with The New York Times article Facing Up To The Inevitable, In Search Of A Good Death of Dec. 30, 2003, which speaks of physicians who withdraw from patients rather than address feeling "guilty, insecure, frustrated and inadequate." It is true that you informed my wife off handedly, that the hospice staff would care for her during the phase. As they did -- with dedication and great dignity. However your coldness during her final weeks made it more difficult for us because she felt that she had lost the medical anchor you had provided and no longer had a doctor she could trust to explain what was happening to her as her body withered and her vulnerability grew."

"Much precious time was wasted trying to turn her mind from your dismissal of her that she experienced as a professional and personal betrayal, which I believe it was."

"Would it have cost you so much, doctor, to have picked up the telephone to speak with her after almost seven years of treatment ? Would it have been so intolerable to you to have looked into her eyes -- at the hospice perhaps -- and told her that you wished her well and wanted a chance to say goodbye ? Were you truly unable to offer even a shred of comfort, a word of condolence to her family ? Had she really become no more than another statistic, a failure you preferred to brush aside ? I am asking you to help oncologists like yourself, who work with many patients they are bound to lose, not abandon them emotionally, as you did. I am asking that you suggest that your hospital consider setting up a training program for doctors like yourself so that other patients can be spared the pain of the rejection my wife experienced. Because it is my conviction that doctors treating terminally ill patients have a moral obligation to stand with them from start to finish even when, at the end, those patients must be trasferred to hospice care. It is not easy for me to tell you that from this perspective, I believe that your failure was monumental."

"Perhaps this letter will help you display greater feeling with future patients and not ask them, as you did my wife from a distant height, 'What would you like us to do for you ?' What she wanted you to do was simple: She wanted you to speak with her with courage; she wanted you to show a bit of concern, which would have meant as much to her then as all the chemotherapy you prescribed when there was still hope; she wanted you to help her die more peacefully -- as you had promised that you would do but did not. It would have made the work of the hospice staff easier. It would have been a consolation to her and to the family and friends who loved her.

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There are more words to that article that highlight what the letter said. But that article brought me to tears, because that is what Rob's doctors did. On the hospice floor he met new doctors who really didn't relate to him one on one, who checked the charts and made their recommendations to the hospice nurses and prescribed changes of medication, and then hurried off to the next patient.

So, it seems to me that an important part of a doctor's training should be to teach them to have the intestinal fortitude and empathy to at least stop by the hospice and say goodbye and best wishes to the outgoing patient. Or am I just carping ?

Doctors hurrying to live at the expense of others, I for one have Seen That . . . . . . . . .

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