Should doctors give patients' loved ones hope no matter the situation? Or should they allow loved ones to say goodbye when a situation seems hopeless? In Hope or Letting Go: The Final Good-bye.Dr. Anthony Youn describes why these questions have been haunting him for years.
While a junior surgical resident, Dr. Youn was involved in the emergency care of a man in his mid-30s who suffered burns over 90% of his body in an industrial accident. (identifying details are changed)
The patient's wife and young child arrived and were in the waiting room. Meanwhile, the patient's breathing became more labored. The attending surgeon felt it was time to put a breathing tube in.
Dr. Youn asked the surgeon if they should have his wife and daughter come in to say goodbye before intubating the patient .
His answer? "No...They don’t want to hear that. He’s in terrible shape and can barely speak. We need to give them hope.”
The patient died less than 24 hours later.
Youn asks if it's preferable for the wife to see her husband sedated and to hold onto hope that he might survive, or if it would have eased her loss to have had the opportunity to say goodbye (even if it meant seeing him in grave pain).
I find this story and his questions troubling. Should concern for loved ones' needs ever take precedence over patients' needs? Do patients who appear peaceful give loved ones more hope for recovery?
Stay tuned.
I believe it's preferable to give the wife the opportunity to say goodbye. That's what the hospital did for me when my Dad was dying, and I'll be forever grateful. I've always been in favor of instilling honesty over false hope.
Posted by: Jan Hasak | July 22, 2011 at 10:55 AM
Wendy,
Our family is still dealing with the consequences of my sister's doctors fostering false hope that she would recover after her second breast cancer recurrence had spread to her lungs.
But what's a doctor to do when the patient makes it clear that she refuses to face the fact that she is dying? My sister's denial kept her from receiving hospice care, which would have made her last weeks or months more comfortable and far less painful for her.She did not prepare her children (who were then 22 and 17)for her death.
Kay was full of hope that she would get strong enough to enter a trial that would miraculously cure her lung cancer.
Amazingly, her doctor did a second mastectomy! So she spent the last few weeks in the hospital.
Can I blame the doctor for fostering false hope? No. I think if the patient refuses to accept the prognosis, the doctor is stuck in a bad place.
Only because I talked to Kay every day on the phone was I able to hear her becoming weaker and weaker. I called the family to come quickly.
Sadly, we all arrived an hour after she died. The children were shocked, having never been told she was dying. They never had an opportunity to say goodbye.
The pain of never having been able to deal with some of their grief prior to Kay's passing is still there. It will likely always cause them pain.
Perhaps you will write more about how and why cancer survivors in the same position as Kay might consider the importance of preparing their children. Jeanne
Posted by: Jeanne | July 23, 2011 at 05:16 PM