Nairobi News

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer.

This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from five per cent to 15 per cent—albeit with a poor quality of life. 

Charlie was uninterested. 

He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible.

Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. 

Even medics

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most other people, but how little.

For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. 

They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

According to Dr. Kevin Muriu, a general practitioner at Primecare Health Services, doctors, just like the rest of us go through all stages of grief when met with devastating news about their health. 

“They are knowledgable about the disease, the treatment options, risk of treatment and failure rates. They have also witnessed the effects it has on families and this helps doctors prepare themselves when faced with similar situations,” says Dr. Muriu.

Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. 

Big burden

In Kenya, dying broke and leaving a family destitute because of huge medical bills is also a real fear, so many doctors invest heavily in medical insurance, Dr Muriu adds. 

Almost all medical professionals have seen what is called “futile care” being performed on people.

That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs.

All of this occurs in the Intensive Care Unit at a cost of tens of thousands of shillings a day. What it buys is misery we would not inflict on a terrorist. 

To administer medical care that makes people suffer is anguishing. I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.

How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.

Patients and their families sometimes request doctors to “do everything,” but often they just mean “do everything that’s reasonable.”

For their part, doctors told to do “everything” will do it, whether it is reasonable or not especially because doctors are fearful of litigation and do whatever they’re asked to avoid getting in trouble.

But doctors still don’t over-treat themselves. They see the (negative) consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. 

Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. 

Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. 

Go gently

Several years ago, my older cousin Torch (born at home by the light of a torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain.

We learned that with aggressive treatment of his condition, including five hospital visits a week for chemotherapy, he would live perhaps four months. Torch decided against any treatment and simply took pills for brain swelling. 

We spent the next eight months doing things that he enjoyed, having fun together like we hadn’t had in decades.

Torch had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. 

Torch was no doctor, but he knew he wanted a life of quality, not just quantity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. 

There will be no heroics, and I will go gently into that good night. 

Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.

Adapted from www.dailygood.org