This is a true story. A man just in his 40s went to see his doctor. The man knew he had cancer, but with unforeseen
issues popping up the doctor sent him to see an oncologist again. A series of tests were performed and a bunch
of specialists were brought in. The original doctor went back to see the guy
in hospital, shook his hand, and said I’ll see you in a few days. Once the results came back the doctor was
aware that this man would not live long. He would be gone, forever, and his family
would grieve. But this is what that doctor said about this
reality, “Telling him what this all meant, how it was almost certain that he would die
sooner than he thought, proved too difficult.” This can never be easy; never mind how many
years you’ve put in as a doctor. But it’s also the reality for a lot of people
that work in the medical profession. In the case we just mentioned the man was
very close to death just one month after he experienced those new issues. It can be especially hard telling someone
who isn’t very old that their time is almost up. The end of life is rarely simple, and sometimes
the professionals can’t say how long someone has got. Sometimes they get it wrong and the person
makes a recovery, but more often than not when someone is told they are going to die
the end will come soon enough. Sometimes the patient can be very confused,
perhaps not fully understanding what is really happening. Sometimes legal documents have to be signed,
and anyone who’s had to go through that with a dying person will know it can be difficult
and heartbreaking. This person might have been offered treatments,
but at times they will be told there is nothing that we can do. Right now we just want to make your last days,
or months, as comfortable as possible. This is what is called palliative care. This kind of care is just a way to treat end-stage
patients who might have various diseases. It can give them a good quality of life during
the end in accordance with their circumstances. It should help this end be peaceful. This can also be a very difficult time for
loved ones, watching their brother, sister, wife, husband, best friend, have their last
threads of mortality snipped by the day. At times the patient may not be able to communicate,
either because of medications or the disease itself. With some cancer patients there can be good
days, good hours, when the patient suddenly looks better and does start chatting again,
but then loved ones may become saddened again when the next day the person is in bad shape
again. So, now on to the question, what do doctors
wish patients knew about these end days? One thing is this according to one doctor. A person might look as though they are dying
but actually their days are perhaps not numbered. The person could die, but could pull through. Understandably, the family of this person
might not want to send their loved one to palliative care because that might seem like
sending them on their way to the abyss. It might seem like giving up, and so the family
won’t want this. But the doctor said you don’t have to be
on the verge of death with a countdown to enter into this kind of care. He said don’t be afraid to ask for it if
the person is sick and suffering. Palliative care doesn’t have to be a death
sentence and might just be the best option for a sick person. But then in some cases the person really is
at the edge and palliative care in a hospice is absolutely needed. The thing is, sometimes doctors wait too long
to tell the family this is what should happen now. “Nothing else can be done,” as we said,
are not easy words to say for many doctors. In fact, research undertaken by the U.S. National
Institutes of Health asked this question, “Why do physicians overestimate life expectancy
of a person who is terminally ill?” This research showed that some doctors wait
too long, especially if they are close to the patient. Sometimes waiting until the 11th hour to send
a patient to the hospice is just not recognizing the seriousness of the disease – in most
cases in this study the disease was cancer. When that study was published patients who
had less than six months to live, or at least were thought to have around that time left,
could be sent into palliative care. But the research showed that most of the patients
were in a hospice for less than 6 weeks. Part of the study read, “Providing a physically
comfortable death is a worthy goal; it reduces regrets among survivors. Yet, more time provides the opportunity for
the dying person to participate directly in the process of validating the past and planning
for the future and gives the family the chance to relish or repair bonds with the dying person.” So, what doctors want patients and their family
to know, is that even if the physician doesn’t talk about palliative care they can come forward
and recommend it. They don’t have to wait for the doctor. Do doctors get it wrong sometimes? Of course they do. Timing death is no easy task, and while miraculous
recoveries are very rare, getting the survival time exactly right can be difficult. Another study by the National Institutes of
Health looked at 343 doctors who had given survival estimates to 468 terminally ill patients. In that study the median survival for the
patients was 24 days. But the doctors who were in the research were
more optimistic than pessimistic when telling the patient how long he or she had left. NIH writes, “Only 20% (92 out of 468) of
predictions were accurate; 63% (295 out of 468) were overly optimistic and 17% (81 were
468) were over-pessimistic. Perhaps some doctors just wanted to give more
hope to the patient, but the problem said that being over optimistic can negatively
affect the quality of care given to patients near the end of life. More research was done on this matter, and
researchers came up with a question that can be asked by a family to the doctor. That question is, “Doctor, would you be
surprised if your patient died within a year?” If the doctor replies no, then perhaps the
family might start thinking about a hospice already. Remember that 24 days is the average stay,
but a sick person could stay for months in a hospice. If you are the dying person you might also
ask, “Doctor, would you be surprised if I died in the next year?” It’s not an easy thing to ask, but it might
in the end make the last stint down here on planet Earth a bit more comfortable. As one doctor points out, the healthcare system
is designed to keep you alive as long as possible, but there are cases of people who’ve just
had enough painful treatments. They actually want to slowly fade away in
as much comfort as possible. He said it’s ok to ask for palliative care
in such a case. That same physician actually wrote a book
called, “A Beginner's Guide to the End: Practical Advice for Living Life and Facing
Death.” There is a part of that book that talks about
humor. If you’ve ever been sat around the bed of
a dying person you will know it’s not always the best situation to start telling jokes
and being funny. But he says being miserable and teary-eyed
all the time can be like an early death for the person. Go ahead, tell a joke, be normal, jest, have
fun, don’t make it any more painful than it needs to be. The doctor wrote, “Illness isolates people,
not just physically. When we get sick, people around us start censoring
themselves. The solemnity is supposed to be a form of
kindness, perhaps, but it can feel more like yet another loss, almost a premature death.” He also points out that illness has its fair
share of indignities, but sometimes laughing in the face of such indignities can be helpful. Don’t cast gloom over the bedridden person. Be a bright presence. Perhaps when it comes to man and wife the
joking can be put aside for something else. Another doctor who writes about sexuality
at the end of life said intimacy doesn’t need to stop. She mentioned a case in which the patient
actually died in an act of intimacy. This might sound awkward or even unethical
to some people, but would you rather be able to be intimate until the end or not? She tells people that if that is possible
then got for it. It happens and it’s just a form of showing
love, in that one case, love right up until the end. You see, don’t ever forget that a person
is living until they are dead. It might sound obvious, but some people can
treat a dying person as if they have no lifeforce left. That could be making their final days all
the more difficult. Don’t be afraid to show some love. It can make them feel connected during this
hard time, and while life may be falling apart they still have someone hanging on to them. As we said before, during the final stages
it can be difficult because the patient might be in and out of consciousness. Even when they are conscious they might be
delirious. We read about one particular patient with
cancer who would talk to people from his youth. He would seem to hallucinate, even smoking
invisible cigarettes that he thought were real. He would shout as nurses and call them names,
all the while demanding an ashtray for this invisible smoke. This can be really upsetting for some people,
and sometimes very, very challenging. At times a patient might do things that are
hard to deal with. Their personality might change a lot, which
could make you laugh, or could drive you up the wall. Some patients have been known to say quite
vulgar things, to friends, family and even nurses. But what you must understand as the person
seeing that is that deathbed delirium is not that uncommon and it shouldn’t be taken
seriously. This person really is not in their right mind. Don’t take things too personally if something
bad is said to you. The nurses will forgive the person, we promise. It’s also said that during these final stages
that family or caregivers are often afraid to leave the room, thinking the end is nigh. It might be nigh, but it might also be days
or weeks away. Sometimes you have to leave the room; you
have to sleep, you have to eat, you have to do some work. Don’t be hard on yourself, you cannot be
there every minute of every day. To be your best around this person you’ll
also need some rest. Hospice workers have said many times people
just don’t get that rest and wait over the person for the dying breath. It is very common. But they also said sometimes a person just
dies alone and that cannot be helped. If you are there during the final days please
don’t feel bad that you weren’t there for the last breath. It can be like waiting for a rainbow to appear
outside. Be loving, be funny, be yourself, and if you
are not there at the end just accept it. In the end that person you love who is dying
loves you, too, and the only thing they want from you is to go on having a great life after
they die. They don’t want you to feel full of regret,
to be weighed down with misery. If you do have to go out some place and things
aren’t looking good, give the person a kiss on the head and know it might be the last
time you do that. You did your best, and perhaps your love was
felt even if the person didn’t seem to be awake. Have any of you experienced this kind of thing? Do you have any advice to offer? Tell us in the comments. Also, be sure to check out our other video
What Happens When You Die? Thanks for watching, and as always, don’t
forget to like, share and subscribe.
