WHEN ENOUGH IS ENOUGH: The dignity of letting go

When you take that first breath at birth, there is only one certainty….

That someday you will take your last…..

There is no way to predict how long you will live….

Or how you will live….

Will your life be one of significance ?

Will you change the world ?

Will you make a difference ?

Perhaps you will struggle…

Perhaps you will just get through it…slow and steady…one day at a time…

As a young doctor in training, the teaching we had was focused on saving life. “Do everything you can to improve and prolong life.”

What I have come to learn is that.. in order to prevent suffering , sometimes it is necessary to step back and stop trying. Many of us forget this part you see…

Sometimes we are so focused on treating the disease that we forget the end game…. not to prolong life at any cost, but to assist our patients to lead a life of good quality and vigour in the days they have left.
Our job is not only to medicate and surgically remove…
Our job is also to serve our patients in the way that is most empathetic, kind and appropriate to what they need.

I have to remind myself of this all the time.
Patients remind me of this all the time.
Especially when they decline what I think is a carefully crafted medical treatment plan in favour of no treatment at all.

“Doc I am tired. There is no more fight left in me. I am done.”

In a profession where ego can reign supreme, this is very hard to accept. We validate ourselves by patient and clinical outcomes: Measurements and parameters that we are proud to publish.
Peer review and judgement is all important to us. Oh to be the envy of our colleagues!
This is where we err.

Our only accountability should be to our patients… that we did everything possible for them in the way they needed..

And to ourselves…. That we treated our patients with the best intentions, sound medical knowledge and compassion … right to the very end .

Death has been a recurring theme in my life this last few months.

I lost my father-in-law after his protracted battle with Lymphoma….

I lost a patient who bravely surrendered at the end of a second struggle with breast cancer….

And I lost a dear friend and colleague who suddenly was gone, in a heartbeat, with no warning…. The victim of a drunk driver….

A huge reminder of my own mortality

Am I afraid to die?

No

What I am afraid of is not having lived !

That’s what our patients ask of us – when they decline our treatment – not to respect their wish to die…. But to respect their wish to live. For the time they have remaining.