Truth-telling and Disclosure In Medicine

Five years ago, a dear friend passed on. I did not even know she was sick. She was only 46 years old and stayed for a month and a half at the intensive care unit because of post-operative complications. She underwent major abdominal surgery after she was diagnosed with a malignant growth in her stomach. The surgery took 11 hours to finish. A few hours post-op, she developed respiratory failure and subsequently, an infection. She was placed on life support and she did improve. Unfortunately, her immune system failed and she developed more infections. The question on many people's mind including mine was, what happened? I asked some surgeon friends what their opinion was and most said that since the cancer seemed localized, meaning there was no spread beyond her stomach and esophagus, a resection was the right thing to do. She was young and a fairly good surgical risk so that there was a good chance for a cure. But she died. And her family, friends and acquaintances do not understand why. Many have started to speculate. Although I have not heard her family say anything derogatory but one friend even dared to say that the doctors "experimented" on her. An unfair statement but understandable under the circumstances because from the conversations during the wake, it appears that the family were at a loss of what transpired during the 11 hours of operation. It is no wonder then that people are making guesses and conclusions about her death.

What Is So Funny About Death?

As health professionals and workers, death and suffering is a natural occurrence that we deal with everyday. So much so that many of us have developed a callous and apathetic attitude towards it, even to the point where we make fun and laugh about it.  Just this morning as I opened my Facebook, the first thing I saw was that of a status post about the "heavens opening" and following that, were tongue in cheek comments about patients who died during the shift.  As I read through it, my immediate reaction was to view these statements coming from health professionals, as inappropriate and insensitive.  But then, as I thought about it, I realized that my opinion was made because I knew these people.  Others who were not familiar with them would not think the same way I did, because without any biases, the remarks were actually innocent enough, like some private joke between people who work together.

When No One Grieves...

In the hospital, we experience death and dying daily but because we are so used to seeing it everyday that it has become "ordinary"...in other words, a part of our daily routine, so that hospital workers are perceived to be callous to pain and suffering.  How often do I get complaints about how our emergency room staff  behaves while the dead patient is still in the ER...like how they could be seen talking and kidding around while finishing up their work.  Is this apathy? I prefer to call it coping.  It's not that we do not feel the pain and suffering...but dealing with it 24/7 can drain a person emotionally and mentally. So the fear is always that if  hospital workers do not learn to distance themselves emotionally from their patients, they will not be able to do their work.  I remember as a young intern I used to cry when I see my charity patients dying. I felt so much anger not because they were dying, but that they were poor and I wished I could do more but did not since I too had limited resources. I would also cry for the elderly because they reminded me of my grandmother and other people's grandmother, who in their old age needed to feel the presence of their families.  But the worst deaths were the ones with no one to grieve for them, yet strangely I don't feel as sad or angry. I often wondered about this and I came to the conclusion that maybe because patients whose families are disinterested with their care, also makes me less interested in them and therefore I don't form any connection to the patient. But yes, I would feel some guilt because I knew deep inside me that I should have cared more.