Case history

The terminal care doctor

Much progress has been made in medicine over the past 100 years. No doubt even greater progress will be made over the next 100 years. But some diseases are still incurable, and many of them will always be incurable. The only certainty in life is that we will all die eventually. Terminal careis the branch of medicine which deals with incurable diseases. Doctors cannot prevent death, but they can help patients to spend the last months of their lives comfortably and to die with dignity.

Perhaps the most common cause of loss of dignity is poor communication.The doctor is afraid to tell the patient that he is dying, and the patient’s relatives want to protect him from bad news. When the patient asks if he is getting better, everyone lies to him. This behavior is insulting to the intelligent patient. If you were dying, would you want to know? In the United States, terminally ill patients have sued their doctors for withholding the truth about their illness. The patient is not a child or a fool. Breaking bad news is a painful experience for the doctor and the patient’s relatives, but they all have a duty to be honest. Many people are surprised to find that patients who know they are dying are less frightened about death than patients who have been told they are getting better.

Terminal care is unique branch of medicine because the doctor is not trying to cure the patient. The doctor’s aim is help the patient spend the last few months of his life in comfort and dignity, to help him to prepare for death, to give care and compassion when he dying, and to offer emotional support to the bereaved relatives after the death.

James was only forty-two when he became terminally ill. He had wife and two young children. He began to lose a lot of weight and he developed severe pains in his stomach. He lost his appetite and became very weak. His general practitioner arranged an endoscopy examination which showed that James had cancer of the stomach. The surgeons did an operation to remove the cancer but unfortunately it had already spread too far.

At first, James wanted to stay at home rather than go into a hospital because he wanted to be with his family. But soon he became too weak and dependent; his wife could not look after him any more. His general practitioner arranged for him to go into a terminal care hospice. The doctors and nurses in the hospice were honest with James, and told him that he would probably die within six months. James asked to see a solicitor to make a will while he was still well enough to read and write. He developed large ulcers on his legs, which the nurses carefully dressed every day. A counselor also visited him daily, to talk with him about his fears.

Of course, it was tragedy that James died so young. But the doctors and nurses at the terminal care hospice achieved an important aim: James died in dignity, without pain, and with his family around him.