Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

I may be the only advocate for my dying patient

Monica Williams-Murphy, MD
Physician
November 29, 2015
Share
Tweet
Share

Medical school and medical training attempt to teach subjective humans how to think and practice medicine objectively. This may be one of the unique fallacies of modern medicine, but that’s a subject for a different blog.

Nevertheless, even in the highly emotional field of emergency medicine I’m usually pretty chill. That is, until someone’s dying, and then all of my equanimity can go flying out the window, for better or worse.

Such was the case of Mr. G.  I was waiting out the last five minutes of my night shift, the last of a string of three night shifts in a row. Needless to say, I was chomping at the bit to walk through the exit doors.

While staring impatiently at my watch,  I heard the nurse call out to me, “Dr. Murphy they’re bringing a dying man to room 39 who had a DNR order in the hospital but the nursing home said that has been revoked and are sending him in for a full treatment.”

Immediately, my blood was boiling. I ripped off my watch and threw it in my bag. So much for being chill.

I stood angrily in the hallway, posed in my white coat with hands on hips awaiting the paramedics who were delivering the dying man to me. I was ready to find out exactly whom I should call to reprimand if this was a case of disobedience to patient wishes.

But the minute they turned the corner all of my anger dropped to the floor like a heavy cloak. My heart opened wide at the sight of this man, my patient. Mr. G was lying nearly flaccidly on the stretcher gazing upward toward the ceiling. His trembling hands lay at his side, and his trembling lips offered an inaudible whisper. I felt great love for him.

I generally naturally feel care and concern for most of my patients. But there’s something different about my dying patients. I feel love when I am near them. Sometimes this particular love sensation is even my first clue that someone is dying.

I leaned in and asked him in my kindest voice, “Mr. G do you feel any pain? Do you hurt anywhere? Do you feel short of breath?”

He whispered, “No” to each question but could offer no other words. Feeling satisfied that he probably had no distressing symptoms that I needed to manage immediately,  I turned my attention to his paperwork.

He had just been discharged from our hospital to a local skilled care facility and these were the physician orders written in his chart at time of discharge :

unnamed

My blood returned to its previous boiling state.

I checked his discharge summary that read something like this:

ADVERTISEMENT

Mr. G has stage four cancer and multiple metastases, he has elected to discontinue dialysis for his end-stage renal disease due to rapidly declining quality-of-life and would like an “Allow Natural Death / Do Not Resuscitate” order. At this time, he desires only comfort measures. He is fully conscious at the time of this decision. He is estranged from all of his family and there are no other people available to support him in his decision-making process. He will be discharged to a local facility for supportive care. Per his wishes he will not be transferred back to the hospital.

I put down all of this paperwork in a neatly folded stack and went to stand by Mr. G. I gently placed my hand on his shoulder. Again, my anger receded and I felt love.

Standing quietly beside him, it dawned upon me that I might be the singular person in the world available to support him in his previous decision-making process. I might be his only advocate now. And I might be the last person to love him before he dies.

***

3 lessons from Mr. G

1. Emotional subjectivity, empathy, and love allow us to enter into the lives of our patients as potential advocates for them if our emotions are regarded as tools for greater service.

2. Anger and moral outrage may be harnessed to transform healthcare systems.

3. Used conscientiously, love and anger both have a place in improving the practice of medicine and the supporting the patient’s experience at the end of life.

Names and details have been changed to protect the privacy of the patient. Date of post has no relevance to the date of the patient encounter.

Monica Williams-Murphy is an emergency physician and author of It’s OK to Die.

Image credit: Shutterstock.com

Prev

The next big thing in health care? It probably will start as something small.

November 29, 2015 Kevin 3
…
Next

What academic medicine can learn from #ConcernedStudents1950

November 30, 2015 Kevin 1
…

Tagged as: Emergency Medicine, Palliative Care

Post navigation

< Previous Post
The next big thing in health care? It probably will start as something small.
Next Post >
What academic medicine can learn from #ConcernedStudents1950

ADVERTISEMENT

More by Monica Williams-Murphy, MD

  • Please address suffering in the care of the dying

    Monica Williams-Murphy, MD
  • 8 unexpected reasons why you should have an advance care plan

    Monica Williams-Murphy, MD
  • a desk with keyboard and ipad with the kevinmd logo

    3 myths and 3 truths about hospice

    Monica Williams-Murphy, MD

Related Posts

  • Digital advances in the medical aid in dying movement

    Jennifer Lynn
  • A silent moment with a dying patient

    Ramses Perez
  • Building a bond of trust between patient and physician

    Michele Luckenbaugh
  • More physician responsibility for patient care

    Michael R. McGuire
  • Prescribing medication from a patient’s and physician’s perspective

    Michael Kirsch, MD
  • Dying is a selfish business

    Nancie Wiseman Attwater

More in Physician

  • How New Mexico became a malpractice lawsuit hotspot

    Patrick Hudson, MD
  • Why compassion—not credentials—defines great doctors

    Dr. Saad S. Alshohaib
  • Why Canada is losing its skilled immigrant doctors

    Olumuyiwa Bamgbade, MD
  • Why doctors are reclaiming control from burnout culture

    Maureen Gibbons, MD
  • Why screening for diseases you might have can backfire

    Andy Lazris, MD and Alan Roth, DO
  • Why “do no harm” might be harming modern medicine

    Sabooh S. Mubbashar, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
    • How fragmented records and poor tracking degrade patient outcomes

      Michael R. McGuire | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How I learned to stop worrying and love AI

      Rajeev Dutta | Education
    • Understanding depression beyond biology: the power of therapy and meaning

      Maire Daugharty, MD | Conditions
    • Why compassion—not credentials—defines great doctors

      Dr. Saad S. Alshohaib | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
    • How fragmented records and poor tracking degrade patient outcomes

      Michael R. McGuire | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How I learned to stop worrying and love AI

      Rajeev Dutta | Education
    • Understanding depression beyond biology: the power of therapy and meaning

      Maire Daugharty, MD | Conditions
    • Why compassion—not credentials—defines great doctors

      Dr. Saad S. Alshohaib | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

I may be the only advocate for my dying patient
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...