“Help me, doctor. I’m dying.”
A man I’d never met before gripped my hand with desperate force, as though his physical clamp on me might preserve him from oblivion. The doctor who actually knew him, one even more junior than me, had poked her panicked head out of his room, grabbing me for assistance. A split second glance told me here was a man in extremis. Ashen, sweaty and stricken with fear. My next glance – at his monitor – confirmed my expectations. Blood pressure plummeting, oxygen levels life-threateningly low.
When someone, in our jargon, is ‘peri-arrest’ – on the brink of their heart giving out and stopping beating – snap judgments aren’t lazy, they’re essential. This man was for ‘full resuscitation’: if his heart stopped, my next action would be to start chest compressions. But was this right? Had he, in fact, reached the natural end of his life and would compressions, plus electric shocks to try and restart his heart, subject him to undignified and inappropriate treatment, denying him his right to a peaceful death?
These are the scenarios doctors face in hospitals across the UK every hour of every day of the year so for Professor Sam Ahmedzai, the chair of the committee that developed new National Institute for Health and Care Excellence (NICE) guidance on end-of-life care, to claim yesterday that doctors treat death as a ‘tick box exercise’ was, frankly, insulting.
I fervently embrace every initiative aimed at giving my patients the best possible death. Like so many of my nursing and doctor colleagues, I strive daily to ensure the end of life of my terminal patients is the most meaningful, dignified and humane life possible. And any guidance that promotes a sensitive and holistic approach to death and dying can only be positive. But please, publish without damning doctors.
Prof Ahmedzai states there is no excuse for junior doctors making snap decisions about end-of-life care, as if we somehow take a cavalier approach to the matter of mortality. But this could not be further from the truth. Take yourself back to your twentysomething self, when a typical junior doctor starts out life on the wards. Had you watched someone expire in spite of your best efforts, had someone bled out before your eyes?
Death, to the uninitiated, is as traumatic as it is stark. My five-year medical degree contained one paltry week of palliative care: hardly sufficient to steel anyone against the shock of the actual deaths we witness from day one on the wards. Please rest assured, we feel the weight of every patient’s death, not one is taken lightly.
The greatest challenge, in ensuring patients rest in peace before they die, lies not in correcting an insouciant attitude to dying, but in providing the resources to fund good quality palliative care – including meaningful education for every healthcare professional involved in death and dying.