How doctors die

There is a half-meant joke in the medical profession that your manner of death will be determined by your specialization. This is what they say when cardiologists die of heart attack; pulmonologists of lung cancer; gastroenterologists of colon cancer; neurologists of stroke.

Of course, it does not offer guidance for ophthalmologists, radiologists and public health practitioners — or consider the fact that some doctors nowadays are killed not by diseases but by bullets. But it points to an obvious truth: Doctors, too, pass away. And as they are experts in dealing with life and death situations, looking at how they themselves face death can serve as a guide for end-of-life care.

In writing this article, I draw inspiration from Dr. Kenneth Murray, from whom I borrow the title of this column. Dr. Murray observes that physicians tend to meet death in the eye: “For all the time they spend fending off the deaths of others, they tend to be fairly serene with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.”

Murray’s main point is that, more than anyone else, doctors know the limits of medical care — and they will not prescribe treatments they know are futile. Since they know what to expect, they are also able to manage their families’ own grief about their own eventual passing.

His insights resonate with my own observations in our country’s medical community. When one of my mentors, the late Dr. Alberto “Quasi” Romualdez, was critically ill, he warned my colleague, Dr. Bryan Lim, not to allow him to be intubated. “Or else I will kill you,” the former health secretary, ever affable, jokingly said. He was clear in his advance directives: Do not intubate, do not resuscitate.

He knew the end was near, and faced it with grace and courage.

Sociologists have noted that death has been “medicalized” in modern societies: It often takes place in hospitals, supervised by health professionals, who hand over the task of handling the dead body to funeral chapels, which in turn take charge of everything from the venue of the wake to the embalming of the body. This “hands off” approach both reflect and reinforce our reluctance to deal with death, or even talk about it.

Doctors are not immune to this phenomenon, which is why they struggle to communicate end-of-life issues. Adding to the difficulty is the fact that many patients don’t want to know their diagnosis, fearing it will exacerbate their illness. Sharing the same concern, family members would sometimes beg doctors not to make the disclosure to the patient.

What this timidity achieves, however, can be worse than what it hopes to avoid. When the inevitable finally happens, family members are paralyzed, unable to make important decisions. Overcome by feelings of guilt, they would demand that doctors do extraordinary measures, without realizing that they’re no longer doing it for the patient, but for their own peace of mind.

Meanwhile, wanting to show that they, too, did their best, many doctors participate in measures they know to be futile, and at the end of a harrowing process, many patients’ bodies are riddled with needles and tubes when it should just have been allowed to avail of palliative care. Needless to say, the lack of communication also leads to practical problems: death, after all, has legal, economic and social implications.

But the most important consequence of refusing to discuss death is depriving the dying the chance to exchange goodbyes with their loved ones, discuss their final will, and give advance directives. Neither families nor doctors should easily give up on the terminally ill, but perhaps there’s a time when words are more effective than medicines; when prayers can soothe more than painkillers; when quality of life is just as valuable as trying to prolong it.

Indeed, as the examples of Dr. Quasi Romualdez and other physicians show, communication can make a big difference. We may never know “how to die,” but by learning to talk about death, perhaps we can help ourselves and our loved ones make the most of life.

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