Knowing How Doctors Die Can Change End-Of-Life Discussions
Dr. Kendra Fleagle Gorlitsky recalls the anguish she felt performing CPR on elderly, terminally ill patients.
It looks nothing like what we see on TV. In real life, ribs often break and few survive the ordeal.
"I felt like I was beating up people at the end of their life," she says. "I would be doing the CPR with tears coming down sometimes, and saying, 'I'm sorry, I'm sorry, goodbye.' Because I knew that it very likely not going to be successful. It just seemed a terrible way to end someone's life."
Gorlitsky now teaches medicine at the University of Southern California and says these early clinical experiences have stayed with her.
Gorlitsky wants something different for herself and for her loved ones. And most other doctors do too: A Stanford University study shows almost 90 percent of doctors would forgo resuscitation and aggressive treatment if facing a terminal illness.
It was about 10 years ago, after a colleague had died swiftly and peacefully, that Dr. Ken Murray first noticed doctors die differently than the rest of us.
"He had died at home, and it occurred to me that I couldn't remember any of our colleagues who had actually died in the hospital," Murray says. "That struck me as quite odd, because I know that most people do die in hospitals."
Murray then began talking about it with other doctors.
"And I said, 'Have you noticed this phenomenon?' They thought about it, and they said, 'You know? You're right.' "
In 2011, Murray, a retired family practice physician, shared his observations in an online article that quickly went viral. The essay, "How Doctors Die," told the world that doctors are more likely to die at home with less aggressive care than most people get at the end of their lives. That's Murray's plan, too.
"I fit with the vast majority of physicians that want to have a gentle death and don't want extraordinary measures taken when they have no meaning," Murray says.
A majority of seniors report feeling the same way. Yet, they often die while hooked up to life support. And only about 1 in 10 doctors report having conversations with their patients about death.
A family portrait of Nora Zamichow, husband Mark Saylor and their daughter, Zia Saylor.
One reason for the disconnect, says Dr. Babak Goldman, is that too few doctors are trained to talk about death with patients. "We're trained to prolong life," he says.
Goldman is a palliative care specialist at Providence Saint Joseph's Medical Center in Burbank, Calif., and he says that having the tough talk may feel like a doctor is letting a family down. "I think it's sometimes easier to give hope than to give reality," Goldman says.
Goldman, now 35, read Murray's essay as part of his residency. He says that he, too, would prefer to die without heroic measures, and he believes that knowing how doctors die is important information for patients.
"If they know that this is what we'd want for ourselves and for our own families, that goes a long way," he says.
In addition, Medicare does not pay doctors for end-of-life planning meetings with patients.
Nora Zamichow wishes she had read Murray's essay sooner. The Los Angeles-based freelance writer says she and her husband, Mark Saylor, likely would have made different treatment decisions about his brain tumor if they had.
Zamichow says that an arduous regimen of chemo and radiation left her 58-year-old husband unable to walk, and ultimately bedridden in his final weeks. "And at no point did any doctor say to us, 'You know, what about not treating?' "
Zamichow realized after reading Murray's essay that doing less might have offered her husband more peace in his final days.
"What Ken's article spelled out for me was, 'Wait a minute, you know, we did not get the full range of options,' " she says.
But knowing how much medical intervention at the end of life is most appropriate for a particular person requires wide-ranging conversations about death.
Murray says he hopes his essay will spur more physicians to initiate these difficult discussions with patients and families facing end-of-life choices.
This story is part of a reporting partnership with NPR, KPCC and Kaiser Health News.
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Transcript
ROBERT SIEGEL, HOST:
Doctors don't face death like the rest of us. More of them die at home with less aggressive care at the end of their lives, but very few doctors report having conversations about death with their patients. Well, there are signs that that is slowly changing. Stephanie O'Neill, of member station KPCC, brings us this report.
STEPHANIE O'NEILL: Dr. Kendra Gorlitsky recalls the anguish she felt performing CPR on elderly, terminally ill patients, which looks nothing like what we see on TV. In real life, ribs often break and few survive the ordeal.
KENDRA GORLITSKY: I felt like I was beating up people at the end of their life.
O'NEILL: Gorlitsky, who now teaches medicine at the University of Southern California, says these early clinical experiences have stayed with her.
GORLITSKY: I would be doing the CPR with tears coming down sometimes and saying I'm sorry, I'm sorry, goodbye, because I knew that it was very likely not to be successful. It just seemed a terrible way to end someone's life.
O'NEILL: Gorlitsky wants something different for herself and for her loved ones, and most other doctors do, too. A Stanford University Medical School study shows almost 90 percent of doctors would not want resuscitation and aggressive treatment if facing a terminal illness. It's data that support an observation Los Angeles doctor Ken Murray first made about 10 years ago after the death of a colleague.
KEN MURRAY: He had died at home. And it occurred to me that I couldn't remember any of our colleagues who had actually died in the hospital. And that struck me as quite odd because I know that most people do die in hospitals.
O'NEILL: Murray then began talking about it with other doctors.
MURRAY: And I said, you know, had you noticed this phenomenon? And they thought about it and they said, you know, you're right.
O'NEILL: In 2011, Murray shared his observations in an online article that quickly went viral. In that essay, entitled "How Doctors Die," the retired family practice physician told the world that doctors don't typically die like the rest of us, and he doesn't plan to either.
MURRAY: I fit with the vast majority of physicians that want to have a gentle death and don't want extraordinary measures taken when they have no meaning.
O'NEILL: A majority of seniors nationwide report feeling the same way, yet they often die in intensive care. So why the disconnect? One reason, says Dr. Babak Goldman, is too few doctors are trained to talk about death with patients.
BABAK GOLDMAN: We're trained to prolong life.
O'NEILL: Goldman is a palliative care specialist at Providence Saint Joseph's Medical Center in Burbank, Calif.
GOLDMAN: It's hard for us to say we failed or to let a family down. I think it's - sometimes it's easier to give hope than to give reality.
O'NEILL: Goldman, now 35, read Ken Murray's essay as part of his med school residency back in 2012. He says he, too, would prefer to die without heroic measures, and he believes that knowing how doctors die is important for patients.
GOLDMAN: If they know that this is what we would want for ourselves and for our own families, that goes a long way.
O'NEILL: Nora Zamichow wishes she had read Murray's essay sooner. The LA freelance writer says she and her husband, Mark Saylor, likely would have made different decisions for Saylor's brain tumor treatment if they had. Zamichow says that an arduous regimen of chemo and radiation left her 58-year-old husband unable to walk and ultimately bedridden in his final weeks.
NORA ZAMICHOW: At no point did any doctor say to us, you know, what about not treating?
O'NEILL: In hospice, Zamichow read Murray's essay, which made her realize less treatment might have offered her husband more quality of life in his final days.
ZAMICHOW: What Ken's article spelled out for me was - wait a minute, you know, we did not get the full range of options.
O'NEILL: But knowing how much medical intervention at the end of life is most appropriate for a particular person requires wide-ranging conversations about death that Dr. Ken Murray hopes his essay will continue to spark. For NPR News, I'm Stephanie O'Neill in Los Angeles.
SIEGEL: And that story is part of a reporting partnership of NPR, KPCC and Kaiser Health News. Transcript provided by NPR, Copyright NPR.
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