He yelled, “Get out!” with all that his failing body could muster. He didn’t want any more of our lies. He just wanted to be left alone.
Outside, I took a deep breath. My hands were trembling. Later that night, I learned, my patient’s family arrived — a long-estranged sister and son. By then he was fading away, but they turned the hospital television to the game he had wanted to see and watched together as he died. I never had the chance to talk with him again.
For the next few days, I kept returning to that moment at the bedside. What had I hoped to accomplish? As a doctor and purveyor of science, it can be difficult to accept that sometimes the “truth” is not what a patient needs. Denial was my patient’s only defense mechanism. And as soon as the words left my mouth, I realized how cruel it was to try to take this defense from him in the final hours of his life.
I pride myself on being gentle with my patients and their families, even the “difficult” ones, who demand interventions that we cannot offer and believe steadfastly in a recovery that will never come. In the intensive care unit, we have the honor of caring for people at their most naked and frightened. I try to recognize the emotions in front of me without drowning in them.
But in that moment, I was not gentle. And as I revisit that night, I wonder about why I responded as I did and how we doctors react when faced with people who are dying because of bad decisions about their health.
In the most generous version of that night, my goal was to give my patient the information he needed so that he could reach out to those he loved, to say whatever he would want to say with the knowledge that his time was short. That was one piece of my response. But I also responded to him with my own anger, at the avoidable nature of this tragedy, at how denial had turned deadly. This man was scared and he was going to die of a disease that might have been cured. And I could do nothing about it. When I told him that he had only a few hours to live, I allowed my frustration to obscure the reality of his suffering. And I caused harm as a result.
In most contexts, it is a doctor’s responsibility to tell our patients the truth, to help them to understand even the most devastating realities. But when I think about that night, I know that I added to my patient’s pain in the last hours of his life. I wish that I had done it differently. I could have paused and told him that yes, he was going to go home. I could have simply been there with him and said nothing at all. That small kindness might have done more for him than the truth.