In my years of practicing medicine I’ve always dressed for death in white coat, clutching a stethoscope - but this time was different.  I wore jeans, jotted notes in a spiral notebook, and painstakingly fed the patient when the hospital tray arrived.   This was death from the other side of the stethoscope, and it was different.   It was Dad.

My father died several weeks ago after a devastating, one-month illness.  It is still so fresh in my mind that I am trying to figure it all out, even though I’ve spent my life in medicine and have seen death many times before.  It was like I was cast in a stage play that I knew well, but was thrust into a role for which I was unprepared and didn’t know the lines.

Dad’s condition deteriorated quickly and we were powerless to restore his health to something he would have considered an acceptable quality of life.  Along the way he lost the ability to speak for himself, but thankfully, he had made a Living Will that helped us know how to navigate the rocky terraine of dying in the 21^st century.

The final act opened when Dad began to having trouble swallowing, choking on his food.  I knew it was an ominous sign because it put him at risk for aspiration pneumonia.  Yet, his Living Will indicated that he wouldn’t want a feeding tube in the event of any of the following: 1) mental incapacity, 2) an inability to feed himself if not likely to regain it, or 3) a prognosis likely to result in death in a relatively short period of time.  At the point we were pondering feeding tube, he actually fulilled all three of these criteria – simultaneously.

The kicker is that the young doctors who were caring for him, interns and residents in a teaching hospital, were very hesitant to discuss prognosis, let alone futility, and never inquired about the presence of a Living Will.  Yet, because he'd gone to the effort to make a Living Will and we had the conviction to follow it, Dad’s suffering was shortened by weeks and perhaps months because the fact he wasn’t tube fed. 

I’m wondering how often doctors fail to ask about the presence of a Living Will in seeking to determine the patient’s expressed wishes around end-of-life decisions.  Was ours an unusual experience?  If not, then there is much to be done to help doctors, patients, and their loved ones write a better script for care at the end of life.