With Great Difficulty or More Fully

A few days ago, I came across a folder on my computer that contained a New York Times article (June 30, 2016) titled “At the End of Life, What Would Doctors Do?” by palliative care physician Dr. Ira Byock. The article explored what doctors think when facing death, referencing Dr. Ken Murray’s online essay “How Doctors Die,” which offered a personal observation that doctors who recommended late-stage treatments may not prescribe the same for themselves. However, it was pointed out that Dr. Murray’s observations were not in line with studies that showed doctors’ preferences for aggressive treatment at end of life were not all that different than what patients chose.

Then, Dr. Byock shifts the focus and poses the question, “How do dying doctors live?”

This question reminded me of an interaction with a patient in 2005 during my tenure as a medical humanist at the Bennington cancer center. I was asked, “How does one live when you know you’re going to die?” After a moment to absorb the magnitude of the question, I answered, “With great difficulty or more fully.” The patient liked the idea that he had a choice.

In the article Dr. Byock goes on to share examples of colleagues who found the end of life as an opportunity to express feelings to family and friends in ways they never did before. Others decided to take actions that defied the dire nature of their life’s circumstances. One example he offered was of a terminally ill oncologist and his wife (also an oncologist) renewing their wedding vows. I had the privilege of working with this husband and wife, Drs Herb Mauer and Letha Mills, at the cancer center in Bennington. I recall that it was not unusual for Dr. Mauer who, after having a difficult conversation with a patient, would tell me to go “give them some humanism.” He understood that a poor prognosis needed to be balanced by a positive force. He lived that himself.

Dr. Byock concludes by urging doctors to teach by their own example, by living fully for whatever time they have at the end of life.