The Way We Die Now Read Online Free Page A

hoped, to treat) the source of bleeding. As expected, the patient had oesophageal varices. We were unable to stop the bleeding, and over the next two hours struggled in vain to save him. Meanwhile, my son, locked in my office, wondered if he had been abandoned. Exhausted and bloody, I eventually collected him and drove home. On the drive back, I told him what had happened. He resolved there and then never to become a doctor.
    I have witnessed so many deaths from liver failure in relatively young people. Yet death is rarely discussed as a possibility since patients and their families tend to assume that modern medicine can fix broken organs, or that if they cannot be fixed, they can be replaced. Although cirrhosis of the liver has a worse prognosis than most cancers, patients rarely get the type of palliative care available to people with cancer. They die after long and messy hospitalizations, the medical technology pushed right to the bitter end.
BAD NEWS
    My daily work also caused me to think about cancer care. I regularly diagnose many common cancers, such as those of the colon, oesophagus, stomach, pancreas and liver. Although my main role is diagnosis, I also carry out treatments for cancer, such as inserting stents (tubes) in patients with jaundice as a result of bile duct obstruction caused by pancreatic, and bile-duct cancers. The most challenging part of my job with cancer patients, however, is giving the bad news. This job frequently falls to me, before the patient is seen by a cancer specialist – an oncologist. I believe it is unfair to expect an oncologist to see a patient without first telling that patient what an oncologist is, and why they need to see one.
    One of the more pernicious myths of modern medicine is the notion that a doctor with ‘communication skills’ and a sympathetic manner can somehow magically transmute bad news into something palatable, that he or she can, Mary Poppins-like, give a spoonful of sugar to help the medicine go down. Medical students now attend workshops on ‘How to Give Bad News’. This notion of managing Bad News is symptomatic of the temptation to rebrand the terrors we humans inevitably face – principally death – as almost some form of personal growth. Patients and relatives are said to be on a ‘journey’, and the rather speculative notions of Elisabeth Kübler-Ross on the emotional responses of dying people (the five stages of denial, anger, bargaining, depression and acceptance) are now trotted out, as if they were scientific fact. People react in all sorts of ways to their impending death, and I cannot recall a single person moving neatly through Kübler-Ross’s five stages. The power and terror of death refuses to be tamed by workshops, by trite formulae. No more than life, can death be packaged and processed into bite-sized chunks. Death is always sovereign, always in control.
THE WHIPPING BOY
    Relatives of dying people experience complex emotions. Doctors caring for the dying increasingly find themselves in conflict with patients’ families, and over the years I have endured some bitter and unedifying battles. Many years ago, when I worked in the NHS, an elderly woman with dementia was admitted under my care. She arrived at the hospital with aspiration pneumonia, almost certainly the result of a PEG feeding tube inserted – unwisely, under pressure from the family – in another hospital. When her condition deteriorated, I tried to persuade her many children that intensive care treatment, which would involve intubation (insertion of a breathing tube) and mechanical ventilation, was not appropriate for a woman of her age with advanced dementia. Inevitably, however, she was admitted to the ICU over the following weekend, when I was not on-call, and the medical registrar came under intense pressure from the family to escalate the old lady’s care. She was transferred from the general ward to the ICU, where she was intubated and ventilated and, rather