290 Interacting with Their Patients
illness, you are lucky because you can have a life—at times, com-
pletely normal. You can travel, have a transplant . . . a second
chance. My husband did not.’’
As part of such enhanced empathy, many physicians improved their
ability to discuss and make ‘‘do not resuscitate’’ (DNR) orders for pa-
tients. Confronting one’s own mortality can make it easier to confront
that of others. Mark, the internist with HIV whom I interviewed in a
diner, reported:
I’ve dealt with my mortality. A lot of doctors are not good at
dealing with code status because they haven’t dealt with their own
mortality. When somebody becomes demented, it’s really easy for
me now to draw the line.
Other Aspects of End-of-Life Care
Several of these doctors thought that issues of death and dying were still
not taught with enough time, quality, or follow-up. Deborah said:
A lot of hospitals and medical schools address end-of-life, but not
enough or well enough. No staff is really dealing with end-of-life,
except hospice. Doctors think, ‘‘This is never going to happen to
me.’’
This topic requires meaningful, not superficial, attention.
Hospice training was rare. To improve care around the end of life,
Deborah felt that every resident, especially in psychiatry, should receive
some experience in palliative care:
. . . to really deal with dying patients, and see how they die. . . . A
resident should talk to dying patients about their needs—spiritual,
religious. Our hospital has a rabbi, but I’ve never seen him.
Attitudes toward death and dying need to be changed as well. For
example, doctors should not view a patient’s death as a failure. Eleanor
added:
The phrase ‘‘there is nothing more we can do for you’’ ought to be
banned. There is a lot more we can do for you, even if we can’t cure
your current physiological problem—talking to patients . . . as op-
posed to just doing procedures.