When Should We Start Having A Discussion About Palliative And End Of Life Care?

Many of us are learning and refreshing our knowledge of critical care and vent management, but how about acknowledging that one of the most meaningful aspects of the art of medicine is simply to bear witness to, and ease the suffering of our fellow humans?

So much energy of modern western medicine is fixated on achieving a cure, and so many of us are trained nowadays to follow an algorithm to diagnose a disease, then cure it, and anything less than that is considered a failure. But in reality, most of the day to day “in the trenches” medicine is unclear, and we can only do the best we can with the knowledge we have at the moment.

It seems as though the looming reality for many of us is that we will have patients who need ventilators, and none will be available. It seems like we might benefit from remembering that we can still succeed in practicing medicine by being present with those suffering before us, even when we know we cannot cure them of disease.

In a more pragmatic sense, maybe in addition to logistical discussions and articles about how ERs and ICUs are going to decide who should get a ventilator, we should also discuss how we are going to communicate with empathy and compassion to the families of the critically ill and dying; there are ways to learn to do this well that alleviates heartache for families and for physicians. Those in palliative care could probably contribute greatly right now.

This doesn’t mean we should stop being angry about the lack of PPE and other government failures in preparedness. Hopefully, we will have an effective vaccine one day, and life will return to normal, but we have tough times ahead in the near future.

Elaine M. Colby is a family physician.

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