RP101 – Dying & Death (Jan 2020)



Session Readings

 

BACKGROUND

Although death has been noted to be the one great certainty of life, the dying process is replete with uncertainty, and this dichotomy can be stressful – for the individual facing death, their family members, and those who care for them.  Though not discussed frequently, the impending death of someone with whom we have a connection both forces us to examine our own views about death and dying and to navigate the discordance that may exist between our views and those of others. Doing this in our role as healthcare providers requires thoughtfulness, self-awareness,  and skill in order to ensure that our patients’ needs, and those of their families remain our focus during these times.

Learners in this curriculum have had a wide range of experience with death and dying.  In past years, some students struggled to identify their personal context as it relates to Dying and Death, noting that they had no personal experience with the death and/or dying of someone with whom they had a relationship. For those of you who fall into this category, think about your perceptions of the way your family of origin and the community/ies of which you have been a member (geographical, religious, organizational, or otherwise) dealt with dying and death, including avoiding its discussion, and this will help you to identify the sources of your reactions. You can also consider how exposure to death and dying via movies, TV, or video games influences your context.

At its core, dying and death, for those who remain alive, includes a sense of loss, and sometimes, as providers, a sense of failure. It is also where the ethics of life-prolonging treatments, death-hastening treatments, and patient autonomy often overlap. It is where our reactions to the situation can make something look like an ethical dilemma, when in fact there isn’t.  Our biases can make it seem as though there isn’t an ethical decision to grapple with, when in fact there is. How we cope with the dying process, the death of others, and our sense of loss has significant implications for our care of patients and their families.  There are many facets to this topic, and we explore just some of them in this session.


PANELISTS

Dr. Nicole Dobson, COL, USA, is a neonatalogist and program director for the fellowship in Neonatalogy at Walter Reed National Military Medical Center.

Dr. Flip Williamson, LtCol, USAF is a family nurse practitioner and assistant professor at USUHS.

Dr. Alden Chiu, CDR, USN is a hematologist-oncologist at Walter Reed National Military Medical Center and chair of the Ethics Committee for the hospital.


OBJECTIVES

By the end of the RP101 session on Dying and Death, through written and verbal expression, students will demonstrate the ability to:

  1. Identify their “gut reaction” to the thought of having a (future) patient die; identify concerns which may include:
    1. The personal loss of a fellow human; and of their patient
    2. Thoughts about their own mortality
    3. Their faith and spiritual beliefs, if applicable
    4. Concerns about their own competence as a physician
    5. Concerns about how they might appear to their patients’ family, colleagues, others with whom they work, their own family and friends, and perhaps most importantly, themselves.
  2. Explore the source(s) of those reactions, which may include:
    1. Their past experiences with death
    2. Perceptions of death that were influenced by the family/community in which they were raised, their current family/community, the medical community, the military community, etc.
    3. Thoughts and feelings about death that might vary depending on: the age of a patient, whether death is anticipated or unexpected, the location or the manner in which a patient dies (Home vs. hospital, stateside vs. deployed)
  3. Analyze how these reactions might influence, both positively and negatively, how they care for their future patients and families, both prior to (if anticipated) and after a patient’s death
  4. Identify a lesson learned about the topic of dying and death.

___________________________________________________________________________________

ASSIGNMENT

Reflective Exercise

For this reflection, you may choose from several creative modalities to express your thoughts, feelings, and reactions to this topic, the speakers, and/or the supplemental resources.

Your options are to submit:

  1.  A free-form journal entry (minimum 2 pages) or a standard RSIR essay….or
  1. Other creative modality (painting, drawing/sketch, comic, poetry, photograph) — if you choose one of these modalities, you must also submit at least 1 paragraph briefly summarizing the work, including why you may have chosen it and clarifying its meaning.

Everyone should have a submission in Sakai.  If a painting, scan a photocopy into Sakai. Every document should have your last name in the file name

Remember that, in this course, we are thinking about our reactions, our context for those reactions, and the implications of those reactions in health care, so consider that when using a modality from the humanities to do your reflection.

Your submission may include the following:

  • Your reaction(s) to the panel narratives.
  • Your perceptions of how loss in general and death in particular were/are viewed in your family of origin, faith group, community, and among your peers (both growing up and now)
  • Your perceptions of how loss and death are addressed by your faith group
  • Your experiences to date with loss in general and death in particular
  • Your perceptions of how loss and death are viewed in the military and medical communities
  • What your reactions and the sources of those reactions reveal about your perspective on loss and the death of a patient,
  • Implications of this perspective for how you might care for patients in the future.

At the bottom of your assignment, please also include:  What question would you want to bring to the group discussion to further explore?

thriving-in-scrubsThriving in Scrubs: How Much Time Do I Have, Doctor? Fictional accounts of medical encounters often feature the conversation when a patient asks their doctor to predict the outcome of their disease. Doctors in real life have to answer these questions, too, but without the benefit of a pre-written script. Thinking about prognostication means trying to answer difficult questions, but more importantly trying to get to the heart of what the patient may really be wondering. It’s about trying to connect with the heart of what patients need in times of uncertainty about their health. It’s also about understanding how these conversations affect us doctors as people who struggle with some of the same questions ourselves.
Topics: / / / / / / Keywords: /
tedmed_wh_rgbWhat makes a life worth living in the face of death In this deeply moving talk, Lucy Kalanithi reflects on life and purpose, sharing the story of her late husband, Paul, a young neurosurgeon who turned to writing after his terminal cancer diagnosis. "Engaging in the full range of experience — living and dying, love and loss — is what we get to do," Kalanithi says. "Being human doesn't happen despite suffering — it happens within it."
Topics: / / / / / / Keywords: / /
Journal of General Internal MedicineDying for the First Time by Jesse Kane, MS III Sackler SOM A medical student’s reflection on the first patient he watched die - a story of observing a Code run in the hospital. Brief and poignant.
Topics: / Keywords: / / / / /
NYTAt U.S. Hospital, Reflections on 11 Hours and 91 Casualties Dec 21 - a date these soldiers will never forget - where the casualty level greatly surpassed what everyone was prepared for - logistically and emotionally.
Topics: Keywords: / /
New York TimesHelping patients face death, she fought to live A palliative care doctor, faced with extensive metastatic cancer, grappled with what she recommended for patients and what she wanted for herself - which was treatment and cure, at all cost.
Topics: / / / Keywords: / / / /
Session originally created by: Adam Saperstein | Uniformed Services University | Admissions Medical Officer, USNA | Assoc Prof. Family Medicine