Every disease, from chicken pox to brain cancer, has a typical course. Three-quarters of us will die from heart disease, cancer or stroke - each disease having its own pattern, its own "constellation" of symptoms, in doctor-speak. The events and complications that will come to pass are foreseeable. As doctors,we expect the complications. But our foresight too often is held silently, so as not to worry patients unnecessarily.
Yet this frequently backfires, with patients and their families shocked when symptoms finally do occur, seemingly out of the blue. Pain, bleeding, shortness of breath, even coma - I've seen all of these "sneak up" on patients, even though any doctor reading their medical chart would not have been surprised. It's bad enough to have a medical catastrophe occur, and even worse when it happens without advance warning and without a chance to get affairs in order, prepare family and loved ones, and make plans for palliative treatment and nursing care. Patients deserve to know about their disease, even the not-so-pretty bits.
Some of the sickest patients I've seen, with chronic, end-stage diseases, have come in surprised at the state they were in, not understanding what was now happening to them, when just a few days ago their GP or oncologist had told them how well things were going. Some of this is denial on the part of the patients, but some of it also is denial on the part of their doctors - focusing on small details while losing the larger perspective, inadvertently setting patients up for some hard falls.
Sometimes dealing with the reality of the dying process can be hard, even for doctors. Perhaps especially for doctors, who don't want to be seen giving up, or see their patients lose hope. But palliative care is neither of those things, it's a way to maintain control over a process whose outcome is known. In its own way, it's a form of preventive medicine whose goal is to prevent fear and anxiety, and make every foreseeable death a little easier.
Gary Payinda MD is an emergency physician who would like to hear your medical questions. Email drpayinda@ gmail.com. This column gives general information and is not a substitute for the advice of your doctor.
