20160109 - death and dying

 

What doctors don’t learn about death and dying

Oct 31, 2014 

Dying and death confront every new doctor and nurse. In this book excerpt, Atul Gawande asks: 

Why are we not trained to cope with mortality?

I learned about a lot of things in medical school, but mortality wasn’t one of them. I was given a dry, leathery corpse to dissect in my first term — but that was solely a way to learn about human anatomy. Our textbooks had almost nothing on aging or frailty or dying. How the process unfolds, how people experience the end of their lives and how it affects those around them? That all seemed beside the point. The way we saw it — and the way our professors saw it — the purpose of medical schooling was to teach us how to save lives, not how to tend to their demise.
The one time I remember discussing mortality was during an hour we spent on The Death of Ivan Ilyich, Tolstoy’s classic novella. It was in a weekly seminar called Patient-Doctor — part of the school’s effort to make us more rounded and humane physicians. Some weeks we would practice our physical examination etiquette; other weeks we’d learn about the effects of socioeconomics and race on health. And one afternoon we contemplated the suffering of Ivan Ilyich as he lay ill and worsening from some unnamed, untreatable disease.

The first times, some cry. Some shut down. Some hardly notice.

In the story, Ivan Ilyich is forty-five years old, a midlevel Saint Petersburg magistrate whose life revolves mostly around petty concerns of social status. One day, he falls off a stepladder and develops a pain in his side. Instead of abating, the pain gets worse, and he becomes unable to work. Formerly an “intelligent, polished, lively and agreeable man,” he grows depressed and enfeebled. Friends and colleagues avoid him. His wife calls in a series of ever more expensive doctors. None of them can agree on a diagnosis, and the remedies they give him accomplish nothing. For Ilyich, it is all torture, and he simmers and rages at his situation............................


 http://ideas.ted.com/death-and-the-missing-piece-of-medical-school/