oa Impact on the Physician - A Signature Reflection Dealing with Death

Home visits on patients require checks for the request, the illness, the date last seen, current medications, and who the carer is. Globally, especially in the Middle East, cultural awareness and sensitivity are paramount, particularly in palliative care. Family physicians care for terminally ill patients. Often in the last stages, fatigued, dyspneic, anemic, cachectic, relatively anorexic, a patient’s mind may still be needle-sharp. Sincere empathy should never be standardized. Questions should be answered truthfully. No two caring moments are the same, making each interaction unique. In palliative care, the quality of physician conversations can assume wide empathetic dimensions.

Training in family medicine, while thorough, usually provides lighter exposure to cancer patients. The first serious cancer death experience can be stressful for the carer. However, responsibility for palliative care is a reality. There is no respite. In family practice, deaths from cancer are common. Some bête-noirs include multiple myeloma, ovarian, lung, and breast cancer. Intrinsic patient conversations occur after each diagnosis, at the beginning, in between, and in palliation. What vital information needs relaying by the physician? How much is shared with spouses or family relatives, with consent? What impact does that make on both the patient and physician?

Patient self-awareness being near death in terminal illness is common. It is still unsettling. A physician of care considers the choice of a dying patient choosing to stay home. The gain is avoiding moving to a hospital or a hospice in unfamiliar settings. More poignantly, it enables loving care from one’s lifetime partner and family at home.

After death, an exchange of warm words with facial expressions evokes everyone’s emotions. Personal feelings resonate in care, empathy, hope, truth, trust, and professional respect for one another. The end feels more like losing a friend. Such patients are not forgotten; physicians learn from them.

The dead do not suffer pain, only those left behind. Is healing ever complete when looking after sick patients for the practicing physician grappling with professional and personal emotions? How long does that take? Do multiple deaths cumulate the impact? Recovery is part of being resilient, critical in the profession, and feeling vocational compassion satisfaction in work. What if one does not always cope adequately? Is compassion fatigue a danger? Who tends for the wounded carer? When is physician resilience needed most? What keeps physicians motivated? How do they care for themselves and stay well-balanced? Reflections on practice experiences keep life in perspective. Dying patients, subconsciously, are often our best teachers.