Thread by @WesElyMD

1/🧵 A personal story of misjudgment as a physician.
 
Years ago, when I was a young doctor, I had a patient in the ICU on a ventilator who was doing so poorly, day after day, that I was certain he was going to die.

I confidently told the family he was going to die.

2/ The family members all gathered and were extremely distraught. They listened and trusted me.
 
But I was wrong.

#PalliativeCare #EndofLife

3/ For many years to come, I received Christmas cards from this man.

It was extremely humbling.
 
Until I learned, this happened many other times in my life as an ICU doctor.

Sometimes I was off by just 2 weeks, sometimes 2 months, and other times by 2 years.

4/ I no longer predict how long someone will live.

Instead, when the family or a patient inevitably asks me this question, I “flip it.”

I admit that I honestly don’t know how long s/he will live.

Yet for those severely ill, I prepare them for how quickly death ‘may’ occur.

5/ This “flipping it” both maintains #hope & also helps people become realistic about how sick someone is so that they can mentally prepare and communicate appropriately with one another.

See my entire 🧵👇 on this topic…

6/ I’m amazed by the number of things during the dying process that often happen in someone’s life to bring long-awaited healing (even without cure) for patients & everyone in their love circle.

To me it’s evidence that we are all greater than the sum of our parts.

7/ During people’s dying process – be it hours, days, months, or years – people deserve to have dignity respected & the entire process honored.

In accordance with many patients’ wishes, we regularly remove ventilators & other life support as part of the natural process of dying.

8/fin
My “Christmas Card” patient never once chided me for predicting (wrongly) his death.

Instead, we became very close. He helped me shed bad prognostication habits & more than a smidge of pride.

Our patients lead us.

I’d love to hear any lessons you have on this topic.