Thread by @WesElyMD

1/🧵 End-of-Life: Thoughts
 
I was explaining to others how the end of my patients’ lives is often such a beautiful experience. They looked back at me with utter confusion. I could tell they thought I was crazy.

Since then, I’ve been thinking of what I should have said…

2/ I should’ve explained that too often in life I feel like I hold on to things I need to let go of. That sometimes I try and force solutions in relationships and all sorts of situations when I simply need to let go.

3/ I watch my patients often try and carry the weight of circumstances way past when it’s obvious the burden is too great bear. The only logical solution is to let go of the rock that is drowning them. To let life flow and take its natural course.

4/ In the ICU during critical illnesses like #COVID19, I enter the chaos w them. Its key to recognize when technology is a false solution. To explore other avenues & life goals in dying. The senses saunter out late. I try to be sure each person hears words of love and kindness.

5/ For some, I simply want to walk with my patients and their families to help them come to restful conclusions, shifting the ladder we are climbing from a wall of cure to a wall of comfort and peace.

6/ This is when the magic happens and the real beauty at the end of life emerges. We enter a place of healing and acceptance at the bedside during the dying process.

7/ It’s paradoxical yet true that once I accept as a physician that physical cure is likely beyond reach can another type of cure enter the situation that the entire family and patient find much more healing than a futile fight to the finish.

8/ Patients often drive their own spiritual process to the end way more beautifully than I could ever orchestrate as a physician. Whatever their choices, our teams is there to support them as their life candle burns out naturally…with palliative care to help.

9/ In #EDDB on p.228, I tell a story of an atheist patient who did not believe in an afterlife and who does exactly this. Asking her family three times each, “Do you love me?” What unfolded for her and us that day was transcendent and timeless.

10/ I wish everyone knew the end of life could be this beautiful. I wish people weren’t so afraid by the stories they’ve been told or by what they’ve witnessed when successful palliation of suffering is not accomplished. It’s our failure.

11/ I wish the palliative care was carried out the way it can be/must be in all circumstances so that people never had to suffer through pain, loneliness, and abandonment at the end of their life.

12/ Unfortunately, what is possible and what I witness all the time in the ICU is not the reality in too many circumstances. We do a poor job for many people who then miss out on their beautiful end of life scenario. We must get better.

13/fin
Every person you encounter today will die. Each of these people deserves to have a powerful & peaceful end of life process. We can do better if we focus our attention and time on building great delivery of inpatient and outpatient palliative care as the norm.