Letting Go
A few experiences in the last week or two have reminded me of the importance of Peter Safar’s Laws for the Navigation of Life:
Law 20. Death is not the enemy but occasionally needs help with timing.
Sometimes some of us seem to forget that for all of us the time will come one day.
Death is an inescapable fact of life. Really when it comes to death, our job as doctors is to help ensure that people die in the ‘right’ order – not too soon, not too late. Sometimes this means we shouldn’t intubate, we shouldn’t place central lines, we shouldn’t insert vascaths and start renal replacement therapy, we shouldn’t start myriad infusions of inotropes and vasopressors, and we shouldn’t take the patient to the operating theatre. Recognising that the time is right for a particular patient can save a lot of distress and suffering – for the patient, the patient’s family and friends, as well as the medical and nursing staff caring for the patient.
When this goes wrong, sometimes the only antidote is black humo(u)r. Here are some of the worst antidotes I know:
Q. What is the difference between a Rottweiler and an Oncologist?
A. After you’re dead, the Rottweiler will let you go.
Q. How can you recognise a Hematologist?
A. Look for the scorch marks on his hands from trying to hold back the coffin as it goes into the crematorium.
The oncologist scratched his head. After 19 cycles of chemotherapy, his patient still wasn’t getting better. In fact he was worse.
“Let’s try one more cycle of chemotherapy”, he said.
After the 20th cycle the patient went to see the Oncologist again. The patient was so tired and listless he couldn’t speak. His skin and eyes were yellow, he was unable to eat or defecate, his face was puffy and he couldn’t pass urine.
The Oncologist pondered his options. “I think we should try one more cycle of chemotherapy”, he said.
The patient died. The Oncologist left the funeral perplexed. “Maybe we gave up too soon”, he muttered to himself. “Maybe one more cycle of chemotherapy will bring him back”.
The Oncologist dug into the freshly turned soil with his shovel. Finally he reached the coffin. With sweat dripping from his brow he forced the coffin door open. Inside was empty. “What? Where is my patient?”, the Oncologist exclaimed. He frantically searched inside the coffin and found a note.
The note said, “Gone for dialysis”.
Hat tips to all those who have shared their morbid senses of humo(u)r with me over the years. And to all the oncologists, hematologists and nephrologists out there – no hard feelings – you’re still the among the smartest, most dedicated and caring docs out there.
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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