In this excellent post by JESSICA NUTIK ZITTER, M.D. (April 10, New York Times), she states that as a doctor she had no training in how to let a patient die. She proposes developing a protocol for how to stop the typical ICU scenario of trying to keep someone alive against all odds. The article is very moving, succinct and honest. She brings up a really good point. In one scenario she compares herself to a “LaMaze instructor” (Bradley instructor, Birthing from Within instructor…) as she guides the staff and family through the removal of “breathing tubes.” I love this quote:

“We physicians need to relearn the ancient art of dying. When planned for, death can be a peaceful, even transcendent experience. Just as a midwife devises a birth plan with her patient, one that prepares for the best and accommodates the worst, so we doctors must learn at least something about midwifing death.”

We need more doctors who are willing to relearn the art of dying. That would require acceptance that we are going to die. I’ve been following the development of the field of palliative care. This is a newly developed specialty which I am very much in favor of but which troubles me. I recently heard one doctor say that we need a team of doctors and nurses who are comfortable and specially trained to talk about death to call in when a patient is facing it. I feel like it would be so much better if all doctors were comfortable talking about it.

I recently received a phone call from a woman who, in preparation for completing her advance directives, wanted to talk to her primary care doctor about what she might expect near the end of her life given the medical condition that she had. The doctor could not do this. I’m not sure why - perhaps he didn’t feel comfortable, or he didn’t have the time. More likely it was because it was not a billable expense. This is really sad. Here was a women trying to be aware and make informed choices but receiving no help from her doctor.

Dr. Zitter, I hope you keep working on and writing about this issue. I hope you develop a training for how to do a “code death” that becomes a requirement for every doctor. One that must re re-certified every two years, just like the training for “code blue.” Perhaps we could call it “code love” or “code pink.”