Dr. C: I'm planning for recovery, but thinking about death

Dr. Nikhil Joshi is staying positive about his cancer outcome, but he's also trying to be realistic about the possibility of death, and that's something, he writes, his family finds difficult.

Dr. Nikhil Joshi wonders why some seriously ill people don't think more about the end of life

Dr. Nikhil Joshi has to consider the possibility he might die, and he wonders why more people don't think about the inevitable. (iStock)

There's a discussion doctors have at least 50 times in their careers. It occurs when you are looking after a patient who you think might die. 

The gist of what you say is: "If things get worse and your breathing becomes harder, do you want to have a breathing tube and be ventilated in ICU?"

Or: "If you have a cardiac arrest and your heart stops, do you want to be shocked and receive CPR knowing that even if we bring you back, you have a high chance of brain damage?" 

Or: "Do you want me to make you comfortable? Do you want me to take away the pain and discomfort as much as possible if things get worse?"  

I could die

I remember when I was first aware that I could die. 

It was during the biopsy of my lymph node, and we didn't know what type of cancer it would be, but I was sure that it was cancer. I made some sort of joke about dying before I got the biopsy. 

My mother looked at me with such strength and firmly said, "Don't ever say that again." 

I was kind of taken aback by her response. 

Now, I understand it completely. This would be the most terrible thing imaginable to a parent. 

But as a patient, as a person, I really needed to deal with it, and I'm kind of wondering why all of us aren't wrestling with it.   

When you have cancer, any cancer, you can die. And trust me, you definitely think about it.

It will happen to all of us 

I know I'm not exactly cheering you up, but it's not like it's not going to happen to all of us. 

What do you think about dying? If it happens today, are you ready? 

If you become one of those patients in an emergency room, what would you want? Would you want to live no matter what we can medically put you through? At what point would you be ready to die? 

Sometimes when I'm working and dealing with chronically ill patients who are steadily declining, I'm puzzled. 

I'm surprised that some haven't considered the possibility of death.

We all die. Everyone. No one really wants to, but it's going to happen. There is nothing we can do about it.

So, especially if you're sick or someone you love is sick, don't you have to consider it? 

I want to be prepared

I think so. But my family says no. 

My mother contends that she has never allowed the possibility of me dying to enter her mind.

"If you think these things constantly," she tells me, "they will happen." 

And you know what? Part of me believes her. I don't think that's unscientific, I think it's actually a reasonable opinion. I've seen people give up and just die.   

But another part of me has seen so many people unprepared for death, and that's a tragedy, too. 

That's the wailing in emergency rooms, this broken sound that stays in the mind of doctors and nurses and paramedics everywhere. Those are the kind of cries that follow you home after work. The stuff that you can't forget. 

I'd love to spare everyone – patients, their families, medical staff, even me – from that.

Now, the good news 

OK, now that I have thoroughly bummed you out, let me tell you some of the good news. I'm finishing up chemotherapy on Jan. 10 and my scans look great.

I'm dealing with my mortality by realizing that I am living a life I wouldn't change for the world. 

I would be sad to leave my friends and family, but essentially, I wouldn't pass with a lot of sorrow in my own heart. I'd be pretty OK with it. 

You can either look at life and time as something that's owed to you or as something that's given to you. 

Sometimes life isn't fair, but it is beautiful. 


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