Dying to go (Australian Doctor 24 Jun 2011)

June 24, 2011 § Leave a comment

Just between you and me, I may have killed my father 14 years ago.

He was in his 70s when he mentioned he’d developed a gum boil. His cheek was more swollen than his gum so I suggested he see a real doctor. His GP then referred him to an ENT surgeon. The surgeon took a biopsy and ordered a chest X-ray.

While waiting for follow-up, my mother asked me to check the X-ray. She seemed a bit concerned. It was soon apparent why.

The lung fields looked far from normal. The report, which my mother must have read, said there were multiple pulmonary metastases.

I broke the news to my father, who was visibly deflated. I told him cancer was an unpredictable disease and he’d beaten it before. He agreed but said this time felt different. As usual, he was right.

A couple of days later I went with him to see the surgeon. The surgeon pulled out the biopsy report and embarked on a spiel of how resection would require the loss of an eye and a good part of the face.

I waited for a lull to ask the surgeon if he’d seen the chest X-ray. A flicker of alarm passed across his face. “No,” he admitted as he reached for the films.

My father was a bit perturbed when the X-ray instantly changed his treatment options from curative to palliative — but at least he now knew that the disappointing X-ray result had prevented the excision of half his face.

Eight months later, my father was still battling on against the odds. My mother rang one night to say he was particularly unsettled. I suggested an increase in his dose of morphine.

A few hours later, I was plucked from an RACGP pre-exam course to take a phone call. My father had suddenly died.

I don’t know whether the extra morphine killed him but it’s certainly possible. Luckily, we are sometimes allowed to kill people if our intent is to reduce their suffering — provided, that is, we don’t intend to reduce a patient’s suffering by killing them. In some jurisdictions, that’s literally a hanging offence, even if they do want to die and we don’t want to.

Patients are often more realistic than ethicists or politicians about death. Just a few hours ago during a home visit, a patient with an inoperable 8.5cm liver secondary discussed euthanasia with me. The dying get tired of living more readily than the living get tired of being control freaks.

Last year, a Greek GP friend spied a man at a café who was chain smoking, shirtless and sporting an anti-angina patch. The patch was suspended in mid-air by a thick Mediterranean coat of body hair.

The hairs had infused sufficient nitro-glycerine to explode if a match strayed nearby but the man’s blood concentration was probably zero. My friend couldn’t resist striking up a conversation laced with health advice.

The man’s rejoinder was illuminative. “Many die but none return. It can’t be that bad.”

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