A Patient So Excited About Creating His Ideal Death

Thursday, 14 Jun 2012 18:17

About Dr. Monica Williams-Murphy (120 Posts)

Dr. Monica Williams-Murphy is a Board Certified Emergency Medicine Physician, who practices in one of the largest emergency departments in the United States at Huntsville Hospital. Through her writing and speaking, she is devoted to transforming the end of life into a time of peace, closure and healing. Media Page

Richard B, was a humorous and charismatic man, who’s toupee flapped at the corners when he turned his head dramatically- and he did so frequently to say, “And another question Doctor…”

Richard B. had made his life fortune as a salesman and owned his own company. He had come to the ER for answers about his apparently failing health, but instead, HE gave ME answers about how to plan for and live life when we are near its end.

I had just spent nearly an hour reviewing old tests, recent test and the tests I ordered on Richard. Pulling them all together, I called two specialists to get clarity on their treatment plans for him and came back into the room to deliver the news.

“So, how long do I have doctor?” He asked, smilingly as I pulled up a chair alongside his bed.

“Boy, you like to cut to the chase don’t you Mr. B?” I responded.

“Yes!” He replied, “So what’s the answer to my question?”

The answer is “I don’t know.” I went on to explain in great detail how his tests had identified a blood cancer and how this complicated the cardiac and neurological issues that he was already coping with. “The cancer is very slow growing, so your heart may stop from another reason before this cancer becomes the main issue.”

“But here is what I do know about the big picture and this is the advice that I will give:”

1) No matter what your age or medical problems, get your affairs in order. Take the time to do things like estate planning and advance directives.

“Check!” He held up his official signed and dated Advance Directive. “I want to protect my family from having to make decisions they don’t have to make. I don’t want to burden them.”

“Check!” I replied back to him, giving him a thumbs-up sign.

2) Keep asking your doctors the same question you just asked me: “How long do I have left?” This gives you clarity on what to do with your remaining time. It will help you set your priorities.

“Well if you don’t know how much time I have left, how will any other doctor?” He asked, still smiling.

“Great question. You see, you are in pretty good shape right now, but you are also 78 years old—you’ve already passed the life expectancy for a man in the United States. So, all bets are off…you may not wake up tomorrow or you may still have progressive changes that will give your doctors clues- there is pattern that we can identify when one is close to the end of life—loss of appetite, frequent illness/hospitalizations, increasing sleep/ decreasing energy and so on.”

I went on, “It’s very important for you to know how much time you have left because you want to be able to arrange to die at home if that’s what you desire.”

“That’s exactly what I want, Doctor,” Richard replied without hesitation, then he looked at me seriously for a moment. With great intention he said “So, let me make sure that I am hearing you right. You are telling me that I can pass away in my own home if I want to? I don’t have to be in a hospital?”

“Yes, hospice helps us to die peacefully in our own homes.”

He looked around the room at his family with a look of surprise, but also mischief.

“Doctor, I have another question for you,” as he whipped his head around to ask this question, he bore a dazzling smile and his toupee flapped slightly around his ears, “Is it OK to call your friends to come and visit you and start to say your goodbyes? And to talk about old times?”

“YES!” I pointed towards him in affirmation, “That’s a great idea.”

“Doctor,” he was on a roll now, “I want be in my own home with my wife, family, friends and dogs gathered around me, when I die. I want my last words to be, ‘It was an honor and a pleasure.'”

“That’s beautiful!” I replied feeling his growing excitement. I had never had a patient so excited about creating his ideal death before, but it was very cool.

As excited as Richard and I were, his wife and son were looking equally disturbed. So, in an attempt to balance the situation, I spoke; “Now, I am sorry if you feel this conversation is too frank and forward, but it is one that must be had and few doctors will be willing to speak to you like this. This is one of the most important conversations that a doctor can ever have with his or her patients.”

Richard came to my rescue, “When’s the last time you heard a doctor tell it like it really is?”

He then sat up regally in bed and held his head high and with the voice of a radio-talk show star, he announced; “The Memorial Services for Richard B***** will be held on a Thursday evening at 6 oclock.”

Richard then turned his attention back to me, “Will you be there?”

“Sir,” I replied, “it would be an honor and a pleasure.”


Monica Williams-Murphy, MD

( As always names and elements of the patient’s story have been altered to protect patient and family privacy.)

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