“I only want to die once” and Other Patient Lessons by Monica Williams-Murphy, MD

Saturday, 30 May 2015 15:38

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

I was at the end of a long shift. I had already seen too many patients to have any common sense left and it felt as though there were no remaining neurons firing in any agreeable pattern in my brain. And here came my last patient. I peeked into her room before I showed my own face. She was 78 years old with long gray curls piled way atop her head. Her chest seemingly rose and fell too rapidly for comfort. The sounds of bubbles in her airway were audible even outside of the room.

“Uh oh,” I thought…fate has saved the toughest patient for last. Tough because at first glance I could already tell that I would need to have an end-of-life planning conversation with this little lady. She was already triggering my mental screening tool: Would I be surprised if this patient died within the next year?
The answer was a resounding “no.”

I pulled back the curtain.

“Hi Toots!” She called out to greet me as I made my way into her room. (This was a first…and I liked it!)

This spunky little lady was in the ER for shortness of breath. Again.

As we talked it became clear that she had entered her end-of-life pathway. The last six months she had multiple hospitalizations for pneumonia. She now only routinely walked to the restroom or to the dinner table. She was beginning sleep a lot and there was about 20 lbs. weight-loss.

Despite my fatigue it was my duty to have “the conversation” with this patient and her husband, regardless of the physical and mental energy costs to myself.

So I took a deep, tired, ragged breath and started my usual condensed ED-goals of care conversation:

“Do you have a living will?”

Her husband quickly responded, “What’s a living will?”

Secretly, in the recesses of my imagination, I slapped my forehead, yelled out “Oh brother!” and rolled my eyes. As I sat motionless, fake-smiling at the gentleman, I hoped that none of my true sentiments had shone through in my facial expressions or demeanor.

Before I could continue my spiel with this fake-smiling expression plastered on my face the husband asked, “Does that mean that we ask about her wishes?”

Oh wow!

Suddenly I felt as refreshed as after a good nights sleep! “Why yes!” I gushed to
him, my fake-smile now genuine and deep.

“Well, let’s just ask her then,” he said turning to her as my smile turned to an expression of near-astonishment. This had never happened before.

“Honey,” he leaned over her bed rail, “This nice doctor wants to know your wishes like whether or not you want life support and things like that.” He looked toward me as he spoke to her searching my face for confirmation.

Boy, did he get it! I was shaking my head vigorously, “YES!”

Her response?

“Well, I don’t want all of that. You see, I only want to die once.” She said impishly.

We all burst into laughter.

She apparently took this as her cue. So, she continued, “I mean who in their right mind would want to die twice? Right?”

(She began to remind me of Joan Rivers on stage.)

She kept going…”Why break my ribs just so I can come back to do it all over again? And who came up with that plan anyway, doctor ?!?”

#LOL #ROFL were understatements!

Observing my uncontrolled laughter she said, “At least you’ve got a sense of humor kid. But let’s get on with this admission, I’m hungry….”

So, we did.


Lesson 1- Things are not always as they first appear. Sometimes we are pleasantly surprised.

Lesson 2- Fatigue is no excuse for skipping what could be the most important healthcare planning conversation in a patient’s whole life.

Lesson 3- Always find a reason to smile or laugh with your patients (even if it’s a choice :) )

Our Book: It's OK to Die

"It's OK to Die" is a ground-breaking book filled with graphic stories straight out of the Emergency Room illustrating how most Americans are completely unprepared for death and dying. In response, the authors have created a unique and comprehensive guide urging EVERYONE to prepare in advance, to assure their own peace and to prevent the suffering of their loved ones.
Learn More..

10 thoughts on ““I only want to die once” and Other Patient Lessons by Monica Williams-Murphy, MD

  1. Rea

    The patient as teacher: absolutely. Why don’t we take lessons more often?!
    Exhaustion is, unfortunately, not a good excuse for good patient care.
    There is no substitute for LISTENING!
    If we listen, there is virtually always a reason to smile.
    People surprise us often..IF we care to enter their world.
    “Never judge a book by its cover.” First sight is not always insight!
    Turn stumbling blocks into building blocks!! (Thank you, Dr. Murphy, for this pearl.)

    Wise lady! Who would want to die twice if given a choice?? Well said — with humor and spunk!

    1. Rea

      Amen to amen!

      The doctor may have been tired, but her sensitivity to her patient was entirely intact! Quite a gift to patient and family.

      1. Sandi

        AMEN, again! How delightfully refreshing to find a patient (and spouse) so open and realistic! Makes our jobs so much easier, after we take that first uncomfortable step to open the conversation.

  2. Ronee Henson

    This should be taught to every volunteer as well!
    It is the best lesson there is, and needs to be also a part of the Conversation within the family, (which should be held before the patient is no longer able to participate.)

  3. Lise Arseneau Lee

    Great important 3 lessons! Your book is definitely on my list to buy!
    Keep up the fantastic good work!

    1. Rea

      BUY THE BOOK, Lise!! It’s just as fantastic as this article!! I have it. I keep it close. I reread periodically. So many worthy, useful, wise lessons there!

  4. Robert Jones

    What a wonderful story of making the most of the present moment as well as planning the best for future moments. Its a matter of doing the loving thing, “Time after time.” Bravo Monica!

  5. Sandra Silva

    Again, as always: on point, direct, kind, insightful and gracious. You are a peal of great price to each and everyone of your patients.

  6. Mariah Edgington

    It’s interesting, but not surprising that they were unsure what a Living Will was. Advanced Directives. Yet another piece of medicalese that we are convinced should make all the sense in the world to everyone. Seriously! We are a funny group.

    Thank you for your candor Monica. We’ve all put on that same fake “you HAVE-GOT-TO-BE-KIDDING-ME smile.” And, of course, it’s when we’re bone tired, starving and have to pee so bad we’d swear our eyes have a jaundiced cast. Your patience is a gift, a rare finding in the ED.


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