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When dying should not be an emergency

Wednesday, 31 Oct 2012 20:12

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


If you are 15 years old and you are walking to school and are hit by a car and you are dying, this is an emergency.

If you are 85 years old and you are out doing your morning walk and are hit by a car and are dying, this is an emergency.

An unexpected dying at any age is an emergency.

In contrast, there are many people dying of advanced chronic and terminal illnesses whose dying should really NOT be an emergency. Yet these poor people come to the Emergency Department for help because they do not know two very important things:

  1. They do not know that they are dying at all. No doctor or healthcare provider has ever told them, “You have stage 4 cancer, this means that you are near the end of your life.” Or “You have CHF and have been hospitalized for this 4 times this year, this means that you are near the end of your life.” So, they come to the emergency department with the symptoms consistent with the end-of-life or dying because no one told them otherwise and they are unprepared for what is happening.
  2. They have never been told that there comes a time when almost all end-of-life symptoms can and should be managed by hospice, in the comfort of their own homes, rather than in the sometimes cold, chaos of an Emergency Department or sterile hospital environment.

You see, if you have an advanced terminal or chronic illness, your dying should rarely be considered an emergency. ** Your doctors should have verbally prepared you for this path long ago and should have helped transition you to hospice care long before active dying begins.

Let’s look at the 4 proposed trajectories of dying, specifically at the 3 titled “Terminal illness, Organ Failure and Frailty”. Hopefully by the time you get half way down one of these slopes, some doctor in his or her right mind has told you, “Look, this is a terminal process, this pattern means that you are approaching the end of your life and we have got to make sure the end is as peaceful and meaningful as possible for you and your family. For most people that means dying at home, being as comfortable as possible, not dying in an emergency department or in a hospital.”

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Real, compassionate, and frank conversations like this can change how and where most Americans die.

If I you have been diagnosed with terminal cancer (or you are advanced along one the 3 sloped pathways above) and end up dying in an emergency department on a ventilator while receiving CPR, then the medical system has failed you- your death should have not have been allowed to become a medical emergency (shocking and unexpected for both you and your family). Instead, your doctor should have shown you and your family these graphs and told you which one fits your expected course. Your doctor should have prepared you for the inevitable and created a pathway for a peaceful and expected end.

If your present doctor cannot speak this honestly with you, then find another who will. How and where you die may depend on how well your doctor can communicate about one of the most fundamental facts of life, that it ends.

Monica Williams-Murphy, MD

http://www.oktodie.com

**Note: There are instances where advanced chronically and terminally ill patients experience emergencies that warrant emergency department visits and even hospitalizations for symptom managment or dying. However, these should be the exception and not the norm when appropriate hospice care is being provided.

Proposed Trajectories of Dying by Glaser and Straus

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