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Hope or letting go: The final goodbye
July 6th, 2011
07:55 AM ET

Hope or letting go: The final goodbye

Anthony Youn, M.D., is a plastic surgeon in Metro Detroit. He is the author of “In Stitches,” a humorous memoir about growing up Asian American and becoming a doctor.

Ten years ago, as part of a Burn Unit team, I faced a moral dilemma.

Should a doctor give a patient’s loved ones hope no matter the situation? Or should he allow them to say goodbye when a situation seems hopeless?

The decision we made haunts me to this day.

I am a junior surgery resident.

I stand with my attending surgeon, Dr. M., a physician who has spent more than 25 years in the Burn Unit. We’re gowned, gloved, and waiting in silence with the rest of the team for our patient to arrive. The double doors fly open, and the EMTs wheel in our patient - Jerry, in his mid-30s, the victim of an industrial explosion.

Severe burns cover over 90% of Jerry’s body. I can see that Jerry is awake and able to speak through a large plastic mask blowing oxygen into his face. I help the EMTs and nurses sweep him from the stretcher to the table.

I look at Dr. M. I’ve been in the Burn Unit only a few days, but anyone could read the concern on his face. Jerry is fighting for his life.

The nurses spring into action. They cut off the remainder of Jerry’s charred clothing, place another IV and insert a catheter into his bladder. As Dr. M assesses the extent of the burns, Jerry thrashes in agony. The Burn Unit secretary pulls me aside. “His family is here. His wife and young daughter are in the waiting room.”

I look at Jerry. His breathing becomes more labored.

“We need to intubate,” Dr. M says.

The anesthesiologist, the respiratory therapist and Dr. M ready the ventilator.

I know what this means. A patient who has suffered severe burns over 90% of his body faces approximately a 15% chance of survival. If Dr. M puts Jerry to sleep on the ventilator, chances are he will never wake up.

I’m new on the Burn Unit and we are working against the clock, but I am part of the team and the moral dilemma hits me head on. I have to ask.

“Before you intubate him, do you think we should have his wife and daughter come in to say goodbye?”

Dr. M stops. He considers my question.

“No, Tony,” he says. “They don’t want to hear that. He’s in terrible shape and can barely speak. We need to give them hope.”

I look at the head nurse. She nods.

Dr. M and the anesthesiologist sedate Jerry, insert a breathing tube and attach it to the ventilator. Dr. M walks out to the waiting room to speak to his wife and daughter.

In a few minutes, he returns with Jerry’s wife. They walk to Jerry’s bedside where Dr. M pulls a chair over for her. She sits heavily, looks at her peacefully sleeping husband and holds his bandaged hand. When I leave a few minutes later to prepare physician orders, Jerry’s wife is still sitting by his side.

He dies less than 24 hours later.

I have no doubt that Dr. M believed he was doing the right thing. He’s an experienced, compassionate physician who’s saved thousands of lives.

Would it have been preferable for Jerry’s wife to see him sedated, peaceful and for her to cling to the slight hope that he might survive? Or would it have eased her loss to have had the opportunity to say goodbye, even if it meant seeing him in grave pain?

Ten years later, I still wonder.

Editor's note: The patient's name and other identifying details have been changed to protect his privacy.


soundoff (402 Responses)
  1. GinnyL

    My husband died, much too young, last August from a stroke. He survived for three months after the stroke but could not talk, read, or write and the right side of his body was paralyzed, though it caused him extreme pain that could not be controlled by morphine when it was moved. Unfortunately, that side had to be moved in order to care for him. He was able to understand what people said to him and could respond with facial expressions. I brought him home from the medical facility three weeks before he died, which completely delighted Hal. The last week before he died he was in a coma.

    One thing I learned during this process is that there is never enough time or a good time to say goodbye. It was very heart wrenching to watch him when he was in pain the weeks before he slipped into a coma. At that time, I wished he would die so his pain would disappear forever and yet I did not want him to go.

    Major burns are are one of the most excruciating pains possible, seldom relieved by major pain killers that still allow the patient to verbally communicate. I think Dr. M made the right choice. I can't imagine that the last memory of my husband would be seeing him in that much pain. Supposedly, hearing is the last sense to go before one dies. I console myself with the possibility that Hal heard my words that last week before his death.

    July 6, 2011 at 13:17 | Report abuse | Reply
    • Paul

      My condolences to you Ginny on your loss. It took a lot of courage to share your story. I wish you peace and many blessings.

      Paul

      July 6, 2011 at 14:03 | Report abuse |
    • VelveteenLady

      Please accept my deepest condolences on your loss. I agree with your post. I believe that most people would agree that they would rather see their loved one in a state of peaceful rest rather than seeing the loved one wracked with pain.

      We take great comfort in knowing that our aged and/or desperately ill loved ones are not suffering. There is no doubt that the experienced surgeon made the right decision.

      July 6, 2011 at 14:05 | Report abuse |
    • Mike

      Ginny-

      Good luck in the future. I hope that eventually you can focus on the good times.

      July 6, 2011 at 14:10 | Report abuse |
    • Andy

      I sure hope he did Ginny.

      July 6, 2011 at 14:20 | Report abuse |
    • babsii

      My heart goes out to you GinnyL. I too lost my husband way too early. I agree with you. I would want my loved one as comfortable as possible. That comes first. Above all, what I wanted for my husband was peace. I know he loved me...he didn't need to tell me...I saw it through his actions, his smile and the way he treated me. We had talked about what we would want for ourselves if we ever got into such a situation, so I'm glad for that. As for that last goodbye from me....for me, it will never be enough.

      July 6, 2011 at 14:38 | Report abuse |
    • Paula

      Ginny,
      I am sure your husband heard you. When my elderly uncle was on a ventilator and dying, he was unconscious but I spoke to him for the three days I was with him though he never responded in any way until one evening. He and his wife had no children and I knew he would be very worried about her being all alone. I leaned close to him and told him not to worry about his wife, that I would take care of her. When I said those words, tears rolled from his eyes and down his cheek. It was the only time he gave any indication he could hear me, and it was very significant. I am convinced he heard me. So, I hope you can take comfort in knowing your husband heard you.

      My condolences on your loss.
      Paula

      July 6, 2011 at 15:11 | Report abuse |
  2. virginia

    I know that doctors and nurses are Gods angles here on earth but after almost dying several times with no family around
    i think I would have liked to say goodbye if possible.

    July 6, 2011 at 13:17 | Report abuse | Reply
    • Mike

      Virginia-

      Obviously there are a lot of jaded people out there. Just ignore them.

      July 6, 2011 at 14:13 | Report abuse |
    • VelveteenLady

      It is unfortunate that "togoodtobetrue", (who doesn't even know that the there are two letters "o" in the word too, as he/she uses it in his/her name), chose such harsh words to express his/her disagreement with your post. Internet anonymity lets some folks write mean, adolescent things.

      Regardless of the negativity that was posted, I agree that the medical professionals can be wonderful, caring people; and, that's what we need when we face grave illness or possible death. As togoodtobetrue has shown, there are exceptions. I would not want to use a broad brush to paint the entire medical profession. I have "fired" a few doctors, who either were not patient-focused, or who did not take the time to put all of the puzzle pieces together to make a diagnosis.

      I hope that your health has improved.

      July 6, 2011 at 14:14 | Report abuse |
    • Drew

      God's angles here on earth? Do you mean, like, obtuse angles, or right angles? I didn't realize god made a lot of angular creations. His stuff mostly seems kind of rounded off, ya know? I mean, I suppose trees grow at more or less a 90 degree angle to the earth, but not really.

      July 6, 2011 at 14:59 | Report abuse |
    • Lydia

      Doctors in those life and death situations have to make split decisions most of the time. In your case, you were fortunate enough to live to be able to continue. Why not take the time now to make sure your loved ones know how you feel.

      Some of us will never have the chance to say final goodbye's, so why tempt fate?

      July 6, 2011 at 15:01 | Report abuse |
    • Oodoodanoo

      @Drew - of course they're God's angles. Every one of them is a sine that God loves you.

      July 6, 2011 at 15:19 | Report abuse |
    • Anon222

      Togoodtobetrue: Sorry, but you are way off base. The docs/nurse do their best. That guy robbed a bank because of the health care system, not a particular doc.

      And docs don't make alot of money. Really. They spend 4 years in college working harder than most to get into a medical school. They study extremely hard for 4 years and incur huge debt then go do a residency at a whopping $45K per year for 4 years. And that's at least 60 hours per week. And for all that, a pediatrician only makes, if they really move through patients, about $175K. Sure that's a good living but not for what they had to go through and that salary won't increase much. And they will only make about $110K if they are a University/Hospital based pediatrician.

      There may be money in medicine but the docs don't get it.

      July 6, 2011 at 15:30 | Report abuse |
    • K

      Meh. After having been both a nurse and a patient (cancer), I hate the perpetuation of sayings like this. They're just people doing their jobs.

      July 6, 2011 at 15:34 | Report abuse |
    • amanda

      i think it's a real shame that toogoodtobetrue's posting was taken down just because he said some uncomfortable truths without tact.

      July 6, 2011 at 15:44 | Report abuse |
    • amanda

      there's money in medicine and doctors do get it. US doctors are the highest paid in the world. but again, i am not going to tsay that is necessarily a bad thing because we do have the best care available.

      there's also money in drugs and again, i don't know what to do about that either because we do lead the world in advances in medicine and it takes a lot of money to develop a successful drug. plus europeans and everyone else bootlegging off our patents (in the form of cheap drug prices) doesn't help our costs.

      but again, again. it is naive to think that doctors' salaries aren't a major part of the reason why the cost of care in the US is so high.

      July 6, 2011 at 15:50 | Report abuse |
  3. Anon

    As someone who has spent a lot of time battling cancer and being in situations where she came dangerously close to dying, I assure you that I felt a tremendous amount of sadness knowing that my family had to witness me in agony and would have much preferred that they see me in a restful, peaceful state. Better to make sure that you have a lifetime of I love yous so that they don't have to be uttered at the final moment, because chances are you won't even be there to say it anyway. As for those of you who think that doctors are only in it for the money, you are wrong. These people dedicate their lives to saving and caring for others and should be compensated well for the blood, sweat, tears and time they sacrifice on our behalf. If they were only in it for the money, they are smart enough to make it and then some another way.

    July 6, 2011 at 13:22 | Report abuse | Reply
    • VelveteenLady

      I am touched by your post and I agree with your thoughts. I hope that your health has improved and that you enjoy good health for many years to come.

      July 6, 2011 at 14:17 | Report abuse |
  4. JoshK

    Its complicated.
    As an individual and a husband. There is no way I would want my wife to see me like that. Burns are horrid and from what I have read and been told by burn survivors it is the worst pain imaginable. There is no way I would want my wife to see me like that. The thought of the image of me writhing in pain being the last image she would see of me makes me ill. She would never forget it. As much as I as her husband and as a patient would want to say good bye to her, I would rather spare her that image so she could move forward in life. I know she would want to say good bye while I was awake, but what people want and what they should have are not always the same thing.

    I believe the doctor in the story did the right thing.
    Its a hard decision but that's the life of a doctor. You will see people at the happiest moments of their lives as well as their saddest.
    The best thing you can do as a doctor outside of making medical decisions is to interact with your patients loved ones in situations like this. Explain to them how you did what you could, let them know they weren't just a number to you and that you are also upset about the loss of a patient.
    Thats the hardest thing for people who loose loved ones in hospital situations. When a doctor doesn't seem to care the pain is a thousand times worse along with the doubt that you may have been able to do more.
    There may be times you have to look past the patients well being and look towards the families. Like in the case above.

    Sleep well Doctor Youn, and God bless

    July 6, 2011 at 13:23 | Report abuse | Reply
    • Lydia

      Thank you for an eloquent comment. My sentiments.

      July 6, 2011 at 15:04 | Report abuse |
  5. Futuredoc

    This is one example of gray areas in medical care where there is no right answer. Although it probably would be ideal to ask the wife if she wanted to say goodbye, or ask the patient for that matter, in the minutes it took to get that arranged his airway could of swelled up and closed and then he could of died immediately. In that case she would not get to even see him one last time. I think this doctor did the right thing because although the chance for survival was low it was not vanishingly low. He did what he had to do to give the patient the best chance at survival. That being said death is not always the enemy in medicine, it is suffering. Although in this situation physical pain and suffering may have been reduced, perhaps emotional pain was increased by husband and wife not being able to say goodbye.

    July 6, 2011 at 13:23 | Report abuse | Reply
    • VelveteenLady

      Many times, there is a disconnect between a physician's science mind and his ability to relate on a human level. I understand that this detachment is necessary in order that the doc doesn't get emotionally entangled in his cases. I believe that it can be a function of maturity in the profession that brings a doctor to the point where he can make the type of decision that the experienced surgeon made. However, there is also the danger of the doctor becoming too detached. I have stopped being the patient of such doctors, when I have had the choice. Unfortunately, there are times (such as hospitalization) when a patient has no choice.

      July 6, 2011 at 14:22 | Report abuse |
    • ebullient

      Dear Futuredoc,
      I know medicine is your specialty and I applaud your thoughtful response. However, I'd like to bring something to your attention: twice you have used the words "could of" when in fact, the correct words would be "could have". I see this mistake a LOT but I do not expect it from a Future Doctor. Many people think "could've" means "could of" but in fact "could've" stands for "could have". This is basic English 101.

      July 6, 2011 at 14:35 | Report abuse |
    • VelveteenLady

      Dear ebullient: Seriously? You actally taked the time to corect somebodies grammer? That jus ain't rite. I jus caint beleev that you are reel. Dats cold.

      July 6, 2011 at 14:40 | Report abuse |
    • amanda

      @ebullient - i agree. i caught it too. it made me wonder whether he has yet been accepted to med school. i have never met a medical school student in the US who had poor grammar.

      July 6, 2011 at 15:55 | Report abuse |
  6. Lady M

    Having been in a similar situation, I think the opportunity to see the loved one is the best for all. Particularly, when the patient was so close to the end.

    It is a tough call for the doctor but then again if he is going to treat 'code blue' situations then he should be well versed and trained in the dynamics of it. Those situations go beyond just medically treating a patient.

    July 6, 2011 at 13:25 | Report abuse | Reply
    • Lydia

      "Lady M", With all due respect, while you may think it is better for all to say goodbye's, what makes you think the patient in that state could have appreciated much less experienced what you were trying to do? Try, just try to put yourself as the patient with burns over 90% of your body? The pain is agonizing and in all probability the mind is already shutting down or probably completely incapable of recognizing the surroundings.

      Instead of wanting what's best for you as the survivor, the focus should always be on the patient. The doctor did the best he could. He gave the spouse the opportunity to see her husband, although unconscious, at least he wasn't visibly suffering.

      There is no way to know how each of us will react when seeing a loved one suffering. The outcome could have been worse had the doctor allowed the wife to see the husband in such dire straits.

      July 6, 2011 at 15:21 | Report abuse |
  7. IgM

    I don't understand why Dr. M said not to have the family come in to give them hope. You can still prepare them for the fact that his chance of survival is slim after he is sedated. These two things are not related. However, sparing them of the horrifying image of a loved one's final moments was still the right thing to do.

    July 6, 2011 at 13:27 | Report abuse | Reply
  8. Lauri

    My husband was in ICU for 12 days and never once did anyone say anything about him dying. I wish daily that someone had given me even an inkling that it could happen.... But on the morning of the 12th day in ICU I was charged by a doctor that I had never seen before and he had never worked on my husband's case. He told me my husband would probably die within 8 hours. I called his family, my family and his employer to get to the hospital as soon as possible. At least his 2 best friends (co-workers) were with me when it happened. Nothing can prepare you, but to understand it is a true possibility that it could happen is better than being left in the dark. I wanted to know...I guess some people don't.

    July 6, 2011 at 13:29 | Report abuse | Reply
    • VelveteenLady

      I am sorry for your loss. I agree that there should be continuity of care, whenever possible and that the family should be given true and accurate information (as much as it can be true and accurate) about the patient's condition. I cannot imagine your shock when you learned of your husband's impending death, especially from a doctor, who had not treated him.

      July 6, 2011 at 14:26 | Report abuse |
  9. Jacquie Janulis

    My father died of liver cancer almost thirty years ago. By the time I got there he was in a medically induced coma and died later that night. To this day I am so so sorry that I did not get to say goodbye to him. I truly believe, if given the choice, he would have endured the pain to wait until I got there to say goodbye.

    July 6, 2011 at 13:30 | Report abuse | Reply
    • Gary (MD)

      Its not about saying a good bye... Its about saying a goodbye when the loved one is covered up 90% with burns and in excruciating pain... Do yu think saying a goodbye to a medically-induced coma patient is different than someone who is in the worst pain of his life and is about to die with it.....?

      July 6, 2011 at 14:10 | Report abuse |
    • SweetsWars

      I understand your point of view. I lost my mom to breast cancer. My worst fear was not being with her. As it turned out, I was. She passes on Christmas Day, she was breathing very shallowly when I got to the hospital and I asked the nurse about it. She said it started that morning about an hour before I arrived. About a half out after I arrived she stopped breathing. It was over a year before I could take a shower without thinking I heard the phone ring and I had nightmares for years afterwards, waking in the middle of the night thinking I heard the phone ring and that I missed being with her. However, had she been this patient in this state, I would have preferred the goodbye the wife got, quiet and peaceful not horrible pain and suffering.

      July 6, 2011 at 14:25 | Report abuse |
    • VelveteenLady

      @GaryMD: your question is moot. And, some folks read these articles and it brings up memories of (similar but not exact) situations, through which they have lived. Let Jacquie have her memories and don't try to lead her response.

      July 6, 2011 at 14:29 | Report abuse |
    • reuben

      Gary – yes.

      July 6, 2011 at 14:31 | Report abuse |
    • Joan

      No question in my mind that I would much much much rather have my loved one be comfortable. I can live with not being able to say goodbye to someone who hears it. I don't know how I would live with knowing that my mother, father, husband or child endured excruciating pain due to my selfish (sorry, but that's how I feel) desire to say goodbye. If it's me – give me the morphine.

      July 6, 2011 at 15:05 | Report abuse |
  10. Soldier

    I have been in the military a long time and have seen and experienced many accidents and combat actions where Soldiers are injured or killed. In one incident a Soldier was gravely injured and his wife was flown to the site where he lay. Moving him would have caused him to bleed out faster so the decision was made to have his spouse come to his side. I am not saying it was the absolute correct thing to do, but in this case the spouse was asked and she wanted to talk to him and she asked to have that right. That incident haunts me even today. I recently came back from being deployed in Iraq and lost a few friends. Their family was not able to see their loved ones, but it was a different situation. The situation depends and you should ask yourself one final question. If it were me, would I want my wife or kids to see me the final time in that situation? What would you say. How would you react. Only GOD knows the answer.

    July 6, 2011 at 13:31 | Report abuse | Reply
    • Paul

      Thank you for your words and for your service to our country. I wish I could thank all of your comrades, both fallen and alive.

      July 6, 2011 at 14:10 | Report abuse |
  11. lsmyers

    In being about hope, I think the doctor did the right thing in granting the peace she would have hoped for. There is a part of him which would have known she was there, and maybe that is all they both needed.

    July 6, 2011 at 13:33 | Report abuse | Reply
  12. Mary-Margaret Norman

    Always, always, always give people the opportunity to say goodbye to each other. That last moment can mean so much and can help heal the would left behind when the love one is gone. No physician has the right to make the decision. Why would any of you assume that you would know best for anyone else's feelings?

    July 6, 2011 at 13:38 | Report abuse | Reply
    • Monica

      So Mary-Mararet, let me get this right...you would rather your loved one be in excruciating pain (and that's exactlywhat burns feel like) just so you can get to say good-bye? That is pretty selfish on YOUR part. If you tell your loved ones how much you love them often enough, that won't be necessary. The very idea that my loved one is in that much pain would KILL ME. I hope to God that most people don't feel that way.

      July 6, 2011 at 15:33 | Report abuse |
  13. guy

    If everyone knows you have a DNR order, including your doctor in your will or on your posted on your fridge it does help...and yes to doctors are a dedicated bunch for sure...i know it from past experience...remember the docs don't save lives, they prolong your life with the most quality of life as possible depending on your situation. Thanx doctors all over:)

    July 6, 2011 at 13:41 | Report abuse | Reply
  14. Anon

    As hard as it is, you and Dr. M. made the right decision. If Jerry's wife and daughter came in to say goodbye, his chance of survival, as low as it may have been, could have been even lower because it may have put Jerry in the mind set to give up. You were in a very unfortunate position, but I believe it was a better choice.

    July 6, 2011 at 13:42 | Report abuse | Reply
  15. Maria

    We knew from the time of his cancer diagnosis that there was nothing that could be done. He asked how long and the doctor said 3-1/2 to 4 weeks. He died almost exactly 4 weeks from the day he was admitted to the hospital. Throughout these weeks I spent 10-12 hours a day in the hospital with him. We had time to cry, laugh, tell sardonic jokes and make plans for my future. I would not have changed those 4 weeks for all the gold in the world. I thank the doctor every day in my prayers for telling us, together, that he would not make it. We were deeply in love for over 61 years and we treasured out last days. God Bless all the doctors and nurses. They knew that we knew and we were both treated with reverence, love and respect. I was with him at the end and treasure the memories that the medical community allowed us.

    July 6, 2011 at 13:46 | Report abuse | Reply
  16. Billy

    This story is a perfect example why it's important to not only tell, but to show our loved ones what they means to us on a regular basis.

    July 6, 2011 at 13:47 | Report abuse | Reply
  17. MrNobody

    I think it depends on the situation. If a person who has just encountered and unforeseen tragedy (like car accident, explosion, etc.) and they are going to die, then I think the family should be told the truth and allowed to say goodbye. On the other hand, if a person has cancer or other ailment that has led to a slow, drawn-out death, then chances are the family has already said their goodbyes many times over and would rather just see their loved one at peace.

    July 6, 2011 at 13:48 | Report abuse | Reply
  18. Edd Hanzelik, M.D.

    Dear Dr. Youn, I have faced this situation on several occasions. I feel this is not a decision that the doctor needs to make for the patient or his family. I believe families and patients can accept the truth of what we know. Then they can make the best decision for themselves. In other words, the family could be told how grave the situation is and how small is the chance of recovery. Yet, there is always hope. How often we are surprised by people who turn around and recover when we think they don't have a chance. Then the family can be told about the current situation. They have a choice to see him after he is fully sedated or they can see him now in pain. I trust the family will make the best decision for themselves and for the patient.And they will make a decision that they can live with.The doctor needs to be very sensitive and supportive so the family knows either decision is OK. They can choose what they feel will be best for the patient and for themselves.

    July 6, 2011 at 13:49 | Report abuse | Reply
  19. Maryland

    From either the patient or the family member's perspective, I would not want to prolong such horrific pain as described in this story any longer than absolutely necessary. However, the chance to say one last "I love you" is priceless. Those words can often have more healing and pain relief in them than any amount of morphine.

    My father died of a sudden heart attack. I happened to call him the night before and from what he was telling me, I knew something was terribly wrong. I took the time to tell him, "I love you, Daddy!" from the bottom of my heart, and I received an equally heartfelt, "I love you too, Sweetie!" in return. We had often been fighting at that time, and those words helped to heal a lot of hurt on both sides. About 8 hours later, I received the call that he was dead. I will always be eternally grateful for that last chance.

    Each situation and person is different, and there is no one answer to this question. This situation also illustrates how important it is to have a Living Will/Advanced Directive and to make sure that you and your family have copies readily available in case of emergency. Such a directive can help make sure that your wishes are followed, e.g., to not be intubated or that, if at all possible, you would like a chance to say goodbye to your loved ones, even if it means being in pain longer. However you and your family choose to proceed, an advanced directive can help take the uncertainty and dilemma out of the equation.

    July 6, 2011 at 13:51 | Report abuse | Reply
  20. munkittrick

    No matter the pain, no matter the result, no matter the possibility, no matter the injury, no matter the chance...I would rather have my last 10 minutes speaking to my family than my last three weeks lying there without closure. When my life comes to an end, I'm confident that I will have said "I love you" everyday to everyone that I love, but will they feel the same? When we exit, there are no more tears and no more worries for ourselves, but the same cannot be said for the survivors of our demise. Will they get to share the end with you or face the chance that all of their words of consolation go unheard as they speak to your body? I'd give 5 years of my life to go back to the week my Grandfather died to let him know what his gifts meant to me. I'd want to KNOW that he heard my words, that he knew that he was appreciated more than I could speak with words. I'd wish to hold his hand and have him squeeze mine. Once a person has been stripped of their ability to fight either by failing faculties or "medically induced comfort", the sparkle that made them human, the very essence of what they were in life ceases to be. My Grandfather knew, KNEW he loved me, but did he know, KNOW how much I loved him? I cannot place blame on a doctor for the decision to suggest that his life was ending and place him in a place of personal comfort, but knowing my Grandfather, I think he'd have held on long enough to say goodbye, and more importantly, allowed me to do the same.

    There is no sorrow for those who have passed on. Sorrow is a curse on the living.

    July 6, 2011 at 14:01 | Report abuse | Reply
    • SweetsWars

      I have two children and a loving husband. I would not want my children's last memory of me to include the horrors of burn pain and suffering. I would much rather they didn't get to see me at all or only after I had been sedated and they would see the wounds but not the horrid paid. I would much rather my children remembered our last argument and eventually all the I love you's that went before than that horror.

      July 6, 2011 at 14:30 | Report abuse |
  21. Josie

    I think it is up to the family and the situation. I watched a very dear friend die at the beginning of the year. I was the one that finally got him to agree to go to the hospital. He in a way I think knew he wasn't going to be coming out of the hospital, especially when they told him he was going into the ICU unit. I last saw him alert when they took him into the ICU (I wasn't family and just a friend...so not allowed in). Within two days they had told us he had two hours to make it, he stuck around for another 8 hours. At that time his parents decided that if his friends wanted to stop by one last time to say good-bye they would allow it. Some chose to come, others did not. Each person had their own reasons to do what they did. I kept my promise to him and stayed with him till the very end. Though the doctor wanted to pull him off life-support his parents decided to allow things to go the way it was to....thankfully he was gone before he was pulled of.

    I also watched my grandma fight cancer and she eventually died from it as well. I and my family never got a chance to see her one last time, we did make it to her funeral. She died in her sleep. It hurts everyone, especially my own mom considering it was her mother and she spent a lot of time with her, traveling and helping her in and out of hospitals. I got a letter my grandma had written me in the last month she had been living, she wrote one to every person in our family. It was her way of saying good-bye.

    It's hard giving hope when you know a person is not going to make it, but at the same time the families should be able to decide what they need to do and how to do it themselves.

    July 6, 2011 at 14:02 | Report abuse | Reply
  22. Gerald

    Just read the approximately equal number of people posting on either position here. So how is a physician to choose. One would condemn him for waiting until the patient was unconscious. Another would curse him for exposing them to the screaming bundle of pain the husband and father had become. But it was his lot to make the decision, to take it on himself, rather than confront the wife with the impossible choice between things she couldn't even imagine. If you go through your whole life and never have to decide, just you by yourself, this question or decide who gets a chance to live and who surely dies, don't presume you would be certain to pass the test. And if you think you're so righteous that you know just what should have been done, you're beneath the contempt of those who do the hard things when it's time.

    July 6, 2011 at 14:07 | Report abuse | Reply
  23. Bonnie S

    As a nurse, I see your dilemma, however, some people are very strong and some are not....to us, that unimaginable pain is something we see and have learned to deal with, for some people, to see a loved one like that is something that will never leave them, no matter what.... It would have been nice for him to be able to say something to his wife, but, again, he could have said things that haunted her forever... each case is different. I have been present when the situation was presented, and the options were offered, and sometimes the family member chooses to go in, and sometimes not. Sometimes I think they should have gone in, sometimes not. I think they choose what they can live with afterward when given the option....still, very, very difficult for them, and a lot of responsibility for us....

    July 6, 2011 at 14:07 | Report abuse | Reply
    • reuben

      You must be strong enough to give them the opportunity to speak their mind and allow it to "haunt"/live with you forever.

      II know it's not the same, but I had to put my dog to sleep on Easter and I stayed with him until the very end- nobody (or animal) deserves to die alone.

      July 6, 2011 at 14:34 | Report abuse |
  24. Mom and wife

    Ever consider at least asking the family of their wishes???? With all due respect, this decision is NOT either the responsibility or the privlege of the medical staff. Its their job to render medical aid to the patient, with compassion
    to the family. Given the severity and unchangable impact, seeing the loved one in that state is 100% the
    decision o fthe *FAMILY*. As a wife and mother, I'd cherish that last "I love you" over the peaceful look on my
    loved ones face. I can see that look when they are in the casket. Its those last words, both heard and spoken that can never happen again.

    July 6, 2011 at 14:09 | Report abuse | Reply
    • VelveteenLady

      I disagree with your post. If what you write should be the case, then it follows that the doctor should ask the family whether the patient should be intubated or whether the patient should be given morphine before they see him. I can just imagine the doctor going to the family and saying, "Your loved one has been burned over 19% of his body and he is in excruciating pain. He's thrashing around and moaning because of this pain. Now, do you want us to intubate him and give him something for his pain BEFORE you see him or AFTER you see him?" I agree that family wishes should be honored; however, there is a great divide between providing appropriate care for the patient (the doctor's primary concern) and letting the family practice medicine.

      July 6, 2011 at 14:48 | Report abuse |
    • Disagree

      Is it all about you, or them? Is it so important that you would have them suffer for your needs? The patient was burned over 90% of their body which could mean facial features were burned off. Would you still have a peaceful memory of them?

      July 6, 2011 at 15:43 | Report abuse |
  25. John

    Powerful. I was a Paramedic for years and remember some family members being able to say goodbye before we left with their loved one for the ER where at times we would learn later that patient passed away not long after. I think it's important for loved ones to be able to connect to their family member while they can still speak. I would want that opportunity to say good bye if I still could, not be put asleep where I could not express my love and my family members never being able to connect with me except to my system sustained body. I agree with the writer that advance directives are important but all too often that won't provide a chance to say good bye when something happens and family are forced to meet up with you at the ER after something happens like a car accident, etc. Often procedures are completed to try and save the life of the patient if the directives are unknown and until they are available. I would recommend too that you never forget to say you love your family everyday for all too often things happen where you won't have that chance again.

    July 6, 2011 at 14:10 | Report abuse | Reply
  26. Allen S

    This is a tragic story and demonstrates that the entire family suffers. While both physicians were compassionate in their response to the situation, I believe there is a middle ground between them. I feel it is not the medical communities responsibility to decide what shold or should not be said, but to give the families and loved ones the opportunity, when possible to say want they want to say. Many times, families faced with these type of sitations in which their loved one is going to be intubated and sedated do not have the opportunity to just say I LOVE YOU. Giving people the opportunity to say that is the bridge between both physician viewpoints.

    July 6, 2011 at 14:12 | Report abuse | Reply
  27. Jamie

    I love my husband more than words could express, but the last memories stay with you forever. I couldn't imagine seeing him in so much pain. If I had a choice I'd rather not witness it and just see him sleeping peacefully. I'd be afraid of that image in my head every time I closed my eyes.

    July 6, 2011 at 14:14 | Report abuse | Reply
  28. QS

    Give hope when there is hope, give the truth when there's no hope and give the family the specifics even when you as a doctor may think you know better...it's their choice and their decision and they should be given every opportunity to make it for themselves.

    July 6, 2011 at 14:17 | Report abuse | Reply
  29. SE

    When a person is sedated, there are different levels of conchousness. It is very difficult to for the family or the medical staff to know how deeply the patient is out. Many years ago I had an episode where I was not conchous and I heard everything that was said even though I was unable to respond. Just becaude a person is unable to talk, do not assume that they can not hear. This is one of the last sences to go. One more thing. Write a living will. This will give the medical staff and family the opertunity to discuss this issue and follow your wishes.

    July 6, 2011 at 14:19 | Report abuse | Reply
  30. Kristy

    I think it is better for the family to see the loved one in peace. No one wants to see their loved one suffering in agonizing pain. There is never enough time to say goodbye to someone, but images of a burned husband flailing in pain could haunt that lady forever.

    July 6, 2011 at 14:21 | Report abuse | Reply
  31. teremist

    As a nurse, I think Dr. M. made the right decision. The family should be spared the haunting hell of agony this man was suffering. Holding his hand, while he was peaceful and unaware, was when the wife said good-bye. Grief is enough to bear, without adding the burden of the agony of the patient. As a widow, of a cancer patient, there are memories I wish I did NOT have.

    July 6, 2011 at 14:24 | Report abuse | Reply
    • VelveteenLady

      I am sorry for your loss and for the fact that you have those tortuous memories. Thank you for being one of the unspoken heroes (nurses), who many times do not receive the credit that they deserve.

      July 6, 2011 at 14:51 | Report abuse |
  32. Joe

    Yesterday a doctor told my wife and I that our baby will probably not survive. In fact he said it about 15 times, 15 different ways during the interview. Apparently 90% of babies with Trisonomy 13 die within the first year. Although our baby looks normal and has no significant problems internally, the Dr. felt more comfortable in telling us that he probably will not make it based on the odds. Even while my wife was crying, and I said that there was nothing to indicate he would have a shorter life he immediately disagreed and said the Trisonomy 13 diagnosis itself indicates it. His assistant said if we had another baby this won't happen again. Although we need to be aware of potential problems Doctors shouldn't remove people's hopes. I'll take the 10% for now.

    July 6, 2011 at 14:34 | Report abuse | Reply
    • Sorry Joe

      Sorry to hear about that Joe. Hang in there.

      July 6, 2011 at 15:08 | Report abuse |
    • Suzanne

      Joe – my daughter was told my grandson would not make it to full term when she was five months pregnant due to a neurological issue with his brain develepment. She underwent an amniocentisis that was inconclusive, numerous sonograms, and was scared to death the day she went into labor. He was born at full term, seemingly fine, but yet they were still concerned and ordered an MRI. As an infant he had two MRI's that resulted in inconclusive evidence of any brain abnormality. Today he is a wonderful, healthy of body and mind, six year old who has no signs of any abnormality. doctors do not know everything! Beleive and pray for good health. I hope your doctor is wrong.

      July 6, 2011 at 15:18 | Report abuse |
    • Southern_Belle

      Joe – I am so sorry to hear the news of your unborn baby's health. In 2006, my sister and her husband were told their baby had Trisomy 13 and would not survive. He lived until approximately 10 minutes before delivery. He was still born, but we loved him regardless. We dressed him and made pictures of him so that our memory of him would never die. I pray your baby is one of the 10 percenters who survive. You and your family are in my prayers. God bless you.

      July 6, 2011 at 15:29 | Report abuse |
    • Maryland

      Never underestimate the power of hope! Hold on to it! Do research, get different doctors' opinions, find out what your options are. Every day is a gift, and no matter for how long, do your best to make each day his life meaningful, nurturing, and full of love.

      That's the good thing about odds: It may mean that something is high improbable, but it also means that it is POSSIBLE.

      Bless you and your family!

      July 6, 2011 at 15:55 | Report abuse |
    • Joe

      Thank you guys for your kind words. It is much appreciated, truly! God bless

      July 7, 2011 at 15:25 | Report abuse |
  33. Jovie

    It doesn't matter... he passed away, and he would have passed away either way. That's what the family is trying to deal with... not the fact that you doctors might have given them false hope. Heck, if it were me, I'm sure I would be in too much shock to even remember much of what the doctors say.

    July 6, 2011 at 14:35 | Report abuse | Reply
  34. Lotusfoot

    Well, the decision is easy. If the patient was writhing in pain, how can he say goodbye or hear his wife's goodbye in this condition? It would be better to sedate the patient and ease his pain, so that his wife could say goodbye. Besides, you wouldn't say goodbye literally.

    July 6, 2011 at 14:43 | Report abuse | Reply
  35. hijadeediliaa

    Having lost my mother to a massive stroke, and my older sister to congestive heart failure i'm a firm believer that being able to say goodbye to your loved ones, eases their passing. My sister a nurse, fought not to be intubated because she knew what it meant, she died later that evening. I'm certain that if given the opportunity Jerry would have opted to say goodbye to his wife and daughter, no matter how much pain he was in. If the patient is able to communicate, the decision should be theirs.

    July 6, 2011 at 14:48 | Report abuse | Reply
  36. BethTX

    I absolutely believe that the wife should have been the one to make the call. A burn victim is a gruesome sight and the doctor should have prepared her for that, of course. She could then have decided whether or not she wanted to see him, and whether her child should see him.

    In this case, there was no hope. If the burns hadn't killed him, infection almost certainly would have.

    July 6, 2011 at 14:50 | Report abuse | Reply
    • Difficult

      Is it right to make his suffer excrutiating pain for their benefit of seeing him that way? Seems like a physician is more obligated to ease suffering of the sick than the family. Tough call.

      July 6, 2011 at 15:05 | Report abuse |
  37. Peetwo

    I lost my wife two years ago, she was 39. It is far better to say good buy and be at peace with your loved one and yourself, it makes living on easier.

    July 6, 2011 at 14:54 | Report abuse | Reply
  38. Hmm

    I can see the dilemna. My wife's mother lost her second husband to cancer. He endured numerous surgeries and endless pain to "live a little longer". However, I don't believe it was a choice based on his needs or desires. I feel there's a fine line between doing what's in the best interest of the patient and what's in the best interest of the family.

    When I read the above, it was a no brainer. Sedate the patient to end his suffering, or keep him in agony to hopefully reduce the suffering of his family. Wouldn't a responsible family member's first question have been, "Can't you do something to stop his pain?"

    I think if doctors approach it as if they were lawyers obligated to serve the best interests of their patients, they would find it easier to make these decisions. The problem I see is when the family becomes selfish and no longer thinking rationally, and isn't ready to accept the loss. Then it becomes a conflict of them wanting to prolong life in their own best interest and at that point, I'm not sure there's a right decision. I guess it's the one you can sleep with.

    July 6, 2011 at 15:02 | Report abuse | Reply
  39. Jackie

    In 2004, while on vacation, my dad was in an ATV accident. We were hundreds of miles from home when the accident occurred. My dad was in a medically induced coma for almost two weeks with broken ribs, collapsed lungs and a ruptured spleen. None of the doctors had mentioned or indicated that his life was in jeopardy; in fact they were discussing rehabilitation options with us. One particular intern (I’ll call him Dr. P) often took care of my dad. For some reason he felt the need to complain to my brother and me about how tired he was and how little sleep he’d had. Not what I want to hear from the man who holds my father’s life in his hands. He was so concerned with his own “problems” yet he didn’t seem to register the pain and difficulty that my family was going through. We were five hours from our home, living in a motel located on the hospital grounds and every second of every day we thought of nothing but what the future had in store for my dad and our family. How hard will his recovery be? Will he be in much pain? Can he feel pain now? Can he hear me when I talk to him? Can he feel it when I hold his hand? And then there were the practical matters. Will he be out of work? If so, for how long? How much will the insurance cover? How will my Mom pay the bills? Will they lose the house? It was agonizing. The final straw for me was the night when Dr. P told me that I should go back home because “my husband” was going to be there for a while. After almost two weeks, he didn’t realize that the man in the bed was my father, not my husband. He had no idea who any of us were or how we were related to his patient. We were just another chore for him to deal with while making his sleep deprived rounds.
    On the morning of the 11th day, at 5am, the phone in our hotel room rang. My father was crashing and they wanted us to come to the ICU. We ran. When we got off of the elevator, we were met by the hospital chaplain. I knew what this meant. They led us into a small room outside the main waiting area. This was the same room where I’d seen people enter hoping for good news and come out lost and weeping. Two nurses and the chaplain sat with us. I remember that one of the nurses had on ankle socks with little green frogs with googly eyes. I remember staring at those googly eyes. Finally the attending physician and Dr. P came in to tell us that Daddy had passed away and they didn’t know why. Dr. P was a pale and silent. I think he’d realized that he’d said plenty in the prior week’s because he wouldn’t look me in the eyes. I have since wondered if my father’s death was a hard learned lesson for him. I wonder if he remembered how he’d complained about his petty discomforts when my family was being torn apart. I can only hope that our tragedy opened his eyes and he’s a better doctor because of it.

    July 6, 2011 at 15:05 | Report abuse | Reply
  40. Noxious.Sunshine

    Unfortunately for me, the chances of me getting the opportunity to say goodbye to my parentsin a situation like that are slim to none. My dad had his 3rd heart attack the Thursday before Father's Day & just 3 days after his 62nd birthday. He's also had 3 strokes. My parents haul military equipment for the gov't & had a load on that was an extreme inhalation/ppison hazard. Had my dad been driving, it would have been Game Over for both... And I wouldnt have gotten to say goodbye..

    July 6, 2011 at 15:07 | Report abuse | Reply
  41. Katie

    I am so glad I don't have to make difficult decisions like this. For all of you who do have to make these decisions, you have my full respect. It can't be easy.

    July 6, 2011 at 15:10 | Report abuse | Reply
  42. WenVenice

    Thank you for such an introspective article. We lost my in-law's unexpectedly during a six month period recently. We were able to say goodbye to my father-in-law but not my mother-in-law. We would have liked that chance.

    July 6, 2011 at 15:11 | Report abuse | Reply
  43. My Experience

    When I was 18 I was called to my grandmother's bedside. She had going through bypass surgery and her kidneys were shutting down. Her body was swollen and attempts at dialysis caused her heart too much stress. After I returned to where I was stationed, she passed. To this day, I can't get the images of her lying there in pain and swollen out of my mind. I have lost a number of other relatives since, and many of which I did not see after they passed. I can remember them they way they were when they were alive. I think everyone handles loss differently. I think every situation is different.

    I think it's important for families to discuss some of these topics in advance and agree up front how to handle things like life support, etc. In this case, if he was suffering, I believe the doctors were obligated to ease the pain as quickly as possible. They are obligated to the patient first. The family does not need to know they were "awake" upon arrival. They don't need to be made aware of every detail. The doctors can easily say the patient was sedated to help try and stabilize them. It not only eases the suffering, but keeps hope alive, even if it's minimal.

    July 6, 2011 at 15:15 | Report abuse | Reply
  44. Angela

    What a thought provoking article.

    My own personal wish would be to go ahead and intubate and sedate my loved one in a burn situation. The visual image/memory of him suffering in such pain would haunt me for the rest of my life.

    My father was intubated and put into a medical coma twice in 2010. Once for a hemorrhagic stroke, then 9 months later after a car crash (he was not driving). Miraculously he survived both traumas.

    Our family is very close so there was never any doubt in my mind that my father knew how much I loved him. Saying good-bye one last time (while conscious) would never erase the shock, pain and grief I felt surrounding my father's tragedies. However, I have absolutely no doubt he somehow felt our presence and heard our words. I can never explain this phenomenon to people who have never been through such a situation, but it's real. Your words and presence help comfort and heal.

    July 6, 2011 at 15:18 | Report abuse | Reply
  45. J Powell

    I have worked both as a Paramedic since '94 and a Nurse Tech with a Hospital for 6 years as a Nurse Tech ( They passed a law where I live that Paramedic's can push drug's and since a nurse is only doing what a doctor is Telling them to do, then sure, a Paramedic can work in a hospital environment ) I worked in the ER, I've always been the one that functioned better under more stress.

    anyway, going through Paramedic school we were always taught to be brutally honest with the patient's family, some instructor;s will tell you, even though we know there;s know viable cardiac activity, that if you see even the slightest murmur of fib, then your going to be working the code, even though their skin is already somewhat ashen.

    I guess the best way to answer the question, it just depends on the underlying condition's and the state of the patient upon arrival . but then it becomes a decision show. do you run a 6 second flat line strip, tell the family, contact medical control and get a time of death . of do you put on a circus act giving the family false hope and then just passing the blame and let the hospital be the messenger . it's a bad situation to be in

    July 6, 2011 at 15:18 | Report abuse | Reply
  46. virginia

    Its not about the living at that point get a clue yes the doctors and nurses go above and beyond and yes relatives see the pain but it isn't about the living almost died several times alone.

    July 6, 2011 at 15:25 | Report abuse | Reply
  47. Angela

    It all depends on how long the patient has to wait in pain, but if possible, I would prefer to say my last goodbyes and then have him intubated..

    July 6, 2011 at 15:30 | Report abuse | Reply
    • Huh?

      Wouldn't you rather hold onto the hope of saying, "Wow! That was close, but you're alive" if they survive?

      There's a story about a man who was shot. They took him to the hospital and the doctors and staff looked down on him with a look that said they didn't think he could make it. Since he was conscious, they asked him if there was anything he was allergic to before the operated. He said, "Yes. Bullets. Now operate on me like I'm alive instead of dead." He survived the operation. Everyone is treating him as a dead man versus someone with the hope of survival. Give them a chance to live and they might surprise you.

      July 6, 2011 at 15:40 | Report abuse |
  48. David H, M.D.

    Dr, no decision you made at that moment would have been the right one for you, and either way, you would have had to live with that decision. I wasn't there, so I'm not going to try to second guess. But as a physician, I think the correct decision was made at the time. Jerry was dead before you even saw him. Nothing you could do would have saved him. As a physician, the only think you could offer that man was to ease his pain and suffering, and that is what the the surgical team did. We can't guess the family dynamics, but would they have been better off seeing their loved one screaming in agony and thrashing? Would that have been a kind, humane, caring final memory to have left them? I think not. We all have to live with our nightmares, the second guessing. I hope this note eases your pain. You were correct in asking. And Dr M was correct in saying no.

    July 6, 2011 at 15:30 | Report abuse | Reply
  49. No way

    Treat the patient and then worry about family members saying good-bye. Isn't part of the oath, "Do no harm"? I'm not saying the family shouldn't be informed, but visiting should not take precedence over easing his suffering and worki to save his life.

    If you had a loved one in a car accident with a 10% chance of living, is it more important for the doctors to stabilize them and address issues such as internal bleeding, shock, and other trauma....or is it more important for them to put all that on hold while you come say good-bye to someone who isn't dead? If you went in and interrupted the treatment, would you feel guilty when they died knowing that you took precious time they could have used to try and save them?

    July 6, 2011 at 15:33 | Report abuse | Reply
  50. Stephanie

    Patients and family's shouldn't be mislead. Everyone deserves to know the truth and not have it sugar-coated. It's wrong. As hard as it is to see a love one that way it would have been best if the patient and his wife had a chance to say "I love you's" and be told there wasn't much chance that he would survive. Sedation to follow to ease the pain. Life is hard. It's even harder when you are denied the right to say "good-bye"

    July 6, 2011 at 15:36 | Report abuse | Reply
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