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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. Keep it Simple

    Who was the patient? The writhing man in unimaginable pain. Not the wife. I appreciate the concern for the family, I do, but doctors need to take care of their patients first. I think the surgeon in charge addressed your concern, but failed to discuss the whole of the situation later. Worrying about goodbyes is placing the needs of someone else above that of the patient. To extend the horrific suffering of this man for the eternity of ten minutes to satisfy the needs of the wife surely violates medical ethics.

    I think American medicine, with its emphasis on survival, makes it very difficult for young doctors to understand how simple the ethics of this situation are. Do you see the reasoning you used as a young doctor? Injury that will almost certainly cause death meant that you could turn from the patient and consider his family. You did this out of kindness, but – if you were not schooled to calculate all action on survival, if you remained your patient's advocate in palliative care, I can't imagine that the wife's needs could possibly override the patient's need for relief from excruciating pain.

    I truly hope that I do not have relatives who would withhold relief from ultimate pain to "say goodbye." That is not love.

    July 6, 2011 at 15:38 | Report abuse | Reply
    • JeramieH

      > To extend the horrific suffering of this man for the eternity of ten minutes...

      Bingo. Let's focus on the needs of the man writhing in unimaginable pain first, shall we?

      July 6, 2011 at 15:52 | Report abuse |
    • Zeke2112

      +1 to you, sir/madam. The Hippocratic Oath mentions nothing about providing hope to family members at the expense of a patient's suffering. If there is time and no immediate pain, great – go get the family and let them have their moment. In this case, the doctor made the right call.

      July 6, 2011 at 15:57 | Report abuse |
    • I agree

      The patient comes first. My cousin had a horrible motorcycle accident. They didn't think he was going to make it and were literally carting him into the OR to amputate his leg because they couldn't find the bleeder that was killing him. It was a last ditch effort to save his life.
      If they had written him off. If they had decided not to rush him in. If they had stopped treating him and instead considered him a likely goner, they could have stopped and let everyone come in and say "good-bye".
      Fortunately the doctors didn't stop treating him...the patient and found the bleeder minutes before removing his leg. They were able to stabilize him and even though he'll never walk without a cane, he lived. I can't think of anything worse than taking those precious seconds that made a difference in him living, dying, or at a minimum living with the loss of a limb.
      In the above case, you can be pretty certain if the died and the family found out they hadn't done quite everything, there's a good chance the hospital would have faced a lawsuit.

      July 6, 2011 at 16:01 | Report abuse |
    • GinaBonBon

      very well put!! i agree completely!

      July 6, 2011 at 16:21 | Report abuse |
    • jim

      sorry but I disagree. The surgeon knows 100% the man will die. He knows his efforts will be in vain but he has to try anyway. He therefore should shift his attention to the family. Would you rather see a loved one alive even if they are in bad shape or see them after they die? I personally would rather see my loved one alive even if just long enough to say goodbye. But thats just me.

      July 6, 2011 at 16:41 | Report abuse |
    • BD

      Well said.

      July 6, 2011 at 17:00 | Report abuse |
    • Glenn Pate

      The Doctor could have asked the patient what he wanted to do. Many couples have already decided how they want to spend their last minutes and it should be up to the patient if he/she wanted to say something before being put in a treatement mode that would disallow it.

      July 6, 2011 at 17:41 | Report abuse |
    • Shan

      I agree the patient is the first priority...but this isn't just about the wife or daughter getting to say goodbye...Jerry didn't get to say goodbye either...I know *I* would accept a few more minutes in pain if it meant I got to say I love you one last time.

      July 6, 2011 at 18:43 | Report abuse |
    • Bill

      I completely disagree. When a MD treats someone who is dying and there is a family present, it is the doctors responsibility to take time to meet with the family. Of course one would not expect a doctor who is in the middle of treating someone to stop what he or she is doing and go talk to the family. Once the patient is stable a doctor needs to talk with the family. One of the main areas where so many doctors hopelessly fail is they do not address the emotional pain/fear of the patients and their families.

      The reason for malpractice suits is not so much medical mishaps but that the doctors failed to express concern to the patients and /or their families. This is the failure of medical schools who teach medical students to treat organs like the heart, kidney, lungs rather than a person who has a heart, kidney and lung and that the patient has feelings.

      The doctor who wrote this article asks – should a doctor give a family hope no matter the situation? Should hope be offered when the situation is hopeless? To me the answer is simple. You tell families there is a 15%, 10%, 2% chance the family member will survive and they should prepare themselves for the worse. You tell them you are doing the best you possible can but sometimes medical situations are so severe it is beyond the current state of medicine to save everyone – but you will keep them updated. And don't tell them this in a waiting room, take them in a private office.

      July 6, 2011 at 18:53 | Report abuse |
    • Respectfully disagree

      If it was me suffering and in the danger of death, the last thing I want to hear is my husband's voice telling me how much he loves me and will care for our children. No matter how much pain I'm in, I will need to say the same to him. Then sedate me. So, I disagree with the logic that it is unethical to give a patient and his/her family a moment to say goodbye. We're humans with relationships, not animals needing to be put out of the misery.

      July 6, 2011 at 19:22 | Report abuse |
    • Kelly

      I would not want to see my husband in that much pain, I would rather the Dr do what they need to do to make him at peace! I know he loves me and our children so I want him to be pain free and at peace. I hope this helps you as a DR and I'm sure people have different answers but that is mine. Thank you for what you do and god bless you for carring!

      July 6, 2011 at 19:29 | Report abuse |
    • Mica

      You have a valid point save for the delivery. Bill's post is the very thing we try to do. As a newbie nurse, we are advised to have compassion and comfort but never give false hopes and, at times, those decisions are made at a moment's notice when the first thing on their mind is saving a patient. There is no right answer, these decisions are never easy and they are made during really stressful times when it's not the only thing you need to prioritize.
      Jim: You mistake 15% for imminent death.Your point is based as a family member not as patient and on an intellectually moral standpoint. Miracles can happen and anyone would ask for it when in a similar situation be it as patient or family.
      Glenn Pate: That is the most ideal situation when not in an emergency. When time is of the essence and you're patient is unable to think logically due to excruciating pain and families are in shock, it may not be so easy.

      July 6, 2011 at 20:01 | Report abuse |
    • SharonMississauga

      Many years ago a doctor told me that I was going to lose my baby ... he said I should be prepared and it didn't look like there was any hope. Well that baby is now 33 years old and has 2 sons of his own. I can remember being upset with the Doctor for taking away ALL hope... you never know what will happen and sometimes hope is all we have left to help us through. I believe this Doctor is very compassionate and used good judgement. I wish there were more doctors like this. Good on ya!

      July 6, 2011 at 20:06 | Report abuse |
  2. He talked

    The story mentioned hearing him talk. What if HE said HE didn't want the family to see him period? Do you tell the family he's probably going to die and doesn't want them to see him so they won't be allowed back period?

    July 6, 2011 at 15:45 | Report abuse | Reply
  3. liz

    10 years ago, my mother died after a brief illness and I think we were in such shock at the prognosis that we didn't know what to do. We had the opportunity to "awaken" her and say goodbye but opted not to at that point. She was running an extremely high fever and hooked up to a respirator so we let her sleep and die that way. I have struggled with whether or not we made the right decision ever since.

    July 6, 2011 at 15:47 | Report abuse | Reply
    • Condolences

      Sounds like you made your decision based on what was in her best interest, not yours. There's no right answer and only the hope we did what was best given the information available at the time.

      July 6, 2011 at 15:54 | Report abuse |
    • Zeke2112

      You did what was best for her, Liz. At the very end, you put her needs above yours – a fitting final gift from a grateful and loving child to any parent.

      July 6, 2011 at 15:58 | Report abuse |
    • GinaBonBon

      condolences and zeke2112 are right, liz! you did what was best for your mom. i'm sorry for your loss!

      July 6, 2011 at 16:24 | Report abuse |
    • Gary Williams

      Liz... I applaud you for putting her comfort first... there's lots worse than death... suffering is not what ANY loving family member wants to see their loved one go through. Thoughts and prayers your way...

      July 6, 2011 at 16:59 | Report abuse |
    • Frank

      Liz, I think you made the right choice. I also believe that while a person sleeps they can still hear. She knew you were there and caring for her.

      July 6, 2011 at 18:37 | Report abuse |
  4. jay

    To all
    September 10 2006
    6:54am Arrowhead study

    3:00am
    Wide awake
    Flip thru the channels
    A program starts

    "Simple Wisdom"
    By Erwin Kula
    A theologian
    A rabbi
    A cutting edge thinker

    This 30 minute show
    topic: Connections

    "the dearness of the vanishing moment"

    The phone calls on 9.11 from planes, from the towers, from fire police and
    rescue personnel....

    Clarity
    Willingness
    Love
    Courage
    No remorse
    No revenge
    No anger
    No hurt
    Just last thoughts...for no tomorrow

    "I love you a 1000 times over and over again. I love Emmy, please take care
    of her. Whatever decisions you make in your life-I need you to be happy.
    I will respect any decision you make. I will always love you"
    Just one of the calls on 9.11.....from the towers

    The dearness in..."the dearness of the vanishing moment"
    Life
    And life and death

    The energy of a last connection
    Reconciliation
    Want to know
    Need to know
    And release
    Affirmations
    The mostest truth
    An intimacy

    In to me see....
    I want to show you one last time.

    The dearness of the vanishing moment
    Every courageous good bye

    College kids
    Weddings
    Job change
    Death
    And moments of birth...rebirth

    The edge of the grand canyon
    Vast
    Deep
    Time
    Awesome beauty
    Scary at the edge
    Awareness of the gap
    And then....just faith.

    The dearness of the vanishing moment

    Hands both held
    One by God
    One by love
    Fingers laced

    Peace at hand

    This I know for sure
    And then in a blink of the eye
    Forever and even after that
    Amen
    Jay

    July 6, 2011 at 15:50 | Report abuse | Reply
    • Hayden71

      What on earth does this mean????

      July 6, 2011 at 16:04 | Report abuse |
    • tightywidey

      Nice, but I don't get the point of your . . . poem?

      July 6, 2011 at 16:18 | Report abuse |
    • Carla Hurst-Chandler

      Lost my husband to leukemia after a year and a half battle...this poem really does say it all. Thank you for posting it.

      July 6, 2011 at 16:50 | Report abuse |
    • Sahari

      The poem is beautiful. And very appropriate to this article. Those who cannot see this do not seek.

      July 6, 2011 at 19:22 | Report abuse |
    • Annemarie

      We just found out last night that my sister in law is presently living out her last hours from breast cancer, and is now spending time with her husband and three young children. This poem...is beautiful, and poignant. Thank you.

      July 6, 2011 at 19:34 | Report abuse |
  5. Interesting

    At what point does a doctor no longer serve the best interests of a patient? Isn't this about defining when the patient is no longer the main focus of the situation and becomes secondary to the needs of the family?

    July 6, 2011 at 15:51 | Report abuse | Reply
    • Been There

      There is no right or wrong answer here. If I personally were in writhing pain facing death, I would want to remain conscious, with my loved ones present when I died. Not asleep. I was with my mother when she died in severe pain because the morphine was not working well for her. My psyche was not damaged by seeing her in those last moments. I still remember her in her prime.

      My brother was also in the Burn Unit after a car accident. Our family arrived at the hospital and he was bandaged, on a ventilator and we were told that he was not unconscious, and he could hear us....just as this article mentioned, because he most likely would never wake up if they put him under anesthesia. We were allowed to see him, (no one suggested saying "goodbye" evidently because they wanted to give us "hope"–in fact, I said, "You're gonna make it!", not "goodbye") Sadly, we were encouraged to go home and wait for further news of his condition and not stay bedside. My family left and my brother died alone, which breaks my heart. In these moments of crisis and in the last moments of life, I believe human connection and presence for many people is more important than the desire for pain relief. Most severe pain is tolerable for short periods. Ask any woman who's given birth without medication.

      The "goodbye" or "last connection" is not solely for the family member. It's for the patient too and sometimes more so.

      July 6, 2011 at 18:46 | Report abuse |
    • IgM

      The patient's needs are never second to the family's. This raises all kinds of ethical issues like keeping people on life support even after they're brain dead because the family is not ready. Losing a loved one is certainly tough, but the doctor's responsibility is to the patient, during life and after death, and not to the family.

      July 7, 2011 at 13:24 | Report abuse |
  6. USAPatriot

    Idiot liberal doctors. Yes, I'm sure his wife would have loved for her last memory of him, the one she'd see in her dreams for many years, be one of him writhing in pain and in fear. You'd have taken her pain and compounded it with nightmares. That's not compassion. Your problem, Doc, is that you're thinking of you through all this...what you think and feel, without consequence to her.

    July 6, 2011 at 15:52 | Report abuse | Reply
    • JeramieH

      > You'd have taken her pain and compounded it with nightmares

      That's what I thought too. Do you want to shout your final goodbyes through their agonizing pain, or whisper them softly in their painless sleep?

      July 6, 2011 at 15:54 | Report abuse |
    • Lydia

      Why the nastiness? You don't know these doctors and neither do we. Your first comment makes no sense. What does liberal have to do with the decision made?

      You wear the label "USA Patriot" on your sleeve and you do a disservice to it.

      Be respectful. The doctor wrote the article because obviously this particular death impacted him very much.

      I'm sure they have made many decisions throughout the years and I'm more than sure that there are some families that would prefer to say their good-byes before the patient is given pain meds to ease their suffering while others would opt to make sure their loved one is at peace and pain free.

      In the final analysis it is the patient's desire what they want. Unfortunately, sometimes we don't talk about what our wishes would be if something like this happens. Some people don't like to talk about funerals or if they want to be cremated or not. Some don't like to even talk about going to the doctor, or if they have an illness, what they are doing for themselves.

      So for any one of us to second guess what a doctor should do or not do at a critical juncture is a moot point. Because anything they do will be criticized by everyone.

      July 6, 2011 at 16:08 | Report abuse |
    • Sara

      When my husband rotated through the burn unit, he said it was the worst experience of his life and medical career. He saw things he hoped he'd never see again–and wouldn't wish on his worst enemy. The average person has no idea just how horrible burn injuries are. I think the more experienced doc made the right choice–both for the patient and the family.

      Reminder folks: You never know what tomorrow will bring. Have the talk with your loved ones. Make a living will/end of life directive. It may not be perfect, but try. http://patients.about.com/od/endoflifedecisions/a/advdirquestions.htm

      July 6, 2011 at 16:09 | Report abuse |
    • Grace

      What Lydia said. Doctors have to face this horrible situation every day and I cannot fathom how much that responsibility could weigh down any young resident. Regardless of if he chose the right decision or not, it was hard one.

      July 6, 2011 at 16:43 | Report abuse |
    • TalkingPoint

      It is a talking point, designed to invoke thinking and a thoughful discussion. Mission accomplished, except in your case.

      July 6, 2011 at 16:51 | Report abuse |
    • Mae

      I disagree with your rude comment. There is no black and white in these situations. Both sides deserve contemplation. She didn't get a chance to say goodbye. And neither did he. Assuming any of us know the desires, wishes or future dreams of another person is ridiculous.

      July 6, 2011 at 17:58 | Report abuse |
    • Ryan N

      Who said anything about this doctor being a liberal? And he graduated from med school – he can't be that much of an idiot.

      July 6, 2011 at 18:06 | Report abuse |
    • Political Tripe

      Liberal doctors? There was no mention of politics in his article. Obviously you are a trolling teabagger without an intelligent thought in your body. Go back to the monster truck races and NASCAR and let those with brains discuss moral dilemmas.

      July 6, 2011 at 19:26 | Report abuse |
  7. Lydia

    "Stephanie". No one is being mislead. The decisions are fast and hard at the same time. The doctors first obligation is to the patient, period. Although most doctors will take the family into consideration, in this particular case, there wasn't time and the situation was extremely dire.

    And best for whom? The wife will have to settle with the fact that she didn't have to see him scream in pain but rather unconscious and still.

    I hope for her sake, she will remember him in the good times and in good health and every day of her remaining life, she'll be able to tell him in her heart she'll always love him.

    July 6, 2011 at 15:54 | Report abuse | Reply
  8. Deanna

    I wouldn't want to see my loved one in pain. That image would be forever seared into my memory.

    July 6, 2011 at 15:58 | Report abuse | Reply
  9. Anon

    If I were the dying man, without a doubt I would not have wanted to be sedated. The doctors should have told the man that he was not going to make it and asked him if he would like to see his family one last time. For some reason, doctors tend to think that they are the only ones capable of making a decision but this was not their decision to make, it should have been Jerry's.

    July 6, 2011 at 16:05 | Report abuse | Reply
    • JeramieH

      90% burns is not a feasible situation to have an idle chat.

      July 6, 2011 at 16:32 | Report abuse |
  10. Michael

    The overall problem that confuses me is that we can show compassion for a suffering animal, and will make a tough decision to end it's suffering, but get all bogged down in what is right or wrong, and administrative bull-cookies over the same situation when it involves human suffering. My only conclusion is that the animal does not carry a wallet, credit card, or insurance card, so there's no money in it for anyone!

    July 6, 2011 at 16:05 | Report abuse | Reply
  11. Kathryn

    It is a tough decision. And probably different in each case. What is right for me and my family may not be right for you and yours. But for those of you who are critizing the doctor for merely thinking this through it is pretty harsh and judgemental. I think it shows a lot of compassion and thoughtfulness and opens up a meaningful dialogue. I just hope none of us has to face this dilema....and have compassion for those that have.

    July 6, 2011 at 16:12 | Report abuse | Reply
  12. Carol

    I was with my husband through his dying breaths and pain and he nor I would have wanted it any other way. Through many surgeries and untold pain and grief, our wishes were to be there together. No one else can make this decision for either the patient or the spouse. I will always value being able to be with him until the very end. Very painful, but sharing everything is what marriage is all about.

    July 6, 2011 at 16:16 | Report abuse | Reply
    • SAHM1979

      You sound like a very strong person. I'm sorry for your loss. 😦

      July 6, 2011 at 16:42 | Report abuse |
  13. berriebug33

    No matter what the situation...honesty will be the best policy. If they know in a situation that chances are slim, they need to inform loved ones so they can prepare for the loss and continue to do what they can to save the life.There is no best interest for anyone here....someone is dying, in pain, mourning etc. we all do what we can and have to, to get through things....doctors included. If you worked hours on end in a hospital, treating people, trying to save them, and also seeing many pass away, dealing with heartbroken loved ones etc. I wonder how capable any of us would be to make the right decision....

    July 6, 2011 at 16:23 | Report abuse | Reply
  14. Anon2

    Everything else is irrelevant given the fact that the man could speak. I've seen this before in my own family. Sometimes even if a patient indicates that they want a few more minutes with their family their request goes ignored and the hostpital staff seems to think that if someone wishes to endure physical suffering to spend more time with their family that they are "obviously not thinking clearly" and they are sedated.
    What I witnessed myself was that the hospital staff could not endure to see someone in pain even if the patient was willing to endure it.

    July 6, 2011 at 16:24 | Report abuse | Reply
  15. herpderples

    Never got the chance to say goodbye to my father... it might be a drag, but there's worse things in life. He knew that I would if I got the chance, but I think it's best that he went as peacefully as he did.

    July 6, 2011 at 16:32 | Report abuse | Reply
  16. shirley

    Two weeks ago to the day we memorialized my beloved brother, who flatlined three times after complications from surgery.The physician told my his wife of 40 plus years he could bring him back again, but most likely, he would a) flatline again, and b) might have brain damage from lack of oxygen. In keeping with my brother's explicit written wishes that he never wished to be a vegetable, she, with a very broken heart, let him go, and she and their only child had a very few minutes to tell my unconscious brother a final goodbye before his heart stopped forever. Sometimes the most compassionate choices for the patient, whose needs and desires should come first, are the very hardest for physicians and families to make. For all of you armchair sages, I pray you never have to make that choice. It's much easier to criticize others when you've never been through it yourself. The doctor made the right decision, in the case mentioned, and in my brother's case as well.

    July 6, 2011 at 16:33 | Report abuse | Reply
    • Mica

      I'm sorry for your loss, Shirley. And I agree with your armchair sage comment. It's easy to preach when you have the luxury of detached clarity.

      July 6, 2011 at 20:04 | Report abuse |
  17. Roseann

    Why didn't they ask the patient if he wanted to speak with his wife and child? Don't you think he knew that might not survive this terrible accident. Why not let the patient have those last few words with his wife and daughter. If he did that maybe his transition would from life to death would have been a much better experience for both the husband, wife and child. To many times a dying person has so much they would like to say, either to a loved one or to a minister, but because they become sedated there is never that opportunity. If a patient is immediately sedated because of their pain, and this becomes a continuing process, how can they ever express their fear of death and dying, or have a chance to talk to their family.
    Maybe things need to change, maybe we need to start seeing things from the dying persons point of view, and somewhere down the line stop the sedation and give them a chance to express themselves before they depart.

    July 6, 2011 at 16:33 | Report abuse | Reply
  18. SAHM1979

    My Uncle was in the final stages of cancer when I was 14. I wanted to visit him one day, but my Aunt didn't think it was a good idea due to his state. I, however, insisted upon seeing him and was let into the room. For the next 5-10 minutes, I watched my Uncle suffer. It was the most terrible thing I've ever seen. As with each time I saw him, I said a final "I love you so much, until we meet again". 7:30pm that night, my Uncle died.

    I don't think I would ever be able to say "goodbye" to someone who was alert and about to die. The thought of having to do such a thing brings me to tears. I think back to when I had to put my dog down a few years ago. It was the first time I ever had to do something like that (he was very old and very sick) and while waiting in the room with my dog...I was an absolute wreck! I couldn't stop sobbing...knowing that in just a few minutes my beloved dog would be dead. I can't imagine having to do the same thing with a loved one (say goodbye that is) who was about to pass away. No, I would rather live with hope and cheer on my loved one until the very end...THEN say my goodbyes. Would I tell them I loved them? Of course! But I would never say goodbye until they were gone. That's just me though.

    July 6, 2011 at 16:39 | Report abuse | Reply
  19. KimH

    How about this? Tell and SHOW your loved ones you love them EVERY day. Then, it won't be necessary to worry about that "last" goodbye. If he had died after being hit by a bus, would it have changed his love for his wife and child? Live every day like the gift it is and make sure your loved ones know your feelings.

    July 6, 2011 at 16:39 | Report abuse | Reply
  20. Chuck

    If I were the patient, I would suffer the few extra minutes in agony just for the opportunity to say goodbye to my family and let them know how much I love them.

    July 6, 2011 at 16:40 | Report abuse | Reply
    • Chuck

      ...and yes, I also tell them that every day.

      July 6, 2011 at 16:41 | Report abuse |
  21. Robert

    I saw my Dad crying at night when he had to make those calls and lost a patient, and praying in church before surgury every morning

    July 6, 2011 at 16:41 | Report abuse | Reply
  22. adanac

    Sign a living will or an advance directive..don't wait for someone else to make the decisions for you..Their choices may not have been one you would ever have considered, or wanted.

    July 6, 2011 at 16:45 | Report abuse | Reply
    • kirstyloo

      This article isn't about living wills or advance directives. It is about withholding care so that a patient can see his family for a last time and they can say good-bye. No amount of preplanning would come up with this scenario. Neither the nor the patient could make an educated desicion in the minute available. Taking 5-10 minutes to inform the wife about what happened, her to deal with the shock, and maybe make a choice? Crazy.

      July 7, 2011 at 14:50 | Report abuse |
  23. Jessie

    Its a very very tough call, my mom was placed in a induced coma when they took her off, My family and I were told that she was all better and I could take her home. That wasnt the case, her health took a turn for the worst and the doctors told her she was gona die soon, my mom didnt cry, she said good bye and everyday it kills me to remember that. That is the memory that I live with every waking moment, so I think it should be the families or the patients choice. Belive me saying good bye does not make it easier.

    July 6, 2011 at 16:50 | Report abuse | Reply
  24. James

    One-day we won't have to ponder over a, as I see, a no win dilema...

    July 6, 2011 at 16:53 | Report abuse | Reply
  25. Gina

    If I were the patient, I would absolutely want my partner holding my hand (or, since in this case it probably wasn't physically possible to do so without causing more pain – to just be there next to me) as I suffered through such pain, whether or not I was almost certainly going to die. It would be immensely comforting. As for my partner, I know he would rather be with me than have to wait in the waiting room.

    I think it just differs for everyone, and it's probably hard to make such emotional judgement calls along with rushing to treat the patient. Doctors hold a lot of moral responsibility, and since morals are subjective, a "bad" decision to one person is a "good" decision to another.

    July 6, 2011 at 16:53 | Report abuse | Reply
    • kirstyloo

      His wife DID get to hold his hand and sit with him. What she didn't get to do was see him or talk to him while he was still awake.

      I wonder if she even realizes that seeing him in horrible pain was contemplated.

      July 7, 2011 at 14:53 | Report abuse |
  26. Ted

    No one knows what they will do in any situation until they are put into that situation.No one who has not been in that kind of pain can know with certainy what they would want.I agree ,the doctors first priorty should be to ease the patients pain.I suffered chemical burns over 80% of my body when I was younger and I can swear to you the only thing on my mind was for the doctors to STOP the PAIN.I doubt that the pain from chemical burns is as bsd as from fire burns but it is bad enough.

    July 6, 2011 at 16:54 | Report abuse | Reply
  27. POD

    Imagine yourself at death's door......how would you like to be treated......for one thing in this life is CERTAIN.....we will all be knocking on heaven's door sooner or later

    July 6, 2011 at 16:56 | Report abuse | Reply
  28. jay

    The dearness of a vanishing moment I spoke of was between two people.......it is that only power (love) that can see thru disfigurement in that moment the burns are irrelevant ......it in my opinion this event would not be for children.....under the age of 18-19-20.
    in the dearness of a vanishing moment there is no hospital, no doctor, just that moment..........

    July 6, 2011 at 17:03 | Report abuse | Reply
  29. things are changing

    There has been a push is some hospitals to allow family to be present during codes. I have only seen the situation happen once for a trauma patient just entering the ICU. There were 2 related people brought in, and the family watched teams work on them both. One died, one survived. During the survivors extended recovery, the family repeatedly expressed how much more at peace they were with the situation because they saw how hard we tried.

    I say, ask the family. It doesn't take that much longer to tell them the situation quickly and ask what they want than it does to prep for an intubation and set up a vent.

    July 6, 2011 at 17:11 | Report abuse | Reply
    • Mica

      Hi, hopefully they would publish these situations. I'm just curious as to how they could implement that given that space in the ICU is limited and every team member has to know what to do, where everything is. It's a controlled environment and traffic flow is important. Is it through a glass window or are they physically with the team?

      July 6, 2011 at 20:15 | Report abuse |
  30. D. Lane

    I believe that his wife should've been given an opportunity to speak with her husband before he was intubated. She should've been told that his situation was extremely critical and there was no way of knowing when he would be able to be taken off the ventilator. She would likely have understood that it might be their last opportunity to speak to each other.

    July 6, 2011 at 17:47 | Report abuse | Reply
  31. Sandy

    What about the patients opportunity to say goodbye? It's not always about the family saying goodbye. Maybe in all that pain knowing his wife was there and family would have been of comfort. Just another view at the situation.

    July 6, 2011 at 17:52 | Report abuse | Reply
  32. Victor

    Dr. Yeun, there's another factor. That is your chinese heritage ties in with some of these critical decision. I remember when we decided to stop mom's life support so that she may pass in peace. Her request was that she be in harmony.

    We were raised to seek harmony above all else.

    July 6, 2011 at 17:55 | Report abuse | Reply
  33. Coralis

    That's definitely a tough decision. If I were the wife I would like for the doctor to give me the straight facts then let me decide for myself. Everyone has different faiths if ay at all. Some will take the facts others will turn to their respective faiths.

    July 6, 2011 at 17:58 | Report abuse | Reply
  34. Michael Cheng

    If I had to make the call, the peaceful and calm choice would easily win out.

    Here are the scenarios I considered.
    Peaceful and calm – He lives (15%) – Best ending
    – He dies (85%) – Family deals with loss
    Pain and agony – He lives (15%) – Family deals with the trauma
    – He dies (85%) – Family deals with loss and trauma

    For a young wife to see him with such severe and probably overwhelming burns, that's quite a lot of psychological stress to overcome. Some people cope better than others, but the memory of the experience will always linger, no matter the outcome.

    July 6, 2011 at 18:09 | Report abuse | Reply
  35. thinker

    I think doctors need to treat a patient's family as adults (assuming we're talking about adults here) and give them the facts. With compassion, certainly, but the reality of the situation should not be hidden. Doctors have no way of determining what the family's feeling are, or how they will react, or what their personal strenghts or weaknesses are. If a family member of mine were in dire straits I would want to know what's the situation is and be able to make up my own mind about what happens from there. If information were witheld from me, even with the best of intentions regarding my emotions, I would not be a happy camper.

    July 6, 2011 at 18:12 | Report abuse | Reply
  36. Sonya

    Always have hope. Never give up.

    July 6, 2011 at 18:16 | Report abuse | Reply
    • Frank

      Yes, fight to there is no fight left. Life is worth fight for.

      July 6, 2011 at 18:46 | Report abuse |
  37. Kim

    A memory of that horrible goodbye may have been worse than no goodbye. Good can come out of either choice. It is good to think about what one can learn from experience, but regret is not helpful. Their life together before that one moment is the memory she will have, and you have no control over that.

    July 6, 2011 at 18:27 | Report abuse | Reply
  38. Stephanie

    You tell the wife exactly what the situation is. Her husband might pass after they incubate him, but he's in terrible agony. Probably not a good idea for the daughter to see if she's young. Once they incubate, they don't know if he'll wake up and they need to do it soon. I as a wife would want to say I love you so he would hear those words and to say don't worry...that I will take care of everything and his job is just to get better.

    July 6, 2011 at 18:38 | Report abuse | Reply
    • Frank

      I don't know you but from your words you sound like you are a wonderful wife. Bless you.

      July 6, 2011 at 18:44 | Report abuse |
  39. Frank

    I was in a sorta similar situation with both my parents. My dad was 76, my mom was 86, they both were ill, organs were shutting down and the doctor recommended we remove antibotics, leave the food and water going and see how their bodies did. My sisters and I agreed. Each time they did within the day. I wish I could remember the doctors names. I believe that from experience they knew and it was time to let them go. In my case we got sometime to talk with them although both slipped into comas. RIP mom and dad. We love you both.

    July 6, 2011 at 18:39 | Report abuse | Reply
  40. Rene

    I don't know what the right answer is. I would like to say I love you and goodby to my loved one before they pass, but I do not have the strength to see them in pain or suffering. Hard choice for a Doctor to make.

    July 6, 2011 at 18:41 | Report abuse | Reply
  41. amir cheema

    I think Dr. M did the right thing. His took care of Jerry the best he could. As mentioned in the article, patients with greater than 90 % burns still have approximately 15% chance of survival. I would not call this hopeless. Jerry is in his mid 30's and certainly deserves the best treatment available. Jerry was thrashing about in agony and had developed labored breathing and therefore appropriately given immediate sedation, intubation and mechanical ventilation. Dr. M was sensitive to the emotional needs of the family and allowed them to visit Jerry as soon as possible. I dont think there was any infringement of autonomy in this case.

    July 6, 2011 at 18:42 | Report abuse | Reply
  42. Powodzenia

    I believe that Dr. M. made the right choice. Good-bye is never said in those last moments after a tragedy like that. Good-bye comes after the grief has abated enough to face the loss for those left behind. We in the United States do not teach our children to live as though today will be their last day; to speak the truth of their hearts every moment to ensure those around them know how they feel. This is especially true for our boys. Dr. M. is a physician, not a family counselor, although the more he uses those skills, the better. When my father committed suicide, I knew he had heard everything I could possibly say to him. Because of that, my grieving was relatively easier. Not easy by any means, but easier than if I had held all my feelings inside. Until his last breath, Dr. M.'s patient is his first priority and saving his life and/or making him comfortable is of paramount importance. Anyone who has experienced seeing someone in a burn unit knows that moments are tormented hours to these patients.

    July 6, 2011 at 19:11 | Report abuse | Reply
  43. Nancy

    Thank you for raising the very human dilemmas faced by all medical personnel. In the time pressured world of medical trauma and emergencies, all one can do is make the best call one can at the time. It is easy to make assumptions about what a patient or family member might want and second guess decisions that were made. To me, this is not so much a story about hope vs letting go but an indictment of how our society does not deal with the reality fo death.

    July 6, 2011 at 19:12 | Report abuse | Reply
    • Mica

      My point exactly. Thank you.

      July 6, 2011 at 20:32 | Report abuse |
  44. Kathy Soel

    As a registered nurse I have seen countless situations where hope won over closure. I think that patients and families have a pretty good idea when the end is near whether they will admit it or not. As a person, not a healthcare provider, I think I speak for many when I say there there are often intances when I think of loved ones who have died that I would give almost anything for a few more minutes with them to share a few more words, a nod, a glance. "Hope" can only take you so far when faced with death. Closure means more. You can't replace those last few minutes.

    July 6, 2011 at 19:12 | Report abuse | Reply
  45. Name*Vivian

    I held my daughter as she lay dying from severe heart failure. She was able to smile, hold my hand and give me some time to " let her go" – I believe it was a two way street for us. She was able to step over peacefully into the next "dimension" and she comforted me on her way there. Those " bittersweet" moments help me make it through the hard times. Dr M really did that wife and husband a disservice – that is what happens when doctors become so smug in there positions that they "steal" final "healing" moments from their dying patients and there families.

    July 6, 2011 at 19:12 | Report abuse | Reply
  46. Maryland

    There is no easy answer to this question, and each person and each situation is unique. I think that doctors should always be honest with patients and family members, but they should remember that hope is extremely powerful and should be encouraged whenever possible.

    All of us: Doctors, patients, and family members, must do what we think is right, to the best of our ability, based on the information we have at that moment. In this scenario, it sounds like the burn patient only had moments to live, no matter what the doctors, family members, or anyone did. There was very little time to assess the situation, ask questions, and weigh the options, and perhaps, if there had been more time, the decision would have been different.

    As the old saying goes, "Hind-sight is 20/20." We have all been faced with making decisions which we thought were right at the time. Sometimes, the "right thing" doesn't end up being so right, or it may be the right thing for you, but not for somebody else. We all have to do our best and accept that sometimes, despite our best efforts, things happen.

    Everyone has their own way of dealing with traumatic situations and with grief, and no one way is necessarily better than another. Based on my experiences of losing my father suddenly, my grandmother and grandfather after brief illnesses, and several dear friends after long battles with cancer, there seems to always be a "What if?" stage: What if I had done something differently?...What if they had seen a different doctor?...What if I had had more time to say good bye? This is a an understandable and natural response. Blame is also understandable, and while it may be of some temporary comfort, not very many lasting and positive things come from it.

    For myself, I found that my healing truly began when I was able to let go of the What Ifs and start focusing on the acceptance of the situation. "Someone I loved a great deal has died. I hope I both said and demonstrated that I loved them every chance I could. I hope we had one final chance to say I love you and good bye, but I accept that it may not have been possible. If they were in pain, I pray that they did not have to endure it for long, and I am thankful that their pain is over now. My loved one will live on in my memory, and I will do my best to focus on the good and happy times. Now let me try to live my life in honor and tribute to the loved one I have lost, building on everything I have learned from them. Let me also remember to love and support others who share in this loss, and together let us help each other in the days to come."

    July 6, 2011 at 19:28 | Report abuse | Reply
  47. TopDogMan

    So is this article shilling to be news?

    July 6, 2011 at 19:55 | Report abuse | Reply
  48. anonymouse

    Most people in these situations are a lot tougher than you'd think.

    I think if you polled everyone who was able to spend time with a loved one before they passed, 99% would say they'd do it again, rather than not.

    July 6, 2011 at 20:14 | Report abuse | Reply
  49. Mytwocents

    My heart goes out to the doctor's that have to make decisions like this. I would like to take this time to thank you all for devoting your lives to caring for people. The fact that this decision haunts this doctor to this day shows me he is a caring man and that's what kind of doctor I would want in this situation. If I were the patient I would want to be asked if I would like to see my family because most likely I would be afraid and needed comfort, But I am not a doctor and have no idea what they go through each day. please do not let mistakes haunt you, and go with you instinct next time. No one is perfect. 

    July 6, 2011 at 20:33 | Report abuse | Reply
  50. cindy

    March 2009 my mother was dying,hooked up to life support that she always said she didnt want,my father who was 82 at the time was hopeful that she would regain the strength to pull through.Dad became hopeful because the doctor gave him that hope.I had spoke to the Dr. and asked if I needed to prepare myself for her impending death,Without hesitation he calmly stated yes,but giving us the option to keep her on support for an indefinate time weeks possibly. When I looked at my mother lying there I took my family aside and made the decision to take her off support. My mom lasted 2 hours,What she went through in those 2 hours still haunts me today.Visions like it was yesterday.as we stayed by her side to the end speaking to her,touching her and promising her I somehow think our words did comfort her. I bear my cross of being there and watching,but I don't think I could live with myself if I was not there.

    July 6, 2011 at 20:46 | Report abuse | Reply
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