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 (405 Responses)
  1. nyvanc

    I would want to say goodbye no matter how much pain I was in. The doctor should ask the patient is able and not make assumptions. I am going die anyway and won't feel it ever again.

    July 6, 2011 at 21:05 | Report abuse | Reply
  2. Melissa

    I would have let them say goodbye while he was in pain, personally.

    July 6, 2011 at 21:12 | Report abuse | Reply
    • Laura

      Everybody here is talking about the false hope or goodbye of the loved one who will live.

      Have any of you thought how it might bother or help the patient who is dying?

      July 6, 2011 at 23:11 | Report abuse |
    • gpgpgp

      I would have hoped to have already discussed my wishes and the wishes of my loved ones before I were in a situation where that would not be possible. It may not be a common topic of discussion, but people do have these types of discussions.

      July 7, 2011 at 10:54 | Report abuse |
    • Blanche

      look her up and explain what happened and your experience at that moment and ask her what she would have liked done. I feel like it's the last goodbye when I visit some of my older relatives, it can be very difficult.

      July 7, 2011 at 14:04 | Report abuse |
  3. Sailor

    My husband died 3 months ago. The EMTs would not let me ride the 35 miles to the hospital with him. The hospital wouldn't let me into the ER until I filled out a massive pile of forms. Finally I put down my pen & told the clerk "Stop stealing time from me!" When I was finally able to see him it was too late. I had known he would not survive, but that there was a possibility he could still hear my voice. I closed his eyes & talked to him anyway, knowing he was past hearing by then. The staff did not have the decency to leave me alone with my husband; someone was with us all of the time, rattling instruments & making notes. It was a horrible thing to lose my husband, but it was made much worse by the lack of compassion demonstrated by the medical profession. I believe I have the right to plan my own death, & it certainly will not be in a hospital.

    July 6, 2011 at 21:20 | Report abuse | Reply
    • Dawn

      it happen to me too with a friend. She was asking for me and the doctors and nurses got in the way. She was dying they knew it she knew it and then they got in the way and i never knew if she knew i was there. then i got thrown out for swearing at the nurse about it after she died.I hate medicine and its GOD complex

      July 6, 2011 at 22:06 | Report abuse |
    • J

      Medicine has a long way to go with end-of-life decision making – and exactly who get s to make those calls.
      My heart goes out to all these stories of painful loss – and not having it happen in a more decent manner... may you be able to forgive *them* their conceited mistakes.

      July 7, 2011 at 03:13 | Report abuse |

      although you might not have the choice you realize...have a sudden loss of consciousness and someone may make the choice for you. try to picture yourself working in a trauma center and imagine how you would function in those hard situations, with demands on you...we all picture what we want but that certainly doesn't give us assurance it will happen.
      my son ended up in the ED with massive brain damage, unlikely he heard me speak to him, but I take comfort that I did talk to him, try to comfort him, and then I guided his last decision: to give his organs so others may live better, and kissed his forehead...at least I was there, and I had him for 25 years...live fully. regret nothing. believe in giving back, and be grateful for all life gives you..

      July 8, 2011 at 01:53 | Report abuse |
    • wordh

      I lost my only child as the result of a motorcycle accident. I never had the chance to say good-bye. They would not even let me in the room with him after he was dead to say good-bye. I will grieve the lost of my son for the rest of my life.

      July 10, 2011 at 13:53 | Report abuse |
  4. L Comfort

    Never give false hope!!!! It is patronizing, at best.
    I have seen SO many DRs lie to Pts- give false hope– You're doing great Mz XYZ- sure, your PA pressure is 82/35, and your systemic B/P is 82/41, you can't freaking breathe-but! You are doing great!!!
    People need the truth. Even little kids need the truth. We are all going to die. That Sr Doc steered you wrong- but it seems you already know that.

    July 6, 2011 at 21:22 | Report abuse | Reply
  5. TeriAnne

    I would want to say goodbye. He may have wished to say goodbye. Even more I would want to be able to say I love you. I would hope he could hear me.

    July 6, 2011 at 21:35 | Report abuse | Reply
  6. Paulette

    Dr when will you allow the love of God to forgive you 
    Dr when will you let go of the guilt ?
    Did you know that our days are numbered ,we can't go over the time set by God to come to be with him .
    He alone gives life also he takes life .
    My prayer is that your understanding become wide open .
    God gave you a gift to use for others Your Hands to help and your heart to have caring feelings for those he sends your . In life we all makes mistakes and hurt each other ,not meaning to .Forgive your accusers as well as you to ask God to release your guilt and past hurt and failures .
    Paulette R

    July 6, 2011 at 21:38 | Report abuse | Reply
    • Mytwocents

      Well said 🙂

      July 7, 2011 at 17:56 | Report abuse |

      we are talking about medicine not sunday prayer

      July 8, 2011 at 02:05 | Report abuse |
    • Ellen

      How dare you spew your self-righteous drivel at those who are doing what your god will not, namely concerning themselves with human suffering.

      July 8, 2011 at 09:50 | Report abuse |
    • Marissa

      Ellen – It seems Paulette is concerned with the potential emotional suffering of doctors. Because they don't always know what to do. Or what is right. And sometimes a wrong choice – wither because they did or did not go "by the books" haunts them for years. I know this because my brother's doctors still feel guilt about not being able to save him from brain cancer. And they believe in the power or prayer. For them and their patients. Paulette isn't forcing you to believe in God, or forcing the doctors, or even forcing you to read her comment. Let's all try to appreciate the thankless job of reflecting on a situation wi love and positivity without getting overly insensitive. Sometimes, yes, I got very angry that God didn't stepnin, answer my prayers and his doctors' prayers and save my brother. But the. Again, God didn't pollute the Earth so badly that mercury exposure caused a massive collection of cells to proliferate in my brither's brain. So...maybe we need to be more concerned with human suffering and not blame him. Maybe we all could use some prayerful compassion?

      July 10, 2011 at 10:25 | Report abuse |
  7. Charlotte Gray

    My husband has severe heart issues and has undergone five major open heart surgeries. The surgeons and doctors have no idea how he is still alive. Me, our children, and other family members have said our good-byes to him on a few occasions and from my personal experience I can honestly say the times where he was awake and in severe agony were far more traumatic for all of us than the times he was on life support and knocked out so I think the doctors in this story did the wife a huge favor by not letting her last memory of her husband be of him awake and suffering the unimaginable.

    July 6, 2011 at 21:43 | Report abuse | Reply
    • Candace

      I agree! Seeing a loved one in severe pain is far worse than seeing them unconscious or sedated. I know from personal experience. And I would not WANT my loved one to be in pain just for my selfish reason of having them hear my voice through their pain.

      July 7, 2011 at 09:25 | Report abuse |
    • ally

      absolutely agree with you. I would not put my little kids through the "truth" and totally understand the MD's decision.

      July 9, 2011 at 00:59 | Report abuse |
    • Me

      What about the person whose life is ending? Wouldn't you, if you were in that situation, and were somewhat aware of what was going on, like to say goodbye too and be surrounded by those who love you? It's not just your family saying goodbye, it's you too. Obviously, this is situational.

      July 9, 2011 at 14:42 | Report abuse |
  8. Odessa

    Occasionally, doctor's prediction can be wrong, but such truth must be known. Everyone must be made ready for facing one's own eternity or that of loved one's. Believing in Jesus brings salvation. Death is not the worst thing that happens in this world.

    July 6, 2011 at 22:10 | Report abuse | Reply
    • Odessa

      By "such thing," I mean the absence of any hope of physical survival.

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

      You can keep your fairy tales. The rest of us will deal with reality.

      July 6, 2011 at 23:54 | Report abuse |
    • Marc

      Beter still – live a good life here on earth. Only cowards behave well only because of their fear of what happens after they depart this earth. Salvation comes from those who pass through life with you, and not despite them.

      July 7, 2011 at 09:48 | Report abuse |
    • Ellen

      What is it about articles like this one that bring out the self-righteous, self-deluded nutjobs? If you cannot live a moral life unless under the threat of hell from some god, then you really aren't a fully developed human being.

      July 8, 2011 at 09:53 | Report abuse |
    • SYDNEY

      To Ellen, it isn't about living a moral life because of the fear of hell. It's about living a life that resembles that of our (Christian) Savior's (Jesus Christ) life. I don't go around telling unbelievers that they are hell bound, persecuting them for their beliefs or calling them unkind names. I respect each individual's right to believe as they wish, I wait until the opportunity presents itself to lovingly and kindly explain my beliefs to them and allow them the choice to believe either way. Rather than name calling, perhaps you could express your views in a little less hostile way. God bless you all!

      July 9, 2011 at 04:38 | Report abuse |
  9. Huntington

    A family member was told his cancer was terminal, go home and say goodbye. He was given 6 weeks to live. Clearly the case illustrated above is a different scenario ... but my cousin is here today, 18 years later and very much alive. He has beaten those seemingly insurmountable odds. He has seen his family grow and mature and have children of their own. Since then, I've met others who have beaten the so-called odds – cancer patients, stroke patients, premature babies now grown up. Though I'm not a terribly religious person, I say it's up to God and each patient's ability to rebound or self-heal and not the doctors (or the family) says who lives and who dies. I personally would have let this patient suffer the pain; I say this based on my experience. When I was in what looked like unbearable pain, my mind blocked it out and I don't remember anything. In any case, if I were the doctor, I would have refrained from ventilating him to see if he that small miraculous percentage. A so-called terminal patient who lives to see his family grow. Intubating this patient was a covert form of euthanasia.

    July 6, 2011 at 22:12 | Report abuse | Reply
    • kirstyloo

      You missed the point of the intervention. The individual needed to be intubated to KEEP HIM ALIVE. The choice the doctor had was to intubate him before or after his wife met with him knowing that there was only a 15% chance that he would ever wake up.

      The question is how much pain should the patient endure to give him and his wife the opportunity to say good bye, whether he could say good bye, and if his wife would find comfort in it.

      July 7, 2011 at 14:14 | Report abuse |

      no, it is not a choice for medical professional. and I agree with this other responder..

      July 8, 2011 at 02:04 | Report abuse |
  10. Chicago Doc

    As a physician who sees a lot of dying patients and their families, it's always a source of amazement to see how opinions are formed by television, motivational speakers and preachers. All of them have little grounding in reality. Faith is a powerful force, but it's frequently misapplied and misunderstood by the ones who need it's support.
    The process of dying is not a struggle and doesn't have to be filled with suffering.
    Those that would let someone suffer because they would choose that for themselves need to be kept away from people. They'd force their choice onto someone else. That's a serious breach of ethics. At best, it's an unfortunate but genuine lack of knowledge and understanding how the world really works.

    July 6, 2011 at 22:35 | Report abuse | Reply
    • gussie1

      Thanks for your comment. The level of trauma and pain endured by this patient is suffering. For a family to have that trauma
      memorialized as their last memory is not kind.

      July 6, 2011 at 22:52 | Report abuse |
    • Stephen

      Well said, Doc. I hope to have a physician like you near me, when I take my last breath some day.

      July 6, 2011 at 23:38 | Report abuse |
  11. Russ

    The first responsibilty is to the patient. Supress the pain, be honest with the family. Dying is a process. Medicine can make this a more peaceful and compassioned response for the patient. If able, let the patient make peace with the family and their God.

    July 6, 2011 at 23:01 | Report abuse | Reply
  12. Bill Dee

    Don't give them hope if there isn't any. It'll just make things worse in the end, and add bitterness and anger to the surviving immediate family members in trying to deal with their grief. Instead, demand and protest if need be, for answers as to why more progress isn;t being made for CURES, (rather than managing the conditions) given the zillions that big pharma and the so-called non-profit medical research organizations receive each year.

    July 6, 2011 at 23:13 | Report abuse | Reply
    • Dying from kidney failure

      Dear Mr Bill Dee:
      Please let us know if your words are worth anything. You have the opportunity to save someone's life by donating organ and tissues NOW, while you are alive. I am in need of a kidney donor, as many others on the waiting list. This is a donation that can be made by you to provide LIFE to someone on that list.
      That's the best treatment (in my opinion) for kidney failure. I'm not even 40 yet. Are you ready to help cure me? (www.nationalkidneyregister.com)

      July 7, 2011 at 18:17 | Report abuse |
  13. Chicago Doc

    There's always hope....just depends what you are hoping for. Not everything is amenable to a cure. Lots of things you can't "fix". You need judgment and knowledge with plenty of experience to tell the difference. Medicine has come a long way but expectations have risen to the level that no one should die. How peculiar is that?

    July 6, 2011 at 23:22 | Report abuse | Reply
  14. Dee

    I second the opinion that the first concern should be what the patient wants ...but what if the patient is incoherent, manic, or not clear in thought?

    The first thing I thought when I read this article was....thank God there are doctors like Anthony Youn. It breaks my heart to read the comments here about people wanting to spend time with loved ones and heartless medical staff and bureaucratic B.S. getting in the way. May all of our last moments be with the ones we love.

    July 6, 2011 at 23:55 | Report abuse | Reply
  15. Don

    Dr. M did the right thing. What most of you fail to realize is that the family
    will always, ALWAYS remember the last time they saw their loved one.
    And you want that stark image to be of a proud man gasping for air and
    struggling to live? I saw my brother dead 40 years ago, and it still is a memory
    seared into my brain. Please people. Try to get this.

    July 7, 2011 at 01:15 | Report abuse | Reply
    • J

      But that was your response... I did not see my brother before he passed but it was my choice not to take away his last hope of getting better. For me, it was a last gift I could give him. It was very hard but it didn't make his passing easier or harder.
      The best thing to take away from this article is doctors don't even agree on what is the best choice – so, have that difficult, slightly morbid, conversation. A moment of rationality is the time to talk about such a decision.

      July 7, 2011 at 03:21 | Report abuse |
  16. Abdulyaqin

    To say bye to loveone while in pain may be more painful and even more complicated to handle for a woman. All thesame the opportunity to have seen him sleeping calm without pain rises hope of his survival. So lossing him afterall left one with the memory and satisfaction that he did not dei in pain.what Dr M did is moral but devoid of reality.

    July 7, 2011 at 02:03 | Report abuse | Reply
  17. arnold

    i speak with the memory of a similar situation when i say Dr M. did the right thing. there is nothing worse that seeing your loved one in pain. i lost my grandmother this january.we all knew it was her time and that she was about to die, but lord, it was a terrible death she got. picture this, a 98 year old crying out from morning to morning, day in day out of the pain.and being in uganda dint make things any better coz there is lack( i wanna call it lack despite the fact that morphine is provided by the gov't and its pocketed by the doctors)morphine. i try to forget, everyday, the sight of my beloved granny in that terrible pain. it would have been better to see her go sedated and pain free.

    July 7, 2011 at 02:12 | Report abuse | Reply
  18. john chiapella

    i would have allowed the relatives to speak to the patient. i placed my wife on a ventilator and my father on a ventilator. we did not get to say our good byes. i will never agree to a ventilator again until the last possibel moment. my daughters really wanted to tell their mother good bye and they were not able to do so. i regret my decision. i did not know any better at the time. in both instances, it was my understanding that the ventilator was going to be a temporary situation.

    July 7, 2011 at 03:32 | Report abuse | Reply
  19. Collins Onyebuchi

    I wouldnt want the last sight of a loved one to be him/her in grave pain and struggling for breath, it will haunt me forever. I prefer Dr M's position.

    July 7, 2011 at 03:47 | Report abuse | Reply
    • rh

      And it would haunt me forever to not have that chance to see my loved one one more time. The imagination is worse than the real thing.

      July 7, 2011 at 08:48 | Report abuse |
    • kirstyloo

      She did get to see him. She did get to say good-bye to him. He was still alive when she held his hand.

      I can't imagine the horrible pain he was in and his inabilty to breath. He most likely wouldn't have been able to say good bye, and I wouldn't want my husband to see my pain or to wait for pain relief.

      I many cases doctors expect intubation to be temporary...and I'm guessing it was in your case. In this case, the likelihood was less than 15%. I was intubated for 2 weeks after an emergency. If someone had waited to do it, I might not be here today. Signed, someone who was intubated, almost died, and thankfully recovered.

      July 7, 2011 at 14:24 | Report abuse |
  20. Chicago Doc

    The last moments of a loved one do not have to be in pain. Suffering can be controlled with medication without hastening death.
    The appropriate application of pain control is not euthanasia, but eases the patient's suffering as well as the family's distress.
    Sometimes controlling pain can't be achieved without sedation, but better sleepy than screaming. When patients are in severe distress they can't be expected to have a rational discussion of their wishes, so having someone do this for them would allow the dying and their families to have time together in peace.

    July 7, 2011 at 06:24 | Report abuse | Reply
  21. Name*jeffyount

    My God what a heart wrenching story.

    July 7, 2011 at 06:41 | Report abuse | Reply
  22. T

    Leave it up to the doctor to make the decision on a case by case basis. There does not seem to be one best decision that would apply.

    July 7, 2011 at 06:43 | Report abuse | Reply
  23. rh

    False hope vs. false doom. Why not err on the side of caution either way? If the person is probably going to die, make sure to let the family see them if they want to. If the person is probably going to survive (but might not), let the family see them too.

    The doctor who wrote this article appears to be an expert at predicting the future. Yeah it may be clear when you can't stabilize a patient and it is a matter of minutes, but any decent person (which apparently doesn't include the doctor who said not to bring in the family) would not "steal the chance" for a loved one to talk to their probably soon departing loved one.

    I have heard a lot of callous things from people when my mom was dying – "remember her how she was" "there is nothing they can do", both months before she died. Why do "professionals" have to take the choice away from the family? If you tell the family (adults anyway) "she is in pain but if you want to talk to her before she is sedated you can", what is the loss?

    This is NOT about giving hope, most people will have hope unless you repeatedly belabor the point "no one has ever survived more than 48 hours with this injury". How about "we don't know how this will turn out, it is not looking good but there is always hope" instead of "he'll die soon"? It is far worse to take away a family's rights than to let them see the truth for themselves. Having been very ill myself, I feel it is up to my husband to decide if he and my kids should see me in a very serious state, not the doctor who is playing percentages on whether I'll live or die.

    July 7, 2011 at 08:46 | Report abuse | Reply
  24. De'Own

    I will agree! with the fact of knowing how i fear any pain.. i would neverwant to see anyone suffer.I would want the best treatment for everyone. But not at the cost of knowing that a person may be suffering..i think a doctor should do the best thing for his or her patient!

    July 7, 2011 at 09:40 | Report abuse | Reply
  25. jon

    This is really a deep question with no straight answer. I was the last person in my family to see my mother alive the night before she passed away. I was there to tell her I loved her, and in the morning received the news that she was gone. My brother, who lives out of state, agonized over the fact that he hadn't seen her in months. But the way I see it, he was fortunate enough not to have seen her hooked up to oxygen tanks and clinging to life. It's an image that, no matter how I try, it's difficult to forget. I can understand the feeling of regret after not being able to say goodbye; letting your loved ones know how much they mean to you. But it's also a lasting image when you're with your loved one until the very end of their life.

    July 7, 2011 at 09:52 | Report abuse | Reply
  26. Arthur

    Prolonging someone's agony just for a concious goodbye to provide closure for the living is chilling. Let the living sort it out after the death has occurred.

    July 7, 2011 at 10:03 | Report abuse | Reply
  27. Carol

    A doctor's first priority must be the welfare of the patient. I would not want someone I love to suffer the unimaginable pain of burns on 90% of his body just so I could say my goodbyes. If he lived, I would be there by his side to give him all the love and support I possibly could. If he died, I believe he would already know how much I loved him and missed him, so those few words I may have uttered while he suffered needlessly at the end would have changed nothing. True love does not put itself first. Doctors playing God? Perhaps, but it's that confidence that gives them the courage to make the hard decisions and do a job most of us could never fathom.

    July 7, 2011 at 10:44 | Report abuse | Reply
  28. Meghan

    my mother died in march after a 6 week illness. we had hope until the last couple days. the last week she was sedated, and we decided to take her off the ventilator. we had a choice to wake her up first...tell her goodbye...but we decided that was selfish. it was SO hard for myself and my siblings, but she had made her decision clear, she didn't want to be kept alive by machines. we let them keep her sedated...and we all, 3 of us, plus spouses and grandchildren, stayed with her, touched her, spoke to her until it was over. she didn't wake up, we didn't get to hear her speak to us again. but we know she died in peace, without pain. so, i think maybe, even though some people would like to think they would want the chance...it may not be the best decision for the patient.

    July 7, 2011 at 10:46 | Report abuse | Reply
    • SYDNEY

      I agree with you. Too often we put our own selfish (while understandable) needs first. It's hard letting go and we would rather have it OUR way sometimes, but there comes a time when you have to stop looking at the situation from our own perspective, and consider the patients experience. Science has shown that the last sense to leave us in death is our hearing, so I like to believe that while they may not be moving, speaking, moaning, they can hear my words and feel my love. God bless!

      July 9, 2011 at 05:20 | Report abuse |
  29. Sick

    I don't think there is a right answer to this situation.

    July 7, 2011 at 11:25 | Report abuse | Reply
  30. mayela

    Wonderful. In agonizing pain AND terrified by goodbyes... Brilliant. Where is the logic of thinking that a family has the right to verbalize a farewell to a person in a process of agony? Where is this person's right to die in peace? Love is unselfish. Goodbyes in this case are foolish; only good for the ones who are not going through the physical pain. Consideration and compassion towards the one in dissadvantage is the logic rule to follow.

    July 7, 2011 at 11:34 | Report abuse | Reply
  31. JT

    I'd prefer truth to false hope.
    I think it's important for both the patients and their families to know what comes next.
    If I was on the death bed, the last thing I want is to be lied to... regardless of the intention.

    July 7, 2011 at 12:09 | Report abuse | Reply
  32. Mignon

    After going through complicated grief therapy for many years, not to be with someone you love or have a person that you've shared intimacy with, is grief and sadness that follows you the rest of your life. To not have this opportunity to tell they loved them, to thank them, to look them in the eyes and let them know this might be a mortal turning point with them, express an encouragement of their faith that may comfort them, or provide a blessing, is a longlasting, non-closure memory that will always stay with you.

    Hindsight of course, is so beneficial. To talk about these situations with one another before it could happen, such as in a medical directive, would somewhat help them, but to let that loved one what they'd like before it's unrecoverable is sadness unspeakable.

    I would like to have had the opportunity to tell my husband that I loved and have forgiven him, before he left and became homeless. He died alone behind a strip-mall back entrance to a bar. The difference was with my parents, several good and dear friends, when we knew our time was near, and we had spoken words of love and appreciation. Having a Christian belief, or other promising faith, assured me that I will positively see them with our Jesus, and to be with the Lord of Heaven and Earth.

    My 25-year old son and I have joyfully talked about this very subject, and although we would miss them if left behind, the comfort that we will see each other again in an eternity without tears, suffering, and no more sorrow.

    July 7, 2011 at 13:05 | Report abuse | Reply
  33. sanjosemike

    There is no perfect answer. The patient was experiencing total body burn, and the pain this causes is beyond human understanding. By sedating the patient to the point of uncosciousness, the doctors were alleviating this horrible pain.

    I don't know the answer. Nobody does.

    Maybe the real answer is to respect and love your loved ones while you still have a chance. This means saying "I love you" even after casual separations.


    July 7, 2011 at 13:07 | Report abuse | Reply
  34. Margene

    The patient should not have suffered a moment longer than necessary. That he was unconcious was humane. His wife should have been told directly that her husband had suffered mortal burns, been made comfortable for whatever time was left, and brought in to say good-by.

    July 7, 2011 at 14:42 | Report abuse | Reply
  35. Kathy

    This patient was conscious and could speak (though barely). It was his death and his decision – not the doctor's OR the family's. He should have been asked if he wanted his family to come in to say good bye before or after he was sedated

    July 7, 2011 at 16:59 | Report abuse | Reply
  36. Chicago Doc

    This patient's condition was horrible as described. There's only one answer: to provide relief. He is unable to have a discussion of preferences while suffering badly. TV dramas give a false impression about the end of life and unfortunately most folks I speak with get their opinions that way.
    Their ideas are rooted in fairy-land.
    The patient's decisions about his life and death should ideally be known before this kind of scene unfolds. Most of us don't have that discussion and avoid it if we can.
    The first duty is to the patient. Sometimes families can't separate their grief from the patient's suffering. They misread their faith and their duty to the patient and too many people are put through pointless treatment and needless pain.
    It's hard for medical personnel to see patients suffer because their families choose to remain blind to the facts.
    Too much suffering is increased when families feel they have to "do everything", not realizing that it won't help. They have been sold a bill of goods by motivational speakers and misguided preachers. sad but very true.

    July 7, 2011 at 23:42 | Report abuse | Reply
  37. Brenda

    The doctor did the right thing. Go visit a burn center, help with bandage changes and see the agony some of these patients go through. Family members are kicked out of the unit at that time because the wound care is so traumatic for the providers and the patients (who are given the max amount of pain medication that they can get). The family's presence wouldn't even bring a smidgen of comfort with the amount of pain a 90% burn would be. And I doubt very much seeing a beloved family member scream in agony would be a great last memory.

    July 9, 2011 at 18:16 | Report abuse | Reply
  38. Dianne Settani

    I worked in a major trauma unit for 25 years as a nurse...human behavior has never ceased to amaze me. This poem is what I want for myself after seeing it all....I wrote it after a particulary horrific day
    When I Die
    When I die, don’t let me die alone. Please hold my hand so I know you are still there.
    Let my last earthly vision be of someone I love.
    Please! Let that person also love me.
    When I die, I don’t want to be afraid.
    Where are you? Where am I?
    What is happening? Oh my God!
    Don’t let me be in pain, or struggling for breath.
    Let my dying be peaceful.
    Let my physical life slip away, if it must. But I don’t want to die alone.
    ………… another human being

    July 10, 2011 at 09:46 | Report abuse | Reply
  39. Marissa

    If a patient is able to communicate, they should always be asked for their wishes. In my opinion, asking someone: Your family is here, do you want to see them first? And, you're not looking good, do you want us to try and save you? should be standard procedure for all patients capable of thought and yes/no expression. It's hard to let go – for anyone. I watched my o.deer brother die from cancer at 22. I held his hand. Being there in the moment to say goodbye offered closure...but sometimes that image haunts me in a way that can be so damaging. Meanwhile a friend of mine lost her father to a heart attack...she was hours away....he was found alone, dead in a parking lot. There were no goodbyes. She hadn't seen him in over a month. She envies our goodbyes...but has no idea how hard it is to watch your loved one slowly suffer, fade away, and disappear before your eyes... It's an issue too complex for doctors NOT to let loved ones and patients (firstly patients, whenever possible) make these decisions.

    July 10, 2011 at 10:32 | Report abuse | Reply
  40. jill wong

    Our relationship with our loved ones is not defined by the final conversation. I would be forever haunted by the image of my husband writhing in pain. I lost my husband a month ago, when I got there he was on the ventilator and in a coma. I don't dwell on not getting there sooner to see him. Maybe it would have been horrible seeing him confused and failing (head injury). Even if our last words were not the best (luckily they were), he knew I loved him and I knew he loved me. We shared 20 years of marriage and six kids. Rest assured that whatever decision you made was the right one in the grand scheme of things.

    December 23, 2011 at 00:50 | Report abuse | Reply
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