Melody Redman: The need for compassion to the very end

‘HE passed away during the night…’

There was a moment of silence as my colleague and I leaned backwards, glimpsed each other’s eyes across the room, and shared a sad acknowledgement that our patient had died.

Mr Black had many problems with his health, and his death was somewhat expected by both the staff and the family. However, even as a doctor who experiences death frequently, I feel saddened by the news that a patient has passed away, and I can’t help but think of those left behind.

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For doctors, our approach to death is a delicate balance. There is some extent to which it must be normalised; it is a normal process and must be considered and prepared for with some of our patients. When deaths are expected we can plan to provide holistic care, encompassing more than just the treatment of physical symptoms.

But it is also important that we don’t become hardened to it. When it happens, it impacts everyone around it and causes a cascade of pain and problems for those left behind.

It is why it is so important for our patients that we remain compassionate and empathetic, and understand the astronomical effect that this ‘normal’ process has on those left behind. Particularly at this time of year, death reminds us of our own lost loved ones, reminds us to re-evaluate our priorities and reminds us to be grateful for the people we love in our lives.

Despite facing death frequently, like most people, doctors can find it difficult to talk about it. Understandably it can be very difficult for some patients and their families to come to terms with the thought that they are dying, and individuals respond to this news in different ways. At medical school we were taught about the importance of using clear terminology, so we don’t say ambiguous statements such as, “Last night, Mrs Jones moved on”, which could leave people thinking their relative was simply moved to another ward.

However, death is often a taboo and when you want to gently break the bad news to a patient’s family, it can be very hard to find the right words. Often there are no right words, but there is, at least, a clarity which can be offered.

To a doctor, death is sometimes thought of as our worst enemy; defeat. But when dying is inevitable, it is important that we provide a good death. A doctor’s job is not always to try to stop an inevitable death from happening.

Our primary role is to benefit patients and when treatment can no longer achieve this, it is right to avoid invasive and burdensome interventions that will not be successful and would cause further complications for the patient. There are still things we can do to continue holistic care, even when curative treatment is no longer possible, and either way, the decision is not taken lightly.

Please do not misinterpret me; a good death is not one that is induced, or even inappropriately attempted to be prevented, but is one in which compassionate care is active right up to the very moment of death. I agree with the view of the British Medical Association, which opposes all forms of assisted dying and supports high quality and comprehensive palliative care.

Death is a complex and emotive subject, making it incredibly important for doctors, nurses, patients and families, to talk about our thoughts surrounding dying, to allow grieving and to identify sources to help and comfort to us when we have to face such heart-breaking times.

Although doctors can often do things to repair mechanically broken hearts, we are unable to fix the broken-hearted. We can’t defeat death, but one lesson I will carry with me throughout my career is that we must continue to provide compassionate and effective care for patients and their families up to the very moment of their death.

On a personal note, I am reminded of the importance of showing our gratitude and patience to our friends and family, and making sure that despite how busy we may be, we share our time which is such a finite and priceless gift.

• Dr Melody Redman is a junior doctor at Scunthorpe General Hospital. Names have been changed to protect patient identities.