Two prominent newsmen bared their souls and their stories of a loved one near death from a devastating illness. British broadcaster Ray Gosling divulged a hospital visit years ago. Responding to the intolerable pain of his lover, near death, Gosling said he "picked up the pillow and smothered him until he was dead." Wednesday, MSNBC's Keith Olbermann shared the story of the crisis that led his father to ask Keith for any relief, even death. Olbermann had the presence of mind to approach a physician, and request the sedative that relieved his father's pain and panic.
I have no desire to contrast the acts of these two men. Their stories touch us deeply, but we stand in no position to second-guess their actions in a desperate situation. But we have much to learn from their stories because there is every chance that each one of us will find ourselves in a similar room, pleading for relief, or standing by the bedside searching for the best response.
Gosling told his story briefly as the camera followed his walk through a graveyard. His partner was suffering from AIDS. "In a hospital one hot afternoon, the doctor said 'There's nothing we can do,' and he was in terrible, terrible pain."
Western medicine is a remarkable profession and I practiced as a physician assistant for over twenty years. Its culture rests on diagnosis and treatment. When people's bodies go wrong, we find the cause and fix it. But the third, indispensable thread in the culture is caring, and relief of suffering. When their inability to find a cure frustrates physicians and they forget to care, their patients and those close to their patients feel abandoned, which can be harder to bear than death itself.
Too many terminally ill patients suffer with under-treated pain. Too many feel abandoned because their physicians forget about their duty to relieve suffering and conflate "incurable illness" with "hopeless situation." And too many loved ones resort to extreme, violent and desperate acts when support is lacking and legal options seem inadequate. Instead of counting on a family member to pick up a pillow, patients should be able to talk with their doctors about a range of legal, safe, peaceful options for easing a painful dying process. Suffering, from the patient's perspective, should be as much the doctor's concern as machines and lab results.
Olbermann spoke at length about the long fight his father waged against a series of infections and complications. "Pneumonia, three or four times -- I've lost count. Kidney failure, liver failure . . ." Five nights before his broadcast, Olbermann found his father thrashing in his bed, repeatedly mouthing, "Help," "Stop this" and eventually, "Kill me."
When I went to see the Surgical Intensive Care Unit resident I told him my Dad had hit his wall. That he couldn't take any other work, that it was now terrifying torture, that he needed it to stop. But I said, look, I'm his health proxy, we've had conversations about end-of-life care -- we've had them in here, we've had them when he was home and well, I'm not operating in the dark here. I said I think he really wants the one word he keeps mouthing: He wants help. Is there any medical reason not to give him some sedation, a little mental vacation from being a patient?
The sedation worked. Olbermann reports his father remains comfortable and breathing well, but has not awakened.
He's not being sedated anymore; he only has the strength to fight off the infections, or wake up -- not both. We're hoping he does the first, then the latter. We're prepared for the probability that he will do neither. His team and I had another "life panel" discussion not six hours ago. And thank God I had those conversations with my father.
At this writing we still hope for his recovery. If he does not, we wish his family peace, and a measure of consolation in the small triumph, that when Dad was speechless yet crying for help, they were able to ease his pain.
Too many suffer needlessly. Too many endure unrelenting pain. Too many turn to violent means. We can, we must, do better.