What is Failure? (Part 2): Discussing Death

The best example I can recall of a failure of the sort described in the first part of this series on failure came early in my medical career.

Physician Holding a Patient's HandI took care of a young couple, and the husband developed widely metastatic cancer and ultimately died. I saw his widow about a year later, and she was able to share with me that her biggest regret was that they decided to focus on “one more scan, one more round of treatment, one more whatever,” instead of on each other. They never took the time on discussing death.

They had planned a trip to Europe, but deferred it for the husband’s final round of treatment, which caused complications that ultimately led to his death. The widow was invited to travel with friends to Europe later, but she cannot bring herself to ever go and face her regrets.

I am not saying they should not have done the last round of chemotherapy, but they should have been able to have an honest discussion with their medical team, and especially with each other, about the risks, and their own life goals. They should have spent time discussing death. If they had, they may or may not have made the same decision. If they had been able to prioritize based on fact, she might not be left with the complicated grief she suffered.

Studies continue to show that good palliative care improves the quality of treatment and care, is what patients and families want, reduces the cost of health care, and in certain instances, may even extend life.

What if we had a pill that did all that? I can hardly wait to see the ads on TV.