In At Death’s Door, I have described what it’s really like to be an end-of-life care doctor. This is very different than the image presented in the films and on TV. I was reminded of this in seeing the latest TV series on doctors – among them Heartbeat, about a heart transplant surgeon, The Night Shift, about a doctor who works at night, Mercy, about a nurse back from military stint in Iraq, and Nurse Jackie, about a pill popping nurse.
In these shows, for dramatic effect, doctors often have a major character flaw that contributes to tension, although in reality, doctors present themselves as stoic to others they work with and their patients, and they are hard-working. Normally, too, in these shows, no end-of-life care doctor or hospitalist deals with dying patients and their families. Instead, the lead actor, whatever his or her specialty as a doctor, deals with the dying patient. And usually he or she comforts the family members and informs them of the patient’s status or death.
But there is no extended discussion with the family members about their concerns, and there is never – as far as I can tell – any discussion about how to handle the patient’s treatment. Rather, when death approaches, the scene generally shows the doctors doing all they can to keep the patient alive. When they engage in these heroics, there is little or no consideration about whether the patient wishes to be resuscitated or not. Instead, the usual practice is to keep reviving the patient until the bitter end – and usually it is a bitter end, because the patient keeps suffering and is often in a worse condition due to the resuscitation attempts, only to die a few hours or days later after experiencing unnecessary pain.
Another common scenario is where the patient is rushed on a gurney into the hospital or from a private or semi-private room to the operating theater, where there is a dramatic struggle to save the patient’s life. Then, the patient often dies on the table, because he or she is too far gone to save. Or we learn that the patient is going to make it, when the doctor tells the worried family that this is the case. After that, the next scene is usually of a family member by the patient’s side, until he or she wakes up from the operation or when the patient visits with his or her family members. But these films generally don’t show what the end-of-life doctor does before or after the operation in working with the patient, family members, nurses, and others in the hospital to ease things for all parties whatever the outcome.
Finally, another common myth perpetrated by these films and TV dramas is that the doctor is a kind of greater than life healer, who is able to save patients. In reality, though, a patient is more likely to be dying, so the doctor cannot offer a cure, but can at best reduce his or her suffering and pain at the end. But somehow, where a patient might normally die, the doctor is often able to do the miraculous, much like lead actors who play cops in the TV series almost always get their man or woman at the end to solve the case.
One of the reasons I wrote At Death’s Door is to help present a realistic picture of what end-of-life doctors really do on a day to day basis and counter these mythical creations of doctors who deal with the dying in Hollywood films and TV series.
Dr. Sebastian Sepulveda has had nearly 30 years’ experience as a doctor and professor of medicine, working with patients in a community hospital and personally caring for them, many times as the sole provider of end-of-life care. Since 2005, he has been in private practice, dealing with private outpatients and with inpatients in hospitals, especially with those who have what appears to be a terminal condition. His book At Death’s Door and Death’s Door TV series pilot based on his work will be released in 2017. His website is at www.atdeathsdoorbookandfilm.com.