Researchers report that 63% of physicians experienced burnout in 2021. It’s important to understand that burnout is different from mental illness. There are a couple of symptoms of burnout. Consequences of job burnout include excessive stress, fatigue, insomnia., sadness, alcohol or substance misuse, heart disease, high blood pressure, or type 2 diabetes. I am unsure if I have burnout. I believe I do, but I have not received an official clinical diagnosis. Of course, many factors contribute to burnout, including the stress of treating COVID-19 patients for more than two years. Unfortunately, none of the burnout’s other symptoms are valid outside of exhaustion and sadness.
My former boss stated I should take advantage of medical leave (if required). I have not thought about it too much, but should one? Does the company have an obligation to accommodate my inability to perform the job? If so, for how long? Given that I am saddled with a terminal disease, what is honorable and not? However, taking advantage of such leave means stepping outside my comfort zone to have that required conversation.
While I cannot confirm, I understand Kanako worked right until the week before her death. I have no clue how she did it. Dying from pancreatic cancer is not the ‘in thing’ one should desire. There’s no romantic version of pancreatic cancer. There’s intense back pain, anemia, fatigue, weight loss, and other symptoms. And although I am not dying from pancreatic cancer, I have lost 36 pounds since October 4th, am tired, and wish (in many ways) many days for all this to end. So, I hope to talk to someone about dying (about wanting it to end) is a damn meaningful conversation.
Determining how often patients want the dying process to be sped up is a complicated undertaking, as the experience of being terminally ill differs for each patient. On the one hand, there is the patient who passively welcomes death. On the other end is that one patient who is actively suicidal. During a recent ChatGPT test, I entered a question or thought, “When a terminal patient wants to die.’ ChatGPT returned, “Please contact the national suicide hotline.”
I did not want to commit suicide. I wanted to express my thoughts and search for an opinion. Instead, I received a suicide hotline referral. To some extent, I have not lost a life of dignity. Although some days have been a battle against pain, I am not in a constant state of intolerable pain. And as of now, there has been no loss of autonomy. Many years ago, a study highlighted that approximately 16% of patients with long-term illnesses wanted to die, but only 2% were actively suicidal. I would be in the latter, at least at this point. However, just because I wish this would end does not mean I am actively suicidal. My motivation is fatigue.
I am tired of fighting. And now, knowing I am a living — but terminal — patient whose thoughts of choosing a nonviolent death should be important for my care team to hear. However, doctors generally do not prescribe and advocate for medical aid in dying as an option. “Aiding in death” at the end of life, which could ease suffering once someone has a terminal diagnosis, is not something most clinicians consider. Interestingly, most patients who request aid-in-dying medication never use it.
Fewer than 1 in 20 end up ingesting the aid-in-dying prescription. However, the option to talk about it is essential. My bedside conversations with terminal patients revealed that the dying experience was significantly improved by enabling patients to discuss their desire, even if not chosen. Even though the final step of aiding death is not selected, most patients are profoundly relieved by the simple fact that such aid is available. And that conversation empowers them to prepare both themselves and their families.
It is a neophyte’s mistake to think that ‘death discussions’ should always be sad. On the contrary, such discussions can be invigorating as we focus on our patient’s stories and professional lives. This conversation led to tears, laughter, and an immediate bond as we hugged, providing just the right amount of comfort.
As clinicians, it’s our duty to listen to our patients. Although I am not a physician, a physician cannot determine what constitutes suffering for their patients. Nevertheless, the Hippocratic Oath demands we listen carefully to our patients and reframe from judgment. When born, our parents carried us through the hospital’s front door. So likewise, we should be escorted out at the time of death, not snuck out the back in shame among the dumpsters and employees on their smoke break.
In the end, talking about our death means talking about life. It’s about living life right up until the end.