The Death of Donald
(Doctor, Heal Yourself)
Harvey W. Austin, MD
Donald Fletcher, age 45, died in the ICU of Alexandria Hospital. He was Dr. Harvey Austin's son-in-law. A week later Dr. Austin wrote a letter to its Ethics Committee objecting that Donald's wife, Mindy, was sidelined during the period of his dying.
This letter was circulated to the Ethics Committees of all the hospitals in the Inova Hospital System. Six months later, Dr. Austin was invited to give the Introductory Address to the first session of a six session evening course entitled: Caring for Patients at the End of Life.
The Course was given on October 14, 2003 under the direction Dr. McCormally and Ms. Patti O'Donnell, Director, Center for Ethics, Inova Health System. There were 20-25 Doctors present, including Dr. Tom McCabe, Chairman of the Ethics Committee of Fairfax Hospital.
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Dr. Austin began by reading his letter.
The Death of Donald
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"Yes, I knew that Donald had died. I was out of town for the weekend" Dr. C______ told me Monday afternoon, some thirty hours after Donald's death in the ICU of A________ Hospital on Sunday at 4:30 in the morning.
I thanked him for taking care of Donald and, after getting his opinion that he felt the requested-but-not-performed autopsy would not be useful, I asked him to thank the other physicians for me. But I also asked him to give them a message.
I told him to tell them this: "My daughter, Mindy , told me that no physician had spoken with her, his wife, for the last few days of Donald's life. Mindy was practically camped in the ICU waiting room during this time and she left repeated messages with the nursing staff that she wanted a doctor to talk with her about Donald's course. None did."
He seemed mildly surprised. "Well, I talked to her on Thursday" he responded quietly. I didn't comment that Donald didn't die for another 2_ days.
I told him that I had no questions about the medical care he received for his serious condition, because I was not in a place to evaluate it. But it appeared that Donald's care was limited to Donald as an individual rather than Donald as a person with a relationship and as part of a family.
I told him I had seen this before. As a physician myself, I understand that physicians treat patients and illnesses and, particularly in severe illnesses, tend to ignore the human being as part of a larger whole. I told him that I had seen this occur at its strongest at its worst in the intensive care units of hospitals. I felt it was unconscionable to ignore the family at one of its most difficult experiences of life.
I wish I had expressed my belief that severe illness not only wounds an individual, but it wounds the relationship and the family as well. This wounding of the relationship and family is somehow thought to be outside the realm of the physician.
To put it plainly, my daughter Mindy lost something of enormous value in her life, her hero, her husband, her finest gift as Donald, her 45 year old husband, died in spite of apparently skilled medical care.
Yet, she, deeply wounded also, was sidelined and ignored. She, kept in ignorance by those to whom she had entrusted the life of her husband, his physicians, was given no care at all. I do not believe that this was deliberate, rather I believe that it was inadvertent. This is the issue: ignoring the spouse and family, other than an in-passing lip service, is simply the way it is. I do not believe this should be so.
I assume that these physicians gave their medical best and I imagine they are chagrined over their inability to have kept Donald alive. Neither I nor Mindy know either of these to be true because little was told about the first and nothing confided about the latter. So I must assume.
Yet I doubt that they are chagrined at their utter lack of compassion and their inhumanity toward Mindy. Rather, I suspect that they are simply unaware of it. I wonder if they knew her name, never mind her terrible angst as she faced the possible loss of her hopes and dreams of a future with the man she adored. I suspect that, to them, she was someone vaguely peripheral to what they considered their real issue, making Donald well, or, if not that, keeping him alive.
To me, this incident poignantly demonstrates the tragic failure of a medical system that has lost its humanity as it has gained dialysis machines, ventilators and other technologic advances. How ironic that one of these technologic advances, the "newest and brightest" drug, Bextra, seems to have caused Donald's demise.
I do not accuse the individual physicians. They may be guilty but they are not at fault. I accuse, rather, our system of medicine, world-historically the only system of medicine to have no recourse to the deity, for inadvertently training their humanity out of them.
Then Dr. Austin asked "I understand that some of you have had similar experiences. Are any of you in the room?"
About one fourth of the doctors raised their hands.
What I will say now is not for all of you. It is for a few of you. For there are but a few of you in this room who will be able to hear what I will say
How many in this room consider that you practice some form of holistic medicine? Treat the whole patient? Or at least attempt to?
About one third raised their hands.
Thank you. I am going to speak about the very water we live in as physicians: If the fish is asked, "How's the water?" He can only reply, "Water? What water?"
There is something wrong with our water
something tragically wrong.
A story will point at it. A close friend attended the orientation of a nursing class at the University of Virginia. She heard the speaker say, "The difference between doctors and nurses is simple. It is a single letter of the alphabet. Doctors Cure. Nurses Care."
While this may be simplistic it points at the problem. We are addicted to curing but unable to do so. And we relegate caring to nurses.
In our hearts, we know that we do not cure. Nature does. The closest we can come to it is to set the stage for the internal healing mechanism to take place. And we are very good at that.
I have been in medicine some 42 years. I have loved it. But there is something wrong with the system that trained me. I was a very young man , 21 years old when I entered medical school, like most of you. I was trained well, I was bright and I was successful. I was the typical product of our medical system. But I did not know how to truly give Care. With a capital C.
I left medicine at the age of 38, burned out. I was not an alcoholic, not a drug addict. But just as bad, I was disillusioned, exhausted and angry. There is an old adage, "Doctor, heal yourself." I set out to do just exactly that, first to know myself and then to begin healing myself.
I returned to medicine two years later, enough healed to begin my medical life again. That was 27 years ago. Since then I have continued to be a student of myself and of humanity. And
I wish to share a few things I have learned.
I have learned that a whole person, like a whole society is a balance between the four quadrants of human existence
the physical, the mental, the emotional and the spiritual.
What a Whole society and its whole individuals looks like
We live in an unbalanced society.
Our society is utterly overdeveloped mentally. And we, as physicians are extraordinary people
but only in the mental realm. I would like to ignore the physical realm and speak only of the emotional and spiritual realms. As a society and as a profession, we are in a state of arrested development both in the emotional and in the spiritual realms.
I suggest to us that our medical system provides utterly inadequate training to work with our patients in either the emotional or spiritual realms. And until we are grounded in these quadrants within ourselves, we can do literally nothing for our patients, who live in the same emotionally and spiritually bereft society we do.
This is not your fault and it is not mine. I am not accusing you. It is not our fault that we do not support the emotional or spiritual devastation of families. We are products of our society, of our training. After all, we do not know how to heal our own emotional or spiritual lacks. We have not been trained to do this.
You and I, as physicians, are in a bind. We live in an impossibility. And it is an impossibility that keeps us from sleeping, that causes us pain, that causes us to accuse ourselves of terrible things.
The bind is that no matter what we do, it is never enough.
And we think that the problem is within ourselves. . Here's how it goes. In my mind. In every doctor's mind. And in your mind:
Let me put my mind
And your mind
Dr. Austin then spoke with eyes closed:
"I don't know enough and I should. I am not smart enough and I should be. My patient died and I should have prevented it. I missed the diagnosis and I should not have.
What in hell is wrong with me. Maybe I shouldn't be in medicine. But I can't let them know. Maybe I should read more. I mustn't let my patients or anybody find out."
Dr. Austin opened his eyes: He asked, How many of you have this conversation going on?
Every single one of the doctors raised their hand a little as though trying to only let him see it and hiding it from the others. Dr. Austin asked them to raise it high. Every one did. Every table of physicians had every hand raised high.
Look around you. You thought you were the only one. Look around you. You are not alone. EVERY ONE of us has it. And it is a secret. But now it is a secret no longer.
The problem is NOT YOU. EACH ONE has this issue.
Why? I only figured this out a couple of years ago. And here's my best guess. See if you agree.
I have to tell it like a parable.
How Medicine Began
Once upon a time, after enough men and women were created, they gathered together in the Garden and they called their coming together Society.
And society spoke to itself. We need someone to take care of us when we get ill and during the time of our dying. We will call these people doctors. You will have to learn a lot and work very hard. We need volunteers.
But there were no volunteers. Life was too easy in their garden to work that hard. And besides, getting old and dying was what happened to other people.
So society sweetened the pot. It said, If you will perform this task, you will have the pleasure of giving to others of your best self.
Not only that, but we will give you much respect, we will call you by a revered name, we will give you the best food and the best shelter and you will have honors.
This time there were many volunteers.
"This is Good" Society said.
But then it whispered three little conditions. "In return, you must agree to know everything, you must cure all our illnesses, and you must keep us from dying. If you do not, you will label yourself as a failure."
Because these conditions were whispered, almost none of the volunteers heard them.
And so they all failed and suffered and accused themselves.
And it has been this way for each of us.
So, under these conditions, we are now taking a course on "Taking care of the patient at the end of life."
Well, then, I ask you
Who is really the patient?
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The Mental and Physical quadrants, where our training has been, are the realms of doing. The emotional and spiritual quadrants are in the realm of Being. These quadrants are the underpinnings of life yet have been ignored by our educational system
While we have emotions, we have no training in navigating them successfully. As a rule, we hold anger, sadness, frustration and fear in tight check because, if we don't we fear we will get utterly swept by them. Discovering the depth of our emotions, discovering their enormous impact on our lives, and learning how to navigate them these are the material of work in the emotional quadrant.
A few words about the spiritual quadrant. I am not talking about religion. I mean something that underlies religious beliefs. A few years ago I was astonished to read that the medical system of our present civilization, our Western Medicine, is the only one of some twenty medical systems over the course of written civilization that has no recourse to the deity. The only one.
Without a system with such a recourse, we can not
as a profession
help heal our patients in the spiritual quadrant. And as a profession, we can not treat our patients in the emotional realm if we have not done our own inner emotional work.
But we can get ourselves trained, in spite of our medical culture. But we will have to step outside the box to do so and train ourselves as individuals. We can do the personal work to know ourselves, then heal ourselves. There is little support for this work and it is difficult work. I have been at it for 27 years and still consider myself a student.
If you wish to do inner work, Find a teacher. There is a Buddhist expression, "When the pupil is ready, the teacher will come." To become a pupil means you will have to give up the arrogance, bred in by our system, that you are beyond being a pupil. This is the first step, which, unless taken, precludes the journey.
You could begin such a journey of personal work by taking certain courses. If you want to leave a huge amount of emotional baggage behind, take the Hoffman Quadrinity Process. It is a ten day residential course that is deeply healing. Take Life Spring. Go into Jungian Analysis. Take meditation courses, Go on a spiritual retreat, Go on a Vision Quest. Ask around. Your questions will draw the right people who have the answers. Ask your patients let them serve you.
How many of you have done any of this work
or something similar? Good. Then I have been speaking to you. I encourage you to continue.
Some of you might wish to begin.
If you wish to embark
upon a course of self-understanding, of self-healing, let me give you a single guide line.
Become a YES to what is in front of you. Only if you are open, will a teacher appear. It might be a wise patient, it may be a five year old child, it may be a book. It may be your mother. It does not matter.
Read books. Stand in front of a stack in Borders, close your eyes, put out your hand and it will go to the book you need. Trust. Open the book and point to a line. It will be the right line. You will need another way to read than the way you read in the mental sphere. These are not medical tomes.
You need a different mind-set. It will not work to ask your usual questions, "Is this accurate?" or "Do I agree?" Ask rather, "How does the truth of this sentence, this book, apply to my growth."
But watch out for books a little, They are all books about skiing. After reading a book, you still can't ski. To ski, you must go where the snow and skis are. To ski, you must ski.
The truth lies not in books, but in human interaction at its depth. There is ultimately no truth in books
They are but a sign post pointing toward the truth. Be careful not to worship the signpost.
And be careful about thinking. Thinking is not a sole pursuit. What we call thinking is ruminating, like a cow, the same thoughts over and over. True thinking occurs in conversation with another, a discourse where both actually listen to the other.
My phone number is  208-4919. If you want to call me, I will share more of what I have learned. My email is email@example.com. Feel free to use me.
Thank you for the opportunity to speak with you.
He left. He did not stay because he was emotionally drained. He went to his car, called his wife Ellen. And cried. He had given them all he had.
Harvey W. Austin, MD
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Harvey W. Austin, MD
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