Crozet Annals of Medicine: It’s Okay to Die

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Emergency physicians and nurses see how people die every day. The good ones learn from it. The great ones use that knowledge to help patients and families when death approaches.

I recently heard from one of my former residents. Dr Monica Williams-Murphy graduated from our Emergency Medicine residency program in 2004 and is in practice in Alabama. Monica has written a book and its title is a little startling for an ER doctor: It’s OK to Die. Not exactly what you want to hear from your doctor in the ER after your car crash perhaps. But as she notes in her book, only 10 percent of us will die suddenly and unexpectedly and for these patients an ER doctor’s role is clear: Do everything possible unless a Do Not Resuscitate order is in place. Having seen much of this sudden death, though, Monica has learned this from it. “Live and love as if every day is your last, or your mother’s last, or your child’s last. Leave no words unsaid, leave no plans unmade.” This would be rather a banal platitude were it not preceded in Monica’s book with seven case histories she has seen of sudden unexpected deaths.

The other 90 percent of us will die more slowly and actually rather predictably. It is Monica’s intention to change the way patients, families and physicians prepare for that death. Monica explains how she came to focus on this important topic. “I had the distinct privilege of working for about a year in an ER where the nursing home residents represented about 30 percent of our patient population. The sheer volume of the extremely aged and dying seemed to bring the topic of death into sharp focus for me. Sometimes half my critical care beds, or more, were filled with those aged or near the end of life. For the most part, I was being asked by their families to snatch them from the jaws of death. Did their families realize that we had come to the time where the jaws would now constantly remain open and any small physical insult or illness would put grandma squarely back onto the teeth? Generally no.”

Americans don’t do death well for the most part. Ninety percent of us want to die at home, yet only 20 percent of us do. Dying in a hospital from a terminal illness means very likely dying alone, after visiting hours are over. Seventy per cent of us have no advance directives, leaving stressed family members to attempt to make highly complex and emotional decisions at the worst possible times. In the face of such duress most opt for all interventions possible for our loved ones, many of them as futile as they are painful. There are multiple reasons for why we pursue care for our loved ones that we would not choose for ourselves and they are laid out well in the book. We no longer recognize when dying is inevitable and we have made no efforts at closure before the final crisis strikes. As Monica puts it in typically blunt ER doc fashion, “If you have not made peace with your brother who lives across the country, it is not going to happen while I am shocking your heart and performing chest compressions on you.”

Monica’s book sets down in great detail all aspects of the process of dying and offers key advice and insight for each step of the process. Her goal is to make death an opportunity for deep reflection, emotional closure, healing of old rifts, and a profound expression of reciprocal love. This is very hard to do comatose in an ICU.

If you have elderly or ill or nursing home bound family members, I recommend this book to you. It will help you understand the modern end-of-life experience and empower you to make choices that are meaningful to you. It can be found online at www.OKtoDie.com.

Do you know what else can be found online? Caskets! Cheap caskets. As I learned from the book, there is a federal law that requires funeral homes to use any casket that you have shipped to them and they cannot charge a handling fee if you don’t buy your casket from them. This can save you money when compared to funeral home prices. I went on Amazon.com and sure enough there is a wide selection of caskets from simple pine ($589.00-easy assembly in 15 minutes, one day shipping) to solid mahogany ($2,095, marked down from $6,285). Unlike many other products available used on Amazon, though, I could only find options for “Buy new.”

2 COMMENTS

  1. Thanks Dr. Reiser, and Dr. Williams-Murphy, for all of your wisdom. I’m eternally thankful for the good fortune to have landed at UVA for my residency training. EM Class of 2004!

  2. Dr. Reiser is a great mixture of “wise” and “smart” ( and not just because he likes my book!) Whether he remembers it or not, during training he encouraged me to pursue the expression of the humanistic aspects of doctoring. I am grateful for that counsel and for his kind words in this review. Thanks!

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