By Zita Xavier
Most of us have had the raw and devastating experience of The Diagnosis: the harsh news that Death is coming to claim our loved one. In an instant our lives are turned up-side-down. Our stress level blows the top off the meter. We may be frozen in shock or in the free fall of tumultuous emotions which challenge our mental and physical health and make it impossible to carry on with daily life.
The human being on the other side of the desk, the doctor--the one tasked with delivering the horrible news--is also suffering. Besides not having had much if any training in end of life conversations, the average doctor is scheduled to see the next patient in less than 15 minutes.
“We are supposed to see more patients in less time and provide much more documentation. We work daily with human tragedy, illness, death, and loss. Many of us don’t take time off or debrief after adverse events or patient deaths. Instead, we move on to the next patient. It’s no wonder that more than half of physicians report being burned out,” said Joan M. Anzia, MD.
Burnout is characterized by exhaustion, cynicism, and reduced effectiveness—unhappy, stressed out doctors.
Physician burnout has been shown to negatively influence quality of care, patient safety, and patient satisfaction. The pressure on physicians is so overwhelming that “…89% of respondents to a 2015 Cejka Search survey (were) wanting to change jobs, cut back, or leave medicine.”
Add to all this the background truth that we live in a culture which is largely in denial of death. Many doctors are trained to hold themselves to unrealistic standards of perfection, and may feel that losing a patient is a blatant failure on their part. So in that fifteen minute consult, they may prescribe harsh and expensive treatments which have the barest thread of hope to extend life. This may give the inner satisfaction of knowing; ‘we did all we could do.’ But more often than not, these processes lead to more pain and suffering and the patients’ loss of precious conscious time with family and friends.
But the culture is slowly shifting thanks to the decades of work by Hospice providers and pioneers in the professional Death Doula field like Tarron Estes, founder of the Conscious Dying Institute.
In the CDI end-of-life trainings, doctors have the opportunity for a retreat from their case loads, and time and space for deep self-examination, sharing and processing their feelings and experiences of dealing with patients and families who are facing death. Doctors can turn their gaze inwards for a change and reawaken and recommit to their own needs for self care and nurturance. The communication skills doctors practice in these trainings can give them new confidence in dealing with this most challenging part of their job.
Dr. Aditi Sethi-Brown, MD, a board certified family physician in Asheville, North Carolina, said this about her experience with the CDI training.
“The CDI Sacred Passage Doula Training has enhanced my practice as a Hospice physician by providing me with powerful, effective tools to serve the individuals and their families whom I have the privilege of caring for. The training offers a contemplative, holistic approach to caring for the dying and to caring for myself. The exercises that involve contemplating my own death and mortality, the reflective exercises examining my own relationship with death and the focus and emphasis on spirit have rejuvenated me and have given me a renewed sense of purpose in the work that I do.
Also, honoring death as a sacred part of life and not a failure of the medical system shifts my perspective and reminds me of the sanctity of this experience. If I can bring a glimpse of the mystery and sanctity of the dying experience to my encounters with individuals and their family members, I feel a deep sense of purpose which minimizes the likelihood of burnout.”
Focused on changing the culture from the impersonal, over-medicalized manner in which too many people die, these trainings help doctors increase their awareness of patients’ true end of life desires, beliefs and wishes and to help them have a kinder and gentler death.
By restoring Death to its sacred place as part of the natural process of a human life, doctors too, can experience relief from their own stress and suffering as their patients travel through the last days of their lives and through the mysterious portal that is Death.