WEBVTT

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I managed to get through most of medical
school, uh, at least the beginning

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of my internship very focused on, uh, what I
needed to know technically and what I was doing to

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the people I was taking care of.
And I, I, really had to be broken

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open by my patients to understand

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what was going on for them, that this
just wasn\'t my experi-, my job. This was

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their lives and often the
most important thing

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in their lives. The most critical
thing happening in their lives.

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[music]

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You tend, in medicine, to get so focused. Not just
on the technical aspects, but even those of us

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who, who try to a-, approach
this from an empathetic,

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compassionate, to a benign standing. We get
so focused on what we\'re doing and how we

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are understanding the situation that
I\'m not sure we always pay enough

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attention to what it means for the
person and that person\'s life.

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Um, and the only way you
can do that is listening.

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[music]

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He brings me a flower every day.
He rides his little mower across

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our border into the empty lot next door. People
have not lived in that house for two years.

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And he picks this, this off
the tree and brings me one.

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Remember I was talking
about no bees this year?

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The bees used to roll around in here
and just get so excited with these

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little stamens.

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Oh, look at the pollen.

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I feel sorry for the bees. I feel sorry
for us \'cause we don\'t have any bees.

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At times

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when our relationship is strained

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and I feel that your life is really being,

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uh, constricted, that\'s the
best word I can use, by my

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continuing presence I think very seriously

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that it\'s time to call it off. Not
just for you but for all the rest of

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the kids and so on. That,
um, you, or what I feel

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is that you at 77 are
full of bounce, full of

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energy, full of ideas about
doin\' everything and you

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could be leading a very lively
life if it weren\'t for me.

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That\'s a fact. Don\'t look
at me like that. It\'s a

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fact. And you smile at me and say
it isn\'t a fact, but it is a fact.

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And furthermore, I see that you

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recognize that at times when you\'re angry.
You tell me, \'Why don\'t you die.?

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Just like that. And I say, \'Well
you\'re right. Why don\'t I die?\"

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So I go through periods like...
When did I do that last?

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Oh, a couple of weeks ago. Do you remember
the circumstances? No I don\'t. And I don\'t

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wanna, it, it, had nothing to do with anything
going on. But it was some little thing that

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irrit-, made you angry. When you get angry
you say all sorts of terrible things to me.

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You do. You know that. Yeah, but you don\'t remember
the day or the circumstances. No, I don\'t.

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I, and it doesn\'t matter. Yes it does. Why? Oh,
go ahead you have the floor. I don\'t remember

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it either. Alright, well then what the hell\'s
the point? The point is that it wasn\'t any

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particular situation. It was you
getting angry about something that I-,

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I do lots of things that
make you angry. What?

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Talk too much, or swear.

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Oh yeah. When I\'m angry. Oh, now I\'m
remembering. It was in the back bathroom. And

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you were... I don\'t\' wanna hear all the details.
It doesn\'t matter. It makes me laugh. Alright,

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it isn\'t funny to me. You see, there\'s another thing.
You laugh like hell about things that I don\'t think are

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funny at all. It really doesn\'t
strike me funny. When you

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glare at me and say, \"Why don\'t
you die?\" You do. Just like

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that. You have more than once. And I\'m

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sympathetic. You\'re wondering why the hell don\'t
I get out of the way. I\'m very sympathetic

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to that. And that makes it for real.
It\'s not

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just laughable. Did you hear that?
Did you hear what this person

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is telling you? This isn\'t
just a rambling story.

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This isn\'t just somebody who\'s
whining about what\'s going on.

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Listen. This is what this person is tell-,
this is what you\'re listening to. It\'s not

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just \'When did the pain start, when
does it-,\" it\'s what does it mean?

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[music]

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[sil.]

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I never thought that I would
be at this point right now,

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right now. It\'s real
weird, uh, I hear my voice

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and I look in the mirror and
I see my face and it\'s not

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the usual me that I\'m used
to seeing or talking back.

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[sil.]

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It\'s real disturbing. And it\'s real strange

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because I\'ve seen it, um, a dozen times

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with

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a bunch of people. Just never
thought I\'d see it, uh,

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quite the way I\'m seeing it now.

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[sil.]

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Who knows. The high pressure would indicate blockage
somewhere wouldn\'t it? I know, but it didn\'t work

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on the, let\'s see what this one
does over here. This may be this.

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It\'s been also pretty
hectic on my mom and dad.

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Um, they may insist that
it\'s not a problem but

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for me it is. Because these are the
years that they should be doing

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things, enjoying their lives, you know?
And I feel very selfish

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and responsible for them
not doing just that. I

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certainly am emotionally wrung

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out sometimes because of how he is.
But Bob and I,

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and I continue to ask him
because it\'s his life. Um,

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I continue to say to him,
\'Well, do you think today is

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quality?\' he said, uh, a week and
a half, two weeks ago he said

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\'I am not ready for this. I am too
week I am not ready for this.\' I said,

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\'Well is it still quality?\' \'Well, yes.\' And I
said, \'Well then you\'re gonna have to be ready.

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If this is still quality then we still gotta
fight. You tell me when you\'re tired of fightin.\'

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We talked about that when he was
first sick. That we\'d just keep him

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while he had quality. And I\'m
gonna tell you somethin\',

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quality is just whatever you think
it is today. We didn\'t decide then

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what quality is. Because you don\'t
know until you get up if this is

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a quality day or not.

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[sil.]

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Going straight down.

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Where you goin\'? Where you goin\'? Son? Bob?

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Bob? Get me some help.

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Get me some help. Bob?

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Bob? He\'s seizing. He\'s
never seized before.

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Never. Could you get some
blow-by oxygen right now?

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Okay. You\'re situated.

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[sil.]

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You\'re alright (inaudible)

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Um,

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I\'m not sure, is there any way
to know if she\'s (inaudible)

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[sil.]

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You look kinda cute like that.
You scared the socks off of me.

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[sil.]

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Sorry. I know. Me too.

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I love you. I love you too. At least
you seized in my arms. How about that?

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[music] Some families need to believe their

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definition of \'everything
possible was done\'. Um, and

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you need to hear what their definition of that is. Not what
your own definit-, you may know that everything possible has

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already been done and there is nothing
more to be done in the line of medical

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care. There\'s never
nothing that can be done.

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[music]

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[sil.]

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She was in the intensive care unit

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then isolation, everybody wearing gowns and
the whole bit. And and this lovely, bright

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12 year-old girl was, of course miserable. She
was now blind, she had bled into her eyes,

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bald as a billiard ball. Could no longer
see that, fortunately, \'cause that had

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bothered her a great deal. Um, and day in and day
out her family was in the, the intensive care room

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with her, all gowned and masked,
isolated from her, as she was from

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them. And all she kept asking for was to be taken
out of the intensive care unit and put back in her

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room on the ward where she\'d been for the past 6 weeks
that was plastered with the cards from all her classmates

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and full of things from home. She knew that was
the closest she was ever gonna get to home again.

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And finally after her begging for
ages, my, I finally heard her.

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Finally heard that as a possibility, not just as a \'You can\'t do
this you have to be in the intensive care.\' You know, finally heard

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what she was saying and, and managed to work
it out so that she actually could go back to

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her room. Which, of course, and with her, her
parents and I were very explicit about this,

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that we knew what this meant. Um, this meant we
were moving her back to her room so she could

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die there. Because there wasn\'t really any
need for intensive care. We, with great

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fanfare rolled her back to
her room, um, and, and ended

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all the isolation techniques.
Um, she was so pleased

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to be back in her room and just, and fell into the best
sleep she had had, almost immediately, that she had been

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in for a week. Um, and we were all greatly

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relieved that this had happened. And I told her parents
that I wouldn\'t be surprised if, if she died in the next

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24 hours, now that we had let her do that.
And, uh, this was in the evening and

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I went home.

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[sil.] Several hours later, someone from the ward room
called me to tell me that she had indeed arrested.

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But that they had taken her back to
intensive care and were resuscitating

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her and had her on a ventilator.
And I thought \'oh my god.\'

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So I rushed down there and by the time
I got there she was, in fact, dead

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in the intensive care unit with an endotracheal tube
down her throat. And I went in to see her parents

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after I saw Mickey and one of the first
things her father told me, he said,

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\'You know, doctor Mohrmann, we asked them not to.
You know, we told them that we knew she was gonna

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go and that this was what she was doing, but they insisted.\' And
he said \'I sat there in that waiting room outside the intensive

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care unit just saying, \'Beat \'em, Mick.
Beat \'em.\' You know, and

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she did.

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[sil.] The best intentioned, most

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compassionate, most humane physicians who
have the strongest sense of wanting to

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do the right and the good, are too often serving
their own sense of the right and the good.

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They, those physicians who were on
that night, taking care of her,

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didn\'t take care of her. They took care of
themselves. They took care of their need to

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do the right thing by their definition.
They did their

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duty. And in doing so they robbed Mickey\'s

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parents of their right to be
there with her as she died.

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They took her death away from her family.

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Let me see if you can move that
hand anymore. Can you move

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it? Hold it up there. There you go. I told

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Dr. Gomez I thought you could
control it a little bit.

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Can you put it back, put it down. Let it come
down on your own. Don\'t, don\'t let it flop.

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Put it down by yourself. Come on. Lay
it down near yours-, come on. Come on.

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Well maybe you can get this workin\' again.

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Mmhmm. What do you need?

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Suction?

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She said she had another long suction tube.
We\'ll see what we

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gonna bring up. Can you give
me another cough? Come on.

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Come on.

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[sil.]

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Each time he comes in with something I\'m
optimistic that he\'s gonna get over that episode.

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But in the long run something\'s gonna take
him. And when, I\'m, I\'m worried sometimes

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that we\'re fooling ourselves. Because if I think
back to when I first saw him and then now

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he\'s clearly deteriorating.

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[sil.] Do you ever resent the

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condition Jesse\'s in? Yes. I do.
But it\'s no fault of his.

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Um, I resent the fact that,
uh, most of the, uh,

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retirement age is gonna be with him here.

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Where we could enjoy life together.
We can\'t.

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Do you feel like it\'s taking away from you?

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Away from him.

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\'Cause he worked hard as a young man.

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[sil.]

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And I don\'t think I have a little stick.
I\'m just gonna use my finger. (inaudible)

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Yeah, well that\'ll put a dent in you.
Jesse, are you feelin\' weak?

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No, he\'s got a good color in his face.

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To me, when he gets like
that, then (inaudible)

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bein\' that red. To me, I would fix

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the salve, though he might have a fever.

00:18:20.000 --> 00:18:24.999
Get the hip. That\'s, that\'s blood.

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I mean I can, I can tell you without
testing it. How does he, um.

00:18:30.000 --> 00:18:34.999
Bleeding, what are you gonna do with that?
Well, What do you think

00:18:35.000 --> 00:18:39.999
we oughta do? Well, I, I, I, think you
oughta just see if he needs blood,

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and if it\'s necessary give it to him.
That\'s one of the things I\'d do.

00:18:45.000 --> 00:18:49.999
To give him blood, you do, would
have to put him in the hospital.

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I would not take that responsibility. I
don\'t think I can handle that. \'Cause,

00:18:55.000 --> 00:18:59.999
if he went into shock, or something, that would really
upset me. No. He said no. You don\'t wanna go into

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the hospital. Well, Jesse, you wouldn\'t have
to stay in there just to get blood. Would he?

00:19:05.000 --> 00:19:09.999
We might be able to work something out of
the transfusion center, if you needed it.

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You know, the concern has been that anything we do to
try and investigate, he might not be able to tolerate

00:19:15.000 --> 00:19:19.999
very well. And then if we found something,
what would we do about it? How, how

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aggressive could we be? Do you understand
what we\'re talkin\' about Jesse? The,

00:19:25.000 --> 00:19:29.999
your stool looks like there\'s
blood in it. And, uh,

00:19:30.000 --> 00:19:34.999
that\'s one reason why you\'ve needed the
transfusing, and we haven\'t found the source of the

00:19:35.000 --> 00:19:39.999
bleeding yet, and the question is, what
other studies should we do to find out

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where the bleeding is coming from.
What do you think?

00:19:45.000 --> 00:19:49.999
Huh? You\'ve gotta have your blood,

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you-, you don\'t wanna die, do you? Huh?

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You don\'t care? Is that what you said?
I don\'t believe you

00:20:00.000 --> 00:20:04.999
[]said that. Hey. You know
you gonna have to have

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blood, honey. You know that, don\'t you? Hm?

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Jesse I want you to, Jesse, I
want you to think about it.

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Okay? I don\'t wanna do anything
that you don\'t want us to do. Um,

00:20:20.000 --> 00:20:24.999
but I don\'t

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know that we\'re gonna be able to stop you from
bleeding. I don\'t, I don\'t know that you\'re s-,

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I don\'t know that you\'re strong enough for us
to schedule a procedure, an operation to look

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for the source of your bleeding.

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[sil.]

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I think that one of the things that lurks in the back
of every physician\'s mind, taking care of a dying

00:20:50.000 --> 00:20:54.999
patient, is how much it hurts.
Um, at some level, um,

00:20:55.000 --> 00:20:59.999
either because, um, you become
attached to the patient and

00:21:00.000 --> 00:21:04.999
then they die, or because the
patient is seen as, uh, sort of an

00:21:05.000 --> 00:21:09.999
embodiment of your failure. Um, or
because just telling somebody that

00:21:10.000 --> 00:21:14.999
they\'re gonna die is so difficult. It\'s, it\'s sort
of broadened my understanding of what empathy

00:21:15.000 --> 00:21:19.999
might possibly mean. Um, that

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that no, I don\'t know how they feel.
No. You know, it\'s, um,

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I don\'t really understand in the
way that my patient understands,

00:21:30.000 --> 00:21:34.999
been living with the illness. But I
can hear and accept and remember

00:21:35.000 --> 00:21:39.999
what they tell me of their
understanding. And I can

00:21:40.000 --> 00:21:44.999
let that uh determine importantly, um,

00:21:45.000 --> 00:21:49.999
how I\'m then dealing with
them and with their illness.

00:21:50.000 --> 00:21:55.000
[music]