Blog: What Doctors Need to Learn About Death and Dying

The old man and the young woman sat across from one another stiffly perched on plastic chairs, staring down at the floor – doctor and patient. The tension in the room, exaggerated by the silence between them, was almost unbearable. Then the patient, stroking a trembling, emaciated hand across a hairless scalp, spoke haltingly, “Doctor, promise me I’m not going to die.”

According to a recent post in the New York Times by columnist Jane Brody, this type of interaction with a terminally ill patient creates occupational distress for many doctors who are not equipped emotionally to handle such a difficult situation. She states that doctors who are unable to cope with “their own feelings of frustration, failure and helplessness … may react with anger, abruptness and avoidance” toward their patients who are dying. When this occurs doctors may recommend futile treatments to patients at the end of life because they cannot connect with those patients on a human, suffering level and have nothing else to offer them.

The article touts mindfulness meditation, a practice recommended by palliative care specialist Dr. Michael Kearney, as a solution for discontent and disconnected doctors. I wholeheartedly agree that mindfulness meditation can be a very helpful practice for calming anxiety and learning to be present. However, I believe that this problem—doctors who find themselves unable to cope with perceived failure when a patient is dying—requires a deeper and more fundamental solution: doctors need a new understanding of death and therefore, life. 

These are the fundamental truths of death and dying that should be taught to every medical student from the first day of training:

1. Death is inevitable.

Every living thing on Earth will die. Death ultimately cannot be avoided or prevented, even though it can and should be forestalled when reasonably possible. The fact that every patient eventually dies creates a sense of hopelessness and futility for doctors if they pit themselves against death as an enemy—for that is a battle that can never be won. But those who recognize that the end of life is actually the final stage of human development can help their patients face their last days with dignity and make reasonable choices for their care and treatment.

2. Death is a mystery.

No matter how hard we try we simply cannot control or accurately predict when natural death will occur. In my hospice work I have seen many patients who lived far longer than expected, against all reasonable odds; and I have also seen patients who died much sooner than expected, from causes not related to their terminal illness. We have to accept this mysterious nature of death even while we work to circumvent it or prepare for its arrival.

3. Death makes life more precious.

When life is perceived against the dark backdrop of death, we can see how it shines and glistens for us, ever more precious because it is fleeting. This is the gift that our mortal nature provides us—an opportunity to cherish each moment simply for the fact that it will not last. 

4. Dying provides an opportunity for transformation.

In my work with hospice patients I have witnessed over and over the transformative power of love and forgiveness during the last days of life. When dying is respected as a natural part of life and time is allowed for the process to unfold, patients can turn their focus to matters of the heart and soul and find meaning in both life and death. But this does not happen when death is perceived as an enemy that must be resisted until the final breath is taken. Doctors can help their patients change focus by advising them with honesty when the time comes that pursuing further treatment is futile and will cause more harm than benefit.

 In my ideal world doctors would be educated in the wisdom of all aspects of health, including the decline of physical health that ends in death. Doctors would be the guides who help us make reasonable choices, who see beyond our fears, and who possess the compassion and tools to ease our suffering.  Doctors then would be the wisest members of our society, never deluded by the myth of immortality.

When a doctor such as this is asked by a patient, “How can I live, knowing I am going to die?’ the answer would be:

“You must turn your focus to those things that matter the most to you. Put your energy into living each and every moment fully rather than trying to escape death. Then when the time of your death arrives—and no one really knows when that time will be—you won’t feel bitter and deprived. You will be filled with the joy of a life of meaning—no matter how many years of life you have been given.”

Healing takes place, not when death is forestalled, but when life is embraced and affirmed in its entirety, from beginning to end. When doctors can fully understand the nature of death and dying they will become the true healers that are desperately needed in this world. 


What My Hospice Patients Want You to Know

The everyday wisdom of people just like you who are facing their own mortality.

As a hospice doctor I have had the privilege throughout my medical career of sitting at the bedsides of hundreds of patients. I have listened to their stories, answered their questions and shared their concerns as they faced the gradual decline that occurs at the end of life. 

But I also asked questions of my own as we sat together over those final days. Always a willing student, I viewed my patients as teachers who have explored unknown territory that I too will some day experience. Over and over again I have discovered gems of priceless wisdom in the words of the dying and have learned valuable lessons for living my own life. 

Many patients asked me to share this knowledge with the world since they are no longer here to tell their own stories. This request led to the book  7 Lessons for Living from the Dying, where I compiled those stories into a framework for living well before we die. That book contains profound spiritual wisdom but here is some of the simple everyday advice my patients also asked me to share:

“What seems important now doesn’t matter in the end.”

Many of my patients discovered at the very end of life that they didn’t care at all about the material possessions or wealth they had accumulated earlier in life. In fact they felt they had wasted time and energy trying to have more “things” in their lives and wished instead that they had focused on relationships and experiences, like travel and time in nature.

“Don’t worry so much about diet and exercise.”

Believing they would live longer and healthier lives, some of my patients had been very strict about eating the “right” foods and staying fit. But when they got sick anyway in their later years they felt they had cheated themselves out of some of life’s pleasures. “Exercise and eat to feel good” they recommended, but enjoy the foods you love and take plenty of time to relax, rest and have fun.

“Your doctor doesn’t have all the answers for you.”

During the early stages of illness many patients believed that modern medicine would cure them. They pursued treatment after treatment and followed medical advice to the tee, but instead of a cure they got severe side effects and complications. These patients wished they had spent less time relying on doctors and more time learning to trust their own judgment.

“Your life’s purpose isn’t what you think it is.”

Finding meaning and purpose in life is one of the great challenges of our human existence. We spend our lives seeking out the “right” occupation that will allow us to achieve both success and fulfillment. But some of my patients recognized that their life’s purpose was much simpler and smaller than they had assumed, such as being a thoughtful neighbor, planting a garden or caring for a pet. Pay as much attention to the simple things of life as you do to your efforts to climb the career ladder.

“Religion is less important than learning how to love others.”

Some of my patients had been devoutly religious throughout their lives but began to see that path as limiting when they faced their last days. They stopped identifying themselves as part of one group or another and saw instead that we are all connected and all deserving of love. In fact, they said that loving others was the most important task of their lives.

“Dying isn’t as scary as you think.”

Many patients were surprised that they no longer felt afraid of death as they got closer to it. They expressed curiosity about the dying process and were able to watch it unfold without fear. One patient told me she was “dissolving” a little bit each day and turning into light, which she described as a wonderful experience. “Don’t waste your time and energy being afraid of death,” she said, “instead … enjoy being alive!”

“You’re going to die anyway so you might as well be ready.”

The fact that death comes for each of us no matter what we do was one of the common bits of wisdom from my patients. Many of them wished they had started preparing for it earlier in life and those who had planned ahead for death were at peace and filled with gratitude. It’s never too early to tell people you love them, to practice forgiveness, and to find joy in the simple things in life.

While not everyone experiences peace or love through the process of dying, I found that those people who were open to it and ready to let go had by far the fewest difficulties at the end of life. Whatever you do to prepare for your later days will benefit you in the end so it’s worthwhile to start thinking about it now.

Remember: death is the one life experience that all living things have in common. Indeed, even stars and planets eventually die. Why not embrace it and follow the wise advice of my hospice patients? A life well-lived leads to a death without regrets … and that’s worth planning for.

Learn more about how to get ready for the last days of life at www.eoluniversity.com with Dr. Karen Wyatt.


Finding Meaning in a Broken Life

Focus on the goodness of life rather than the regrets to find healing.

Jody was just 36 years old when she found out her colon cancer was incurable. I came to her apartment for our first hospice visit and saw that she was depressed and despondent over her diagnosis—as I had expected for someone her age who was raising two children by herself. She told me story after story of all the regrets she was carrying. And I just listened.

Her life had been unimaginably difficult—in foster care for most of her childhood then finally adopted at age 12 by a wonderful couple who loved her dearly. But she had been so filled with rage she couldn’t receive their love. She experimented with drugs and alcohol and was in and out of juvenile detention for petty crimes throughout her teens. There had been other even deeper regrets, but she didn’t want to talk about them. 

Jody was angry and bitter, but also ashamed. She believed she had wasted her life and now her children would grow up without a mother. She asked if there was any way to speed up her dying process because she could no longer face all of the emotional pain that was coming to the surface. 

We talked about things she could do to help with grief for her children, like writing letters to them that they could open at various milestones throughout their lives. She liked the idea that she could make sure her children didn’t feel unwanted, which she had experienced for most of her life.

I wasn’t sure how we could help Jody heal from all of these regrets. There were so many broken threads in her life and so many pieces to help her put back together. But then a little miracle happened. On my next visit with Jody she was like a different person: joyful and filled with energy and laughter. And she had more stories to tell me. 

Jody’s adoptive sister had come for a weekend visit and had brought with her boxes of old photos and a scrapbook. The two of them spent hours each day going through the photos together and gluing them into the album as a keepsake for Jody’s children. They wrote little stories on the pages to explain the pictures, which were arranged in a chronological timeline of Jody’s life.

She showed me each of the pages and told me entirely different stories than I had heard on my previous visit. Here was a family trip to the beach when she was 16. There was her favorite Halloween costume. And look: she was all dressed up for senior prom. Then there were pages and pages of pictures of her with her children: playing games, reading books, opening Christmas gifts, laughing, hugging, eating—all the little moments of life.

Jody wiped a tear away and smiled at me with a radiance I hadn’t seen before. “I’ve had a good life,” she said. “And I’ve been a good mom.” 

Here in her hands were the photos that documented all of the goodness of her life. In comparison to the magnificence of these moments, her regrets had faded away. She found meaning in the memories captured in these photos and was able to weave the broken threads of her life into a beautiful tapestry that was uniquely hers. 

Jody died just two weeks later. But she had been able to go through the album with her children and tell them all the stories that were depicted there. And she managed to write each of them letters that they could open when they were older. They would know they were loved and that their lives mattered and that an angel would be watching over them for all of their days. 

For most of us—like Jody—life hands us a mixture of sorrows and joys. We can view it all through the lens of regret and wish that things had been different. But we can also find ways to pick up the broken pieces and put them together to create a work of art–the likes of which has never before been seen–that might just change the world.


Don’t Focus on Regrets at the End of Life

Why it’s not helpful to ask dying people what they regret about their lives and what to do instead.

“Don’t waste your time in anger, regrets, worries, and grudges. Life is too short to be unhappy.” 

Roy T. Bennett

For some reason there’s been a buzz in the last few years about finding out what people on their deathbeds regret most about their lives. We hear this often: “they regret what they didn’t do more than things they did.” That’s fine to say and tends to be good advice for those of us who aren’t facing our last days. We can learn from their mistakes and pledge to live our own lives differently from now on.

In fact, research on regret as an emotional state has shown that it may be helpful for young people as a reminder to reconsider their current path and make better choices for the future. But when regret occurs in situations where there is no chance to change the current circumstances or make things better, it can cause chronic stress and do both physical and emotional harm. Individuals who feel they have no path forward can experience guilt, self-blame, disappointment and depression as a result of spending their time focusing on their regrets.

Regret sells

However as a society we are drawn to learning about the regrets of other people because we fear making mistakes or missing out on opportunities. We are eager to benefit from someone else’s suffering if it means we can avoid the same path for ourselves. Advertisers rely on our fears by using regret as a motivator to sell products, such as “this person didn’t buy from us and paid more money for worse service.” We don’t want to be the foolish person who regrets their choice so we pay attention to messages like that and we buy products, books and courses that teach us how to avoid these costly mistakes.

Not helpful at the end

There’s nothing really wrong with this tactic except when it applies to people who are nearing the end of life. Because they may not have time to repair the past or forge a new direction in the future, they have no opportunity to truly learn from their regrets. Placing their attention on the mistakes of their lives may lead them to despair and a feeling of worthlessness as they prepare for the end, especially if you are unable to guide them beyond their self-blame.

Do this instead

Instead of asking “what regrets do you have from the past” we would be better advised to ask “what are you grateful for in your life” or even “are there things left undone that you would still like to address.” If the person wants to talk about regrets it’s fine to go there, but it’s not helpful to introduce the topic to them if they’re not already thinking about it. Viewing life as a series of mistakes or regretful events is painful and creates a spiral of negativity. But we can help people avoid that downward spiral and lessen their distress by asking better questions.

Listen and find meaning

People at the end of life generally benefit greatly from doing a life review and being able to tell their stories in a safe setting. The art of being a good listener includes helping them find meaning, connection and resolution through their own stories without judgment or shame. To truly help a person find peace at the end of life focus on forgiveness, gratitude for what life has offered, self-compassion and letting go of self-blame. But don’t ask about regrets unless you know you can lead them out of that dark place to a higher, more healing perspective.


Love Never Dies

How a song about a meadowlark reconnected me to my father’s love across the vast and timeless universe.

We had just finished dinner with two old friends we hadn’t seen in years when they invited us to check out their music room. Inside we found a stereophile’s dream–massive speakers, a state-of-the-art turntable and an enviable collection of vinyl records. We sat on lush leather chairs in the center of the room while our host began to play the songs he had selected for the evening. The sound quality was amazing and the notes washed over me as I relaxed into reverie in my cozy chair.

He put an LP on the turntable by Kelley Hunt, an artist I’d never heard before, and not only did her soulful vocals sweep me away, but the words she sang penetrated directly to my heart. I burst into tears when I heard the opening verse:

I′ll be calling you when the meadowlark sings
I’ll be touching you with the warm spring rains
I′ll watch over you like the moon in the sky
For I know love never dies.

Instantly I was carried back in time to the day after my father’s funeral: I had visited his grave with my baby daughter in my arms, completely devastated by his suicide death. I sat on the ground and cried from deep in my gut, releasing all the pain I hadn’t yet been able to express. When my tears were finally exhausted and my sobbing ceased I began to hear the most beautiful sound. A meadowlark was perched on the nearby barbed wire fence that surrounded the cemetery and singing its pretty melody for me over and over again.

I realized then that the bird had been there the entire time, accompanying my weeping with his lovely song. He kept singing to me and didn’t move away, even when I moved closer. The fact that this bird was sitting vigil with me in my grief was significant because the meadowlark had figured prominently in my relationship with my father. When I was growing up we spent nearly every weekend fishing, hiking or picnicking out in the Wyoming countryside, and there always seemed to be a meadowlark present wherever we went. Dad would whistle the song perfectly as we stopped to listen for a response. And on my first trip back to our family cabin after Dad’s death, it was not a coincidence that I was greeted by a meadowlark singing on the deck. This nondescript bird with its haunting tune symbolized the unspoken bond between me and Dad–often shy and fleeting, but filled with love.

So on that special evening as I listened to Kelley Hunt singing those words that seemed to have been written just for me I marveled at the synchronicities of life. How a friend I hadn’t seen for years–who didn’t even know my story–had selected a song that reached into the core of my being and reconnected me to Dad’s love, healing old remnants of my grief and lifting me to a state of profound joy. Love never dies. In fact it radiates around and through us perpetually, connecting us to one another with unseen threads across time and space and all boundaries. I’ve known this and written about it over and over again ever since that day by Dad’s grave: love is what really matters. And Kelley wrote a song about a meadowlark singing and my friend and I discovered that we are connected to one another in our grief and to Kelley Hunt in our knowledge that love will always find us, wherever we are.

Though the winds may blow
And scatter all our faith and our hope
Only one thing really matters
And that's love ... that's love

Kelley Hunt: Love Never Dies