Dr. Pauline Chen will be the keynote speaker of our Conversation of Your Life (COYL) Breakfast on June 12. Dr. Chen, author of Final Exam, is a powerful speaker, writer and advocate for patients at the end of life.
Through your work as a transplant surgeon and experience with terminally ill patients, you came to understand that physicians often consider a patient’s death a sign of personal failure. How did you deal with that paradox in your life?
The answer is that I did not deal with it for close to a decade. That is precisely the issue and what made writing this book so difficult — and so liberating. It’s hard not to go through school and medical internship and training and take care of dying patients without feeling the pressure to depersonalize care. Just about every doctor goes into medicine to help people. They want to do the right thing. Although end-of-life care has improved dramatically since I wrote the book, there is still a lot of pressure on doctors to see more patients in less time. So forces still make it difficult for physicians to have meaningful and important conversations with patients. That’s why your initiative, Conversation of Your Life, COYL, (supported by The Horizon Foundation for New Jersey) is so important.
What was your motivation for writing this book?
During my training I was too busy to write. When I finished I was drawn to writing and took writing classes to control my obsession. Ideas were just bursting out of me. I was writing fiction, but they were thinly veiled stories of grief. Not grief in the classic sense — grief over what I had become and the way I was taking care of my patients. I was not allowing myself to fully grieve for my patients who died. When that became clear to me I started writing what I really wanted to write: Stories of end-of-life care and the changes in myself over time.
The Quality Institute’s COYL program promotes community dialogue about advance directives and patients’ end-of-life wishes. It’s now in eight counties and will soon expand to six more. From a surgeon’s perspective, how do you see the value of promoting these conversations outside the medical world?
It’s hugely beneficial … for many, many reasons. Providers don’t always have the time to have these conversations because of the pressures on us. For people to have thought about these issues and really discussed them with their loved ones, their closest friends … that’s so valuable. That’s how we treat another milestone, birth. People celebrate birth and there’s support from the community and lots of discussions. I think it’s fantastic to have these end-of-life conversations beyond the doctor’s office. You’re giving the community and families the language and tools to talk about this. That’s critical.
You have spoken about the gift of clarity that people can give to the ones they love. Can you expand on that?
Over the last few years, probably the last decade, there has been on a national level a real push for clarity. The gift of clarity comes from talking about end-of-life care in a way we were not in the past. You see this in medical schools, residency programs, and in private practices. We have palliative care specialists who are giving health providers the language to talk about all this — beyond DNR. I teach residents and I find it so interesting about how comfortably young physicians talk about advance directives, personal choices, and power of attorney. When I was a chief resident I really didn’t have all this information.
So clearly things have improved. But are we still subjecting people to painful and uncomfortable treatments at the end of their lives that will not improve the length or quality of their lives?
We’ve made strides and I credit groups like yours and palliative care specialists, a wonderful group of physicians. But, yes, we still see that happen. I see it in my work. When you are caring for someone who has not had the gift of really talking with their loved ones about what they want at the end of life and you are facing the system pressures while trying to navigate the journey … the path can be harder to take and there may not be the death the person wanted. It does happen. We have more work to do.
For more information on Dr. Pauline Chen, please visit www.prhspeakers.com