As young students and doctors in the midst of profound sleep deprivation and chaotic personal lives centered on work, we are eager to find easy truths or at least comfortable lessons in patient care. Soon enough, however, we discover that death among patients is an inevitable part of our profession. We look to our attending physicians for guidance and we learn that many of them have not only their own difficulties in dealing with death but also little insight into how these attitudes affect the care they give terminal patients. Even our textbooks, usually overflowing with data, provide us with little or no help with the dying.Pauline W. Chen, Final Exam: A Surgeon's Reflections on Mortality (New York: Alfred A. Knopf, 2007), p. 61.
Thus, without guidance or advice, few of us ever adequately learn how to care for patients at the end of life.
Despite our best efforts to improve, our apprenticeship system continues to produce doctors who are unable to care humanely for the dying. The attitudes we physicians have toward death become reinforced each and every time we learn from our attendings and then go on to teach others.Id., p. 73.