When you hear the words, “There is nothing more we can do.”

As a patient, there may come a time where you hear the words, “I’m sorry, there’s nothing more we can do.” I want to apologize for the doctor’s abrupt words. Many doctors have had little training in having these types of conversations and are incredibly uncomfortable. What your doctor should really be saying is, “Even though there is nothing more we can do to cure you, there’s lots more I can do. I can do plenty to keep you or your loved one comfortable, out of pain, minimize your suffering, refer them to hospice, get your religious leader in here to pray and help provide a peaceful and dignified death.” Just because you don’t hear this doesn’t mean you shouldn’t ask for this. You should advocate that the doctor makes sure you get what you need as your disease progresses and as you die. Help the doctor help you by asking for a palliative care referral if you are having problems with pain. Ask for a referral to hospice when the patient is sleeping more and eating less. You want to stay connected to the doctor even if the direction of treatment has turned to comfort and care.

As a patient or a loved one, you will have a strong grief reaction to these words. You may be in denial, in disbelief, in numbness or feel some other strong emotions. If you are in denial, you will not believe that what you were just told is true. This is okay as it is the way your brain protects you from bad news. Eventually, you will hopefully come out of denial so you can use your remaining days wisely. Or you may find yourself in disbelief. Disbelief is where you keep saying to yourself, “I know the doctor just said ______ but I can’t believe it’s true.” In this situation, you may want 2nd opinions or repeated tests. This is disbelief. Your brain knows it’s true but it is not ready to accept this news. This is also okay and normal. Or you may be numb. This can really be a problem when the doctors want you to make decisions. Ask for a few days so you can process what you have been told before you make these final decisions. You may also have many other types of emotions: anger, fear, hopelessness, helplessness, sadness, etc. These are also normal as you come to terms with your life’s expiration date.

You get to choose how you want to spend your remaining days, months or years. Choose carefully as you won’t get these days back. And if you are like someone I knew who was waiting until they got closer to death to write love letters to his children and his wife, realize that sometimes when get closer to death, you may not have the energy or strength left to finish your goals. Please use your time wisely.

Have a kind and respectful day.