Meredith’s Reviews > That Good Night: Life and Medicine in the Eleventh Hour > Status Update

Puri: There were exactly the types of situations that made many physicians wary of difficult conversations with patients and families. After all, it was far easier to do whatever a difficult patient or family requested than to help them understand that their request might be impossible or dangerous or the cause of tremendous suffering. It wasn't right, but it was human.

Puri: Do we know how to listen when the body tries to tell us that it is dying despite our best efforts to forestall death?

Puri: I wondered why I sometimes offered patients treatments that I wished they'd decline. Deep down, I knew I wanted them to assume responsibility for making tough choices ... Yet patient autonomy -- the power to choose the type of care that was most in line with one's goals and values -- hinged on a clear understanding of how the therapies we offered might or might not benefit a patient.

Puri: I was learning that honesty sometimes took the form of measured, compact, declarative sentences. I had to be Ernest Hemingway. And this sometimes felt brutal, the exact opposite of compassionate. But the honesty was the compassion.

Puri: You remind yourself that it isn’t your job to erase or justify all of their suffering, but rather to see it, not ignore it. To ease it when you can.

Puri: We as physicians in training were impelled to prolong life, enable survival. We hadn't become doctors to recognize and accept dying.

Puri: Successfully treating a physical malady didn't necessarily mean I'd eliminated a patient's suffering. And treating suffering didn't always mean curing a disease.

Puri: Human suffering wasn't a topic we discussed in medical school, which I found shocking once I began residency and encountered every possible permutation of patients' physical and emotional suffering. I memorized how to diagnose and treat a panoply of illnesses without considering how a person might suffer regardless of whether we could cure their ailment or not.

Puri: Was a good doctor the one who promised to do everything in her power to save his life, or the one who was honest about medicine's limits?