What not to say to end stage COPDers

Sort of a touchy subject for physicians is dealing with end of life issues. We respiratory therapists see this quite often, particularly when it comes to end stage COPD.  We have patients who are at the extremes of the limits of what medicine can offer them.  While we have to somehow manage to help them keep up their spirits and live somewhat normal lives, we also have to be honest with them. 

This subject was recently brought up at the COPD.net facebook page when a patient wrote: 

"I'm a 66 yo just had my Dr tell me there is nothing else I can do or take to improve or even stay where I am. Working that through before my next lung evaluation in 2 weeks."

A similar comment I once heard was:

"You have two weeks to live." 

Another similar comment was:

"If you go home you're gonna die."  

Now, how does a physician know when a patient is going to die?  Surely you don't want patients thinking they are going to miraculously get better. Still, you don't want to deflate all  hope either.

In fact, the last time I heard a physician tell a patient with end stage COPD that he only had a few weeks to live, that patient went on to live two a few more years. Surely he lived within the limits of COPD, but he was still able to do things.

The patient who was told by one doctor he was going to die if he went home became very confused and depressed.  This only added to his problems.  I assured him that if he is a gallant COPD patient, takes all his medicine exactly as prescribed, wears his oxygen 24-hours-seven-days a week, and wears his BiPAP at night, that he has a very good chance of gaining a few more quality years.

This seemed to cheer up this patient.  The next day I worked he was breathing so much better that he was euphoric.  He was back to enjoying Westerns and telling jokes that made us all laugh.  He was breathing a whole lot better and feeling alive again.

The patient who was told there was nothing else he could do was advised by us COPD.net moderators to seek a second opinion, preferably that of a pulmonologist.  He has since informed us that this is exactly what he expects to do at his next appointment.

As healthcare providers, we must be aware that we are caring for people, not just objects on assembly lines. We must be honest with our patients, but not in a way that deflates their will to live.