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I love London—its size, the crush of all the world's humanity, the onslaught on the senses. I love watching all the people and wondering about their lives and stories. But most of all I love the anonymity, the freedom. It was a similar experience when I used to walk the hospital wards: vast institutions and thousands of people wandering the corridors with their own lives and stories. I was constantly on the move; different wards, different specialists, and different hospitals. Tired and irritable, I often worked way beyond the limits of my ability and training, the only saving grace my complete lack of insight. Faces and families spun and blurred together.
I became indifferent to death. Each death was a release: no more infusions, investigations, and all the other endless interventions that defined care. Why couldn't we be honest and tell these patients it was hopeless? Why not send them home and spare them indignity of yet more mechanised medicine? Instead, in the dead of night I recited in monotone to the family my word perfect, psychobabble death speech. Emotional detachment was encouraged; “Don't get too involved” was repeated a thousand times. This was the collusion of anonymity: so many people were involved and responsibility so divided that the patients and families became emotionally invisible to us. I would like to say that things have changed, but we are fast becoming just another faceless corporation, Medicine Inc.
A good death is a medical priority. Most of us want to die at home with our family around us and the comfort of familiar possessions and memories, but few of us will be this lucky. A home death eases not only the pain of those who are passing but, just as importantly, the pain of those left living. A home death normalises death as the turn of life, something not to be feared but accepted. So why is it so difficult to deliver?
There are many factors, but GPs hold the key. We are healthcare professionals with the opportunity and experience to tell the patients the truth when they are dying. Unfortunately we often abdicate responsibility through the easiest and “best” option, a hospital admission, initiating that chain reaction that denies patients the chance to die at home. GPs could be much more questioning of the practice of admitting patients to hospital in the last stages of illness and do much more to coordinate community services. And perhaps it is time to do the unthinkable: to discard our cloak of anonymity and become emotionally involved with our patients.