Am I dying doctor? This is something I am regularly asked, yet it is still one of the most difficult questions to answer.
It’s not that I find it difficult telling people the answer as it is something that you learn to do as a doctor, but it is in many ways one of the hardest things to predict
That may sound odd to you, particularly when the only sure thing in life is death!
But, it is a hard thing to predict, not so much dying itself, but when it is going to occur.
Let me illustrate this with an example, it’s not a stomach cancer patient, but it illustrates a point.
As well as being a gastroenterologist, I am also a general physician so I get asked the "am I dying?" question for a variety of conditions.
One of the most amazing medical conditions to treat as a physician is a heart problem known as left ventricular failure.
People with left ventricular failure have a failing heart, the old pump is not pumping like it used to. As a result, fluid builds up in the lungs and breathlessness ensues.
Now, when someone comes in to hospital with this condition, they can be very breathless, and I mean VERY!
They look awful; they are pale, clammy and cold and often have an un-recordable blood pressure.
They may not be able to speak and you think to yourself, this person isn’t going to be with us in the morning.
And yet, it is also one of the most satisfying conditions you can treat. Why? Because giving them intravenous Furosemide (the name doesn't really matter, but it stimulates the kidneys to get rid of water) and Morphine can rapidly settle symptoms in some cases.
Let me tell you, I have seen it time and time again. The person you expect to die and would say yes to the "am I dying" question (if they could speak to you), is sitting up in bed the following day eating their breakfast!
But, this isn’t someone with cancer. So, I am going to illustrate another point to you.
Many a time I have seen people with various cancer types, who have asked the "am I dying? question and been told they have 3 months to live, and yet they are telling me this I year later.
They are rightly proud of this and always keen to tell the story of “doctors told me I only had 3 months to live”
Life is full of uncertainty and timing someone’s death is one of those.
Life is fragile and people with stomach cancer as much as any other condition, and even healthy people, can suddenly find their lives taken away from them.
So, let me take this one step further by introducing the concept away from those who defy death and turn to those who foresee their deaths, without ever being told they are dying.
I have seen people outwardly appear really quite well and on the road to recovery, tell me this “Doctor, I'm going to die today”.
Now, this may sound very strange and if I wasn't witness to it, I would say the same. There are genuine people who have told me they are going to die that night and have done just that.
I'm sure that I am not alone in this, ask other doctors and nurses and I'm sure they will say the same thing.
But how do you know you are going to die? A philosophical question or a 6th sense?
So I have now covered those who I think are going to die and don’t and those who have told me they are going to die and do.
But what of the person with stage 4 stomach cancer?
Id someone with stage 4 stomach cancer asks the "am I dying?" question, it is equally difficult to answer.
Stage 4 disease may be thought of as a terminal diagnosis and yet 1 in 25 with this diagnosis survives!
So, is it fair to say to someone that has stage 4 cancer they are going to die? Well I suppose you could look at it in one of 2 ways.
The first is to say that you will die of stomach cancer because 24 out of 25 do.
But equally you could say you are not going to die because 1 in 25 doesn't!
Statistics can be used as you like, but not everyone dies is the major point here.
Let’s now look at the reason why people want to ask “am I dying?”.
In the UK, if you have a pension fund it can be released if you are not going to survive your illness.
There are other benefits that you can have, but I will cover this elsewhere on the site for you. So, there is a benefit in knowing whether you are dying or not.
You are quite likely going to want to put your ‘affairs in order’ before you die and having an idea of time frame is useful for this.
Sharing time with your loved ones and saying your good byes is another good reason to want an answer to “am I dying doctor?”
So, there are good reasons and I am sure you can think of others too.
Doctors are full of stories and some are truly pure gold. A colleague, I used to work with, was seeing a person in his clinic with pancreatic cancer.
Pancreatic cancer is really as bad as stomach cancer in terms of prognosis and equally it often doesn’t get picked up until it’s too late.
This person had the usual investigations including CT scans and this showed a mass in his pancreas gland, confirmed by radiologists who specialise in this area.
Now, with cancers, we usually like to have a biopsy to confirm the diagnosis, but with pancreas cancer this is notoriously difficult to do because of its position and surrounding structures.
The only true biopsy is a ‘big biopsy’, in other words surgery. For pancreatic cancer the only real chance of cure is a pancreatectomy or Whipples procedure. This is a very major form of abdominal surgery.
Unless you are fit enough and appear to have a tumor only in your pancreas, most would not advise this surgery because there is a very real chance that you won’t make it.
So, in this persons case, he asked the question “am I dying doctor?” and was given the answer yes, three months.
They had no dependants and decided, whilst they were still well enough, to blow the life savings on a holiday and much more.
So, off they went and had a great time. 3 months came and went, but they were still feeling well. How can this be? Well, he was rescanned and low and behold the ‘tumor’ had disappeared!
A miracle you might say? No, what the scan had picked up was pancreatitis, an inflammation in his pancreas that had clearly settled.
Now, you would think someone in this position would be ecstatic that they were not going to die, but no the reality was that they no longer had any money, so the opposite was true!
Death is inevitable no matter what we do; you are dying the day you are conceived. How much time we have in this world depends on so many factors and not something that needs discussing here.
So, back to “am I going to die doctor?” what are my thoughts on this? I think telling someone that they are not going to survive their illness really depends on circumstance and what the sufferer wants to know.
If asked directly, I would tell them if I thought they were going to die even though occasionally you have to accept that you can be wrong. What I often don’t do is tell them how long they are likely to live, because I am likely to be wrong!
If I’m pressed on this point I might use the word “statistically” you are likely to live 3 months or whatever, but I usually say that there is so much variation it’s difficult to predict.