"But then I'm finished?"
It was in 2017. Hélène* has been accompanying her father in illness for almost five years.
Suffering from cancer of the larynx, the 85-year-old man goes through hospitalizations and appointments with the ENT doctor who follows him.
One day when the spread of the tumors was announced to her, Hélène witnessed the scene.
“Dear Sir, I regret to inform you that the cancer has reached the lungs.
To tell you the truth, I did not expect to see you again in my office
, ”she says to him.
"But then I'm finished?"
replied my father.
So that she says to him: “Yes”, in a very dry way.
It was terrible
, confides Hélène,
because he carried a lot of hope in her.
It was the first time I saw him burst into tears.
I think the disappointment and the fear came through at that point.”
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According to Alexis Burnod, head doctor of palliative care at the Institut Curie for 12 years, announcing the imminent death of a patient is not a given.
“Without wanting it, we can have an unhappy word, a look that says a lot, or show impatience because we are late.
It can be harmful
, he explains.
However, you have to be sincere, but also gentle because the disease is sufficiently aggressive.
And that the doctor is there to team up with his patient.”
Without wanting it, we can have an unhappy word, a look that says a lot, or show impatience because we are late.
It can be harmful
Alexis Burnod, head physician for palliative care at Institut Curie
Although armed in the face of death, which he encounters every day, making this announcement can be traumatic, observes Marie-Frédérique Bacqué, professor of clinical psychopathology at the University of Strasbourg, editor-in-chief of the journal Etudes sur la
mort
.
“Doctors are often confronted with the traumatic effects of the announcement of death.
The patient then presents the physical signs of the state of shock: he is pale, he widens his eyes, he tries to flee or starts to cry.
Also, how do you find the right words?
taboo word
The first element of the answer lies in listening to the patient.
"We don't literally tell the patient that he is going to die
," warns Alexis Burnod.
The words are chosen, guided, by what he says.
It is then a question of bouncing back on his words in order to stay as close as possible to what he expects.
More often than not, this comes down to a treatment-related question.
Listening silently to the patient's response, aware of his physical condition, allows him to open his eyes to the events to come.
Read alsoTen new words to talk about health
The doctor will never euphemize his speech by employing conventional formulas, such as:
"you are in danger of disappearing"
,
"when the time comes to turn you off"
... However, saying the word "death" is not a evidence.
And this for both the doctor and the patient.
The patient will therefore circumvent the term by circumlocutions.
Example:
“If I didn't leave before
Easter
, I would…”
At that point, the doctor may bounce back:
“What do you mean by 'leaving'?”
And it is at this moment that the taboo word finally comes out of the patient's mouth.
A remark that is also made by Bruno Picavet, pulmonologist and oncologist in Reims for 25 years, who adds:
“This can have the consequence of freeing the patient from a weight.
He will then dare to speak of his own death to his close family circle.
And this is where the doctor can play an intermediary role.
Training almost non-existent
As Marie-Frédérique Bacqué explains, it also happens that the doctor is taken aback and that the patient asks him openly if he is going to die.
“His question is really about his survival time and rarely about the transition from life to death.
However, the doctor also shifts his response to the effects of treatments and physical suffering.
However, the doctor's reassurance does not calm the patient's anxiety.
Indeed, the patient often identifies with the “aggressor”, that is to say, fantasmatically, with this doctor who revealed his disease to him and set up treatments that were difficult to bear.
The patient can then imagine that it is his own fault if he is in therapeutic failure.
Therefore, when the time comes to announce the death to come, the doctor often hides behind his professional skills, promising that he will do the "
maximum"
to accompany the patient until death.
Whether in conventional service or in palliative care, he will always apply his ethics: not to abandon the patient and offer him a remedy for pain and anxiety.
Healing is not only done through drugs, but also through the relationship
Alexis Burnod, doctor and former doctor at Samu
Hence the need for doctors to train in communication.
In this area, they still have many shortcomings.
"In my time, the training dedicated to the announcement of death was non-existent"
, regrets Doctor Bruno Picavet.
If today things have improved, they are only trained for a few hours on this subject during their studies.
“But that's not enough because they have to be trained and supervised, as is the case in a palliative care unit
,” says Marie-Frédérique Bacqué.
Before arriving in this service, doctor Alexis Burnod, who previously worked for 15 years at the Samu, received solid training, including readings on the announcement of cancerology.
“Treatment is not only done through drugs, but also through the relationship
,” he remarks.
Today, he and his team are monitored every month by a psychologist to provide the best possible support for patients.
"Today we live in a society that banishes death, but in the disease some patients can experience beautiful things"
, concludes Bruno Picavet.
*
The first name has been changed