We're all scared of death but I'm somewhat of an extreme case.
Death terrifies me.
It's on my mind an unhealthy amount.
So after years of anxiety, it's time for a new approach.
Over the next few weeks I'm getting up close to death
to find out how we can come to terms with what's waiting for us all.
It's this big, huge mystery that none of us really understand.
All my cats belong to dead people.
Do they?
Yeah …
Oh my God!
Last week, I was immersed in a movement of people running from death.
This week I'm going to learn what it's like when that's not an option any more.
How do people react and what do they want when they know their life is ending?
I'm going to meet Dr Sunita Puri
at Keck hospital and she runs the palliative care ward there.
She spends all day every day with dying patients, she's even written a book about death.
Nice to meet you. – Nice to meet you too.
Thanks for coming on – Thanks for having us here.
So, I'm going to follow her for the day as she meets with her terminally ill patients.
I'm so glad I get to show you what palliative care is because it's so misunderstood.
One thing I've learned in this work is, no matter where you are in the process of dying,
you're still living.
And so what does it mean to live well?
So, our first patient today is Pete McGrath.
Hello! How are you doing today? – Fine, thank you.
And I know we talked about a little bit yesterday that
maintaining independence, going to your Rotary Club meetings is important to you
and so I think if that is your goal then I think that we will be able to really
help you without hurting you.
I would love that.
I would like it to be as painless as possible.
Yeah.
And quick and easy, as we used to say.
So right now if something happened, your heart stopped or you needed to be
on a breathing machine, I would not recommend that we go down the route of
chest compressions or shocks or reviving you.
I agree completely.
Or that we put you on a breathing machine.
No, I agree completely.
You seem quite calm with the idea of being taken off a ventilator.
When I was 90 I gave myself a big party and as I drove home I said:
you're 90, you've had a wonderful life
and something's going to happen in the next few years.
This is just a continuation of life or a way to terminate.
So I'm relatively calm, at this point I'm still relatively calm
and accepting.
Do you feel calm about the idea of just not living anymore?
Does it scare you at all?
No. Everybody does.
A terminal diagnosis can be harder to accept if it comes when you're not expecting it.
So we're about to see Melissa.
She's 39, she's exactly my age.
She's ready for you. – Yeah? Oh, amazing!
So, today is a big day for you to go home.
I'm scared but I promised my kids I would fight so I have to go back for them.
And I think one thing we talked about in that meeting with your family,
was that we will respect the limits that your body imposes
because some of this has so little to do with how hard we want to fight
and so much to do with the limits of biology.
But I have three kids, I don't want to leave my kids.
I'm not ready for that.
So, I'm still fighting for them.
Do you encounter a lot patients who … they just want to keep fighting even
potentially beyond what's medically possible?
So, that's something I encounter quite a bit.
But to help people remember that at a certain point
it's not about them, that it's really about their body,
I have found that distinction to be really actually empowering for a lot of people
that this isn't something that I just need to soldier through another round of chemo
even if it devastates me.
If I want to try enough and I want to live enough then …
We can go down this way actually.
This patient is a gentleman who has a very, very aggressive lung cancer but because
this cancer is so aggressive, part of what I also need to try to talk to him
about is really where we go from here.
Hi, I'm Leah. – Hi Leah.
Hey, good to meet you.
Good to meet you too.
It sounds like even overnight, the pain got pretty bad
even with the higher dose so tell me what happened.
Suddenly yesterday, like around 4am, it was like …
Just a brand new pain came, a brand new pain
and there was a lot of suffering.
I think one of my worries when I heard that you were
having a lot of pain, even with more pain medicine, was what if the tumour is growing?
But then the plan is to, you know, if I respond to the radiation well
and it starts shrinking the tumour, they're planning about doing surgery.
That's the hope, yes.
But it's still in your lung
and it's still in other places.
I also have a friend who lives with a third of her lung
and my vision is for them to shrink this thing and I live with half a lung.
It's never my intention to kind of take away any of your hopes but rather
to make sure that we're hoping for things that are realistic
and it is so important to know that though we can make these efforts to
minimise how the cancer affects you, we can't cure it.
OK.
Do you know how much length of time I have when, you know, it's something incurable like this?
I think we're probably looking at a period of a year or so.
You don't deserve to be going through this.
You don't.
It's hard to explain it.
I don't feel like, 'why me?' kind of thing.
We all are born and we die, sooner or later.
Mine is a little sooner.
You know …
I felt like I was witnessing
something like the biggest moment in someone's life, potentially.
I think the hardest part about it is doing it and being in that very sacred, difficult moment
with the patient and then having to leave the room and go on to the next.
It's not just patients who have to contend with the weight that surrounds death.
That doesn't make sense to me, why it's going to be taking place on Monday?
You're just going to take everything away …
The short term goal is can we get him out of the ICU?
Can his heart do its own work without the need for ICU-level technologies?
If by Monday we can't help him in those ways,
then I think we have to have a check-in about, are we helping him
really to have a quality life or are we prolonging the process of dying?
Why can't it just be there until he initially passes away?
Because that's what's helping keeping him alive.
Right, so why can't it just be there until he naturally passes …?
Because the heart won't stop if it's meant to stop, it's not going to stop
unless that pump is gone.
It's just a machine.
If he's not going to get better …
That's more money for you guys if he's on it so …
It's not about money.
We may not feel that that's how he wants to live his life, unable to walk
being in an ICU, unable to go home, being poked and prodded …
And a lot of people are willing to do all that if we can take them from a bad place to a better place.
Like a place of healing.
But if he's going to be here no matter what we do,
if that is the case, then wouldn't it be best to let him have some dignity and
comfort and peace at the end?
My parents have been married over 40 years but not through the church.
So, my dad asked my aunt to ask my mom if she wanted to get married by a priest.
It's going to be great.
This is our office. – Great.
How do you cope with having
what for most people would be a once-in-a-lifetime difficult conversation
but you're having them like four times a day every day.
I grew up in a very spiritual home, so my parents are very devout Hindus
and a lot of what I was raised with was this idea that life is temporary.
So how do we live our best lives and how do we make sense of what happens in our lives?
We see little deaths all around us.
We see the changing of the seasons,
we see the trees and their leaves that change and that's not the
same as losing someone you love but we do see loss every day.
We do see little deaths every day.
Without mortality I don't know what humanity would be.
I feel grateful for the fact that I won't be here forever because it forces
me to make meaning of the time I do have.
Since we met, Mr Lopez and Mr McGrath have both died comfortably at home.
I'm really grateful that they and their families gave us some time.
Reflecting on the day, I think that I got to see a side to death and illness that I wouldn't
have otherwise understood.
We're all aware of the scary and the painful aspects of dying
but what we don't often get to see or understand is the peace
and the calm that can be there as well.
Thank you for watching episode two of Death Land.
If you're curious about Dr Puri's work, there's a link to her book –
'That Good Night: Life and Medicine in the Eleventh Hour' – below.
Next week it's going to get a little bit personal.
I'm going to be talking about death anxiety – mine and yours.
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