Re "Testing the Limits of 'Terminal'" (Hard Cases, Oct. 15): Dr. Abigail Zuger hits on a central truth that all of us who have accompanied the dying know: In the end, what matters is not how many days or weeks a particular treatment extends life, or how precisely a diagnosis has nailed the problem. It is the memories that stay with us of caregivers who understand the sacredness of life's end and who show kindness and concern about a patient's total being. I thank Dr. Zuger for looking back and questioning whether there was not a better way to have helped a patient through the passage from life to death.
Cathy Bernard
New York
TO THE EDITOR:
Dr. Zuger brings up a thorny issue for every physician: When do we stop trying to save a life? As resident physicians in training, we work hard at saving life even when it seems hopeless. As we mature as physicians, we increasingly recognize there is a time to stop all the heroics and just come to terms that there is an end. The two intensivists who were mentioned in her article understood this and made a decision. It was not cruel, calloused or unfeeling — just a decision.
I can tell from interacting with intensivists for the past 30 years that their decisions are not made lightly or dispassionately. I suspect the next stop for those two doctors was an equally difficult patient with a daunting disease, and more difficult decisions had to be made. I suspect they need some distance from the impact of those decisions so they, too, can maintain balance in their lives and continue to make tough choices.
Harry Katz, M.D.
Midland Park, N.J.
TO THE EDITOR:
Sparing needless and painful suffering to a patient facing an imminent demise is both wise and caring. What bothered Dr. Zuger the most, as she readily acknowledged, were the young physician consultants who reached their decision so quickly. What if older doctors had reached the same conclusion just as quickly? What is so wrong about coming to the proper decision quickly?
Jerry Frankel, M.D.
Plano, Tex.
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