Physician and patient

by Worthington Hooker

Even in those cases in which the physician feels it to be almost certain that the final issue will be a fatal one, it is not proper to give up wholly the idea of recovery, in his conversations with the patient or with his friends. This remark must not be understood to apply to those cases in which the evidence of approaching death is not to be mistaken, and so far as human wisdom can see it is absolutely certain that the patient will die. At the same time it is to be remembered that there are occasionally recoveries when death was confidently expected, and we must avoid being too ready to decide that there is no ground of hope, especially in cases of an acute disease.

I will relate a case in point. A physician was called in great haste to a patient upon whom he had been attending with deep anxiety. He found the family and the friends assembled around the bed of the patient weeping over him as a dying man. The physician himself thought from his appearance that he was really dying. Still he did not know that he was, and as he might possibly be in a condition from which he could be revived, he prepared a cordial at once, and with the look of hope and uttering the words of hope, he administered it. The patient not only revived but recovered. In his convalescence he told the physician that as he lay there dimly seeing with his glazed eyes the sad countenances of his friends, and feeling the oppressive languor of death, as he supposed, upon him, and panting for some cordial and for the pure air of heaven, and yet unable to speak or even to raise the hand, no words could express the relief which he at once felt, spreading a genial glow over his benumbed body, when he heard his cheerful voice speak of hope, and it seemed to him that this had more influence in reviving him than the cordial which he administered.

Strong as this case is, similar cases are in the recollection of every physician who has been in practice for any considerable length of time. And they cannot be distinguished from some other cases in which attempts to revive the sinking powers fail, and the patient dies. Now it will not be claimed that the physician does wrong in uttering the language of hope in the case of those who recover; and he certainly should not be reproached for uttering the same language in the case of those who appear just as likely to recover, but for some reason hidden from human wisdom do not. Just as he would administer the cordial to all of them, so also should he apply to all of them the cordial influence of hope. The same rule is applicable to both the mental and the physical remedy.

It is often said that if the physician, on the whole, taking into view all the circumstances of the case, thinks that a patient is going to die, he ought frankly to tell him so. The considerations which I have presented are, I trust, sufficient to convince the reader that this is by no means true. Shall the physician, I ask, add to all the depressing agencies which are bearing down the patient the appalling idea of death, and thus lessen, perhaps destroy, the possibility of his recovery? Shall he, in the struggle between life and death, give his influence in any way on the side of death? When the powers of life are sinking, and the life-giving fluid circulates but feebly in the extremities of the system, and is accumulating in the larger blood vessels and in the heart itself, threatening every moment to stop its faint throbbings, shall he, while he administers the cordial, defeat its effect, by holding up to the eye of his patient the grim visage of death, to oppress the vital forces and curdle the blood in its channels? Shall he not rather pour into the mind the cheering influence of hope, and thus aid the cordial in reviving the expiring energies of the system, and in stimulating the heart and the whole circulation into a freer action?

Let me be fully understood on this point. Far be it from me to justify the wide departure from truth, of which some are guilty at such times. Giving utterly false assurances to the patient is a very different thing from merely exciting the hope in his mind to such a degree as the case may allow, that the remedies will produce the desired relief. The latter can be consistently done by the upright and high-minded practitioner, but the former is to be expected only in the ignorant pretender, and the dishonorable and unprincipled physician. The quack always gives assurances of a cure to those whom he undertakes to dupe; for, besides being incompetent to estimate the degree of danger in any case, he is unable to inspire confidence in his measures except by a strong appeal to the hopes of the patient. And some physicians imitate the quack in this particular. They are in the habit of exciting unwarrantably the hopes of the sick for their own selfish ends. By so doing they occasionally retain under their care patients who would otherwise pass into the hands of some one else; and they also get possession of some cases, in relation to which their more honest and honorable brethren have not found themselves warranted in giving any positive encouragement. But, though occasional advantage may result from this course to the physician, and sometimes even to the sick themselves, yet on the whole the honest course is truly the politic one.

It is important, as I shall show more particularly in the next chapter, that the physician maintain his character for veracity and candor in his intercourse with his patients; else, when he can consistently utter the language of hope, it may prove no cordial, because his lips have so often uttered that language so falsely. There are cases in which death may seem to the patient and to his friends to be staring him in the face, and yet the physician may see a sure and speedy relief coming to all the alarming symptoms. Now when he gives an assurance to this effect, in order to quell the anxieties and fears of the sick man and his friends, if he has been known to be in the habit of giving similar assurances without any ground for them, he cannot expect to be believed.

The views and feelings of patients, in regard to the expectation of a recovery, are often misunderstood by their friends. They are sometimes supposed to be wholly blind to their danger, when they are really fully aware of it. They perhaps speak occasionally of what they will do if they get well, and allude to the expected effect of remedies, as if they supposed that they would overcome the disease, and dwell, in their conversation with their friends and with the physician, upon the favorable symptoms that may appear. All this may, and often does, occur in cases in which death is almost certain to be the result; and yet it is entirely consistent with the existence in the mind of the patient of a rational view of his danger. I remember well a respected friend, who talked of hope and relief now and then almost to the last; and yet, from day to day, he was making such preparations, even to the framing of his will, as showed that, on the whole, he believed this to be his last sickness.

We are not to confound these occasional expressions of hope, these fitful and momentary states of mind, with the settled conviction of the understanding often existing behind all this. The promptings of the natural desire for life are ordinarily not utterly destroyed by the sure prospect of death. There will be moments when this instinctive love of life, and of whatever in life has ministered to the happiness of the sufferer, will turn off his thoughts from the contemplation of death, and call up by association a thousand objects of endearment.

“For who, to dumb forgetfulness a prey,

This pleasing, anxious being e’er resigned,