The Search for Dignity : Elderly Tell Future Doctors What They Expect From Medicine

Dorothy Wallace, a retired hospital administrator, is going to be honest. We are talking about doctors. Many people Dorothy’s age have had a lot of experience with doctors, not all of it the stuff of happy tales.

“There is a coldness,” Dorothy says. Then she cups her hand around her mouth and lowers her voice a bit.

“Surgeons are the worst. They do their work and they depart. They take dignity from the patient.”

Dignity is why Dorothy and scores of other older men and women are here this morning on the campus of UC Irvine. They are all at least 65 years old. The Question looms.

Why does the dignity accorded a patient seem to decrease when that patient grows old? This is not algebra. This is reality, and it is not right.

The second-year medical students are coming now too, straggling in a little late. They have finals this week. Still, they are required to be here if they want to earn the title of M.D.

Their elders, all volunteers, come because it is the quality of their medical care, and of those that will go after them, that is on the line.

Wes Pearson, 77, has just arrived. “What’s today’s topic?” he asks.

“Ethics,” someone says.

“Can we talk about Keating?” Wes shoots back. This gives everyone a good laugh. Charles Keating just turned 68 himself, the old crook.

This gathering has a name, Senior Partners, but that is not all that important. Formality is left outside. The idea here is to promote understanding, then make that blossom into compassion as well. Old doesn’t mean stupid and it doesn’t mean one foot in the grave.

UC Irvine was the first medical school in the nation to put such a program in place. It started here in 1986 and it is drawing raves.

Dr. Jerome Tobis, chairman of the bioethics committee at UCI Medical Center and professor of physical medicine and rehabilitation, is steering the talk in one of the 10 small discussion groups today. He is 76 years old.

Back when he was in med school--he graduated in 1944--he says there weren’t any courses in medical ethics, and doctors never even discussed such things among themselves.

“In ethics, there are no people who know the answers,” he says. “We are all equals when it comes to this subject.”

This is wisdom that is especially important to share today. In this group, nobody can pull rank, regardless of professional stature and regardless of age.

We are talking now about the end of life. These days a “natural death” can become a contradiction in terms. Who should decide when, or how, a patient dies? The patient, the doctor or a machine?

And how far should a physician go to end a patient’s pain? Should a doctor kill?

“When I went into nursing, people died of pneumonia,” says Jenny Oberschlake, a nurse at Hoag Hospital in Newport Beach. “It was ‘the old people’s friend.’ ”

The older heads around the table nod at that. They are remembering the days when you lived a full life and then you died at home in bed. There weren’t any legal papers to sign.

Now a new federal law says hospital patients must be given the right to decide under what circumstances they will live, or die.

“I had a friend who was dying of cancer,” says Myra Brown, 72. “She was at home, with a nurse, all covered up. I went to see her, to say goodby. I said, ‘I thought you were going to commit suicide.’ We talked about it. She was, but suddenly it got too late. She was waiting for the right time, but then one morning she couldn’t get up . . . .

“All my friends, they are worried about their pills, about getting their supply. They say, ‘How do you keep pills fresh?’ They are not ill. We run around, play tennis. But they all have this in the back of their minds. They want to kill themselves before it gets too bad.”

“If you were a physician, would you help someone to die?” student Greta Perez, 27, asks.

“Yes, I would,” Myra says, jumping in emphatically even before all the words are out of Greta’s mouth.

Greta has already said that she, as a future physician, has “trouble” with going that far. Student Mehran Kadhodaei, 28, feels that way too.

“I believe in God and I believe that only he takes life away,” Mehran says. “Once you start helping people kill themselves, you open a big can of worms. Where do you stop? There are a lot of crooks out there.”

Mehran tells the story of his grandfather in Iran. He had a stroke. He wanted to die.

“He was screaming to my father: ‘Why don’t you bring me opium so I can overdose!’ I will never forget it,” Mehran says.

He says his grandfather, while suffering more strokes, seemed to fall into a comfortable existence after that. He enjoyed his grandchildren. He would smile.

So would this experience color Mehran’s views about future patients who might want control over their own deaths?

“I see my own prejudice in it,” he says. “I really do. I admit it. I wanted my grandfather around.”

Later, he adds this: “I’ve come to respect people’s rights (to take their own lives). Before hearing people talk about it here, I was even more prejudiced against it. But I’m still not going to do it.”

“Many years ago,” Dr. Tobis says, “I had a colleague who killed a patient deliberately. This woman was very dear to him. Her cancer was very far advanced. She was in great, great pain. She begged him for help. So he decided to give her a large dose of morphine.

“At the time he told this to me, I was shocked. In retrospect, I think it was an act of mercy. . . . Obviously, it was illegal; he would have been prosecuted if it had become known. So these are very real issues for physicians too.”

Then student Barbara Boutelle, 29 and pregnant with her third child, asks her future colleague if he would ever actively help a patient to die.

“I think under special circumstances,” the doctor says, pausing just a bit. “If I were very close to this person. If the suffering were very great and I felt that all the medical interventions were only adding indignities . . . I could conceive of doing it.”

“But would you be doing that as a doctor or as a friend ?” someone else asks.

Dr. Tobis doesn’t answer, perhaps because it is impossible to know.

Friend, patient, doctor. The lines blur when personal dignity is not lost. This is a lesson that will last far beyond medical school. And, really, it has nothing to do with age.