insights from Dr. Sunita Puri, M.D.

Last week my wife told me about a live chat being held by someone she follows on Substack (Dr. Lucy McBride). She was going to be interviewing Dr. Sunita Puri who is the head of Palliative Care at USC Medical school. I was super excited to hear her speak not only because she’s a shining star in the end-of-life community (she just wrote an amazing article for the New York Times titled “Living to Die Well”) but also because she’s from my alma mater (FIGHT ON!) where my brother is finishing his fellowship in Cardiology.

As I listened to her and Dr. McBride discuss end-of-life in the context of the medical environment, I was truly blown away by so many of the things she said so eloquently and insightfully and I wanted to share them here with all of you. This is someone who, day in and day out, is living with the dying. I can’t imagine a better person to listen to about this subject than someone who is walking the edge with her patients every single day. These are from notes I took during their discussion, so may not be verbatim, but I wrote them down to the best of my ability.

“Reversing a death is not the same as restoring a life.”

Read that again. Reversing a death is not the same as restoring a life.

This really reminded me of something that I (and I am sure many others) have said before… “being alive is not the same as living.” I think sometimes we can get so determined not to lose someone (or ourselves) to death that we fail to consider that there is a world where living can actually be worse than dying.

This is something that I have often reflected on after completing my death doula course with Alua Arthur at Going with Grace. She asked us to consider this very question, “what state of living is worse than dying?” I think sometimes we are so afraid of dying that it becomes the enemy, something to fight against and defeat at all costs, and in doing so we are actually missing the whole point of living. We are not here to fight away death. We are here to live fully until we die. And sometimes there’s a world where death is the much more merciful option for the patient, the family, the care team - everyone involved.

“Let’s use Allow Natural Death (AND) instead of DNR (Do Not Resuscitate). Allow Natural Death implies an unfolding, not a withholding.”

Words matter. The way we talk about death and dying has an impact on the experience of it, for the patient, their family and friends and everyone around them. I love the way Dr. Puri articulated the difference between these two phrases that essentially mean the same thing but elicit completely different internal reactions and feelings.

I think moving to using A.N.D. instead of D.N.R. completely flips the script. Dying is the most natural process in the world. The body knows how to die (much like it knew how to be born). And sometimes we just need to allow the process to unfold. Not stepping in to alter or change the path that is being walked is sometimes the right thing to do. Shifting to this idea of a natural unfolding instead of a withholding of care I think could bring so much peace to patients and their families.

“I would rather tell you an ugly truth than a pretty lie”

Preach!

What I really loved about this conversation between two doctors was their acknowledgment that discussions about death and dying are hard for them too. It’s never easy be the one who is the bearer or bad news, or to have to be the reality check.

Also, the role of the doctor is to heal. To do anything and everything in their power to make someone better. Doctors are smart, well-trained and committed human beings, but they are human beings after all. They aren’t all-knowing, they can’t perform miracles, they can do everything “right” and it still may result in a bad outcome.

I think because they are often seen as the last and only hope, they often don’t want to be the ones laying out the sad and unavoidable truths. But when we delay or avoid reality, our hearts might be in the right place, but we can often do more harm than good. It’s important for patients and their families to be given the truth — even if it hurts.

I’m grateful there’s a truth-teller like Dr. Sunita Puri in the world. Someone who speaks with such kindness, honesty and mercy. The world is better because she’s in it, and I will to continue to share her words and insights with my community in the hopes of spreading her important message. You can check out her website where you can learn more about her, her work and her book, “That Good Night.”