You Can’t Make a Silk Purse Out of a Sow’s Ear
F. Amos Bailey, MD Dec 7, 2021
“You Can’t Make a Silk Purse Out of a Sow’s Ear" is one of the many Southern aphorisms that I grew up with. It comes to mind recently with several difficult deaths that we have had this last year. Richard Leiter (2021) wrote about a difficult patient care situation in a NEJM Perspective “A Good Death?”. In his essay, he recounts that he and the team thought that they would be able to support a patient to have a Good Death and celebrate his 85th Birthday Party early on their Palliative Care Unit. In fact, they did have the party and the patient and family were grateful but still, difficult pain and delirium had to be managed that ultimately lead him to question was this “A Good Death?”
Karen Steinhauser and colleagues (2000) wrote eloquently about the search for a good death. The take-home message from this article was that physicians identified biomedical challenges as the only domain to address when assuring a good death, while all the other participants (consisting of patients, families, nurses, social workers, chaplains, and hospice volunteers) identified psychosocial and spiritual domains as most important. Although I appreciated their article and the helpful findings I was always bothered by the title “Good Death”. Should Good and Death be next to each other? Was that even possible? Wasn’t this trying to make a Silk Purse from a Sow’s Ear?
This doesn’t mean that we shouldn’t try our best to support patients and families who are nearing the end of life. Goals of Care conversations are important. Pain and symptom control are vital and there are so many other domains that people will need support with. However, we all must be humble. Death is scary, messy, difficult and we mere mortals have limited control.
Therefore, we do best when we work as a team and that team includes patients and families.
Leiter, R. E. (2021). A Good Death?. New England Journal of Medicine.