Los Angeles doctor Ken Murray first started thinking about how doctors die roughly ten years ago, when a physician he knew passed away.
"He had died at home and it occurred to me I couldn’t remember any of our colleagues...who had actually died in the hospital," he says. "That struck me as quite odd because I know that most people do die in hospitals."
Murray then began talking about it with other doctors.
"And I said, 'Have you noticed this phenomenon?'" he recalls. "They thought about it and they said, 'You know? You’re right.'"
Five years later, the retired family practice physician shared his observations in an online article entitled, "How Doctors Die." It quickly went viral. In it, Murray told the world that doctors don’t typically die like the rest of us and he doesn't plan to, either.
"I fit with the vast majority of physicians that want to have a gentle death and don’t want extraordinary measures taken when they have no meaning," he says.
Last year, Stanford University Medical School published a study showing a similar finding: 88 percent of 1,081 doctors surveyed said they would not want aggressive treatment or resuscitation if facing a terminal disease.
Murray and others say that many Americans might alter their approach to end-of-life care if they were aware that most doctors feel this way.
'I felt like I was beating people up'
Dr. Kendra Fleagle Gorlitsky says her opposition to heroic measures is based on some of her early clinical experiences.
"I felt like I was beating people up at the end of their life," says Gorlitsky.
In particular, she recalls the anguish she felt performing cardiopulmonary resuscitation on elderly, terminally ill patients - which looks nothing like what is usually portrayed on TV medical shows. In real life, ribs often break and few survive the ordeal.
"I would be doing the CPR with tears coming down sometimes and saying I’m sorry, I’m sorry, goodbye," Gorlitsky notes. "Because I knew it very likely was not to be successful. It just seemed a terrible way to end someone’s life."
Gorlitsky, who practices family medicine at California Hospital Medical Center and teaches medicine at USC, says that’s when she realized she wanted something different for herself and her loved ones. And while a majority of seniors nationwide report feeling the same way, by and large that's not how many of them die.
A 2013 study of Medicare patients found that while most want to die at home if terminally ill, two out of three die instead in nursing homes and hospitals, often while hooked up to life support machines.
So why the disconnect? One reason, says Dr. Babak Goldman, is too few doctors are trained to talk about death with patients.
'We're trained to prolong life'
"We’re trained to prolong life," says the palliative care specialist at Providence Saint Joseph’s Medical Center in in Burbank. "So it’s hard for us to say we failed... Or to let a family down. I think it’s sometimes easier to give hope than to give reality."
Goldman read Murray’s essay as part of his residency training at the University of Texas. Goldman says he too would prefer to die without heroic measures and he believes that knowing how doctors die would be helpful for patients and their families facing these decisions.
"If they know that this is...what we’d want for ourselves and for our own families, that goes a long way," he says.
Los Angeles freelance writer Nora Zamichow agrees.
She says if she and her husband, Mark Saylor, had known how doctors die, they may have made different treatment decisions for him at the end of his life.
Zamichow says Saylor, a former editor at the Los Angeles Times, was active and wanted to preserve his quality of life for as long as possible. But doctors recommended an arduous regimen of chemotherapy and radiation to treat his inoperable brain tumor. Zamichow says that treatment left him unable to walk and ultimately bedridden in his final weeks.
A family portrait of Nora Zamichow, husband Mark Saylor and their daughter, Zia Saylor. (Photo by Robert Gauthier, courtesy of Nora Zamichow)
No doctor said, 'What about not treating?'
"At no point did any doctor say to us, 'You know, what about not treating?'" recalls Zamichow, a former Los Angeles Times staff writer who has chronicled her experience in several essays.
It wasn’t until Saylor was in hospice that Zamichow discovered Murray’s essay. After reading it, she says, she realized doing less likely would have offered Saylor more in his final days.
"What Ken’s article spelled out for me was, wait a minute, we did not get the full range of options," Zamichow says.
But knowing how much medical intervention at the end of life is most appropriate for a particular person requires wide-ranging conversations about death.
Murray says he hopes his essay will spur more physicians to initiate these difficult discussions with patients and families facing end-of-life choices.