How Long Have I Got, Doc?

Hi Dr Ryen. 

I just had a question about how doctors figure out how much time a patient has left to live. No offense, but it seems like you’re wrong a lot of the time. My grandma was told she was going to die of pneumonia twice, so the whole family gathered to say goodbye, but both times she perked up a couple days later and was eventually discharged home. I mean, it’s great she’s still alive, but flying out for an emotional goodbye isn’t exactly easy.

 - Sueanne, Grand Rivers, KY

Sueanne, your grandmother’s situation is more common that we like to admit. It seems everyone has a friend or family member who defied the medical odds. That’s because a patient’s prognosis (i.e. how their medical condition is going to turn out) is subject to a million different variables, some of which are impossible to predict. Medicine isn’t always a hard science with black-and-white answers. Instead, it’s a game of probabilities, so predicting when a patient will die is notoriously tricky. Every doctor has stories of when they got it completely wrong. Including me.

A few years ago, I was at a rural hospital managing an old farmer with severe pneumonia. Things were looking bad and I was convinced he wouldn’t survive the night. The family was called in for final goodbyes and a bedside vigil. Imagine my surprise when I arrived to fill out his death certificate the next morning and he was sitting up in bed, having just finished breakfast. Flabbergasted, I managed to stutter, “Uh, hi Bob. How do you feel?” To which he responded, “Oh, with my fingers, as usual.” Everyone in the room roared with laughter. “Well, he’s definitely back to his normal self!” Didn’t I feel sheepish.

Unfortunately, the opposite also happens. Another time I was in the ICU caring for a woman in her 60s who was on life support also because of a severe case of pneumonia. Thankfully, the worst seemed to be over: her lung function was steadily improving, and she was awake and communicating. I told her family she should be off the ventilator soon. All was good, until suddenly, it wasn’t. For no apparent reason, her oxygen levels crashed and her organ systems started shutting down one after another. Within a day she had died. The family’s shock at her sudden passing made their grief that much worse. I felt awful about the false hope I’d given them – her inaccurate prognosis felt like my own personal failure.

To make matters worse, miscommunication between a medical team and a worried family is very common. What a doctor says and what a family hears is not always the same thing. For example, “Your dad’s heart is very sick. I’m guessing he doesn’t have more than a few months to live, if that.” But when the news gets shared to the rest of the family, it comes out as, “The doctor gave Dad three months.” If he dies before then, the family is shocked, but if he’s still alive seven months later, it’s a miracle. Either way the doctor looks silly, even though the three month prognosis was never intended in the first place.

So, please don’t hold an inaccurate prognosis against us, whether intentional or not. A full recovery may be expected, but tragedy still strikes. And death may seem all but certain, but sometimes a patient keeps on breathing against all odds. There are no absolutes in medicine, just probabilities.

Remember my patient Bob who looked fine the next morning? Six months later he was gone. So, in terms of your grandmother, I’m glad you made the trip to say goodbye, even if it was premature. Nobody knows for certain how long she has left, including her doctors.

© D. B. Ryen Incorporated, September 2023.  

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