A board certified emergency medicine physician for over 20 years, Dr. Charlotte Charfen had to get comfortable with death. “I think people have a perception that emergency medicine is all about saving lives and don’t actually recognize that a lot of the work we end up doing in the ER is helping people die,” she says. “And in general, we’re kind of taught death is a failure, especially in my specialty.”
Charfen, known to her patients as Dr. ChaCha, began to grow frustrated that she was so frequently the one having end-of-life talks with patients. “I wondered why the heck their oncologist hadn’t explained to them what terminal cancer was. But I got really good, really quickly, at actually having those open and hard discussions. So everything I learned, I really learned from my patients and their dynamics,” she says.
Shortly before relocating to Hawaii five years ago, Charfen started feeling the urge to do something outside the emergency department. Also a writer, an exercise her publisher made her do provided some clarity that what she really loved was working with people at the end of their life. “And as soon as I stepped into the emergency departments here in Hawaii,” she recalls, “I had three of the most intense end-of-life cases that I’d ever had in my career, cases that really pushed my boundaries. Truly, they taught me a lot.”
A year before Hawaii passed its medical aid-in-dying (MAID) law — which she has recently been active in efforts to try and improve — Charfen launched the nonprofit Life & Death Wellness to teach people about end-of-life issues and how to support someone who’s dying. Once the law passed, she wanted to understand MAID better, as patients had been inquiring about the practice even before it was an option for them. “But there was no one here for me to ask,” she says. “Nobody had the experience. That’s when I reached out to Compassion & Choices. I called the Doc2Doc line. The medical director called me back almost immediately. Wow, what a wonderful human. He really walked me through the law. Here I am, this novice, not understanding, and he totally normalized it. Then it was probably a week later that I got my first request.”
Charfen was the first doctor on any neighboring island in the state of Hawaii to write a prescription, and she is still one of only three who provides this service. The stories she heard about what some patients went through trying to access the law made her even more passionate about being involved. “I became not only an attending physician for many patients here on my island, but I also kind of stepped into the role of educating physicians about it, really trying to enlighten the community. I get so much joy and gratitude being in a space where I can offer some kind of comfort, whether that’s medical aid in dying, or talking about hospice, something. Because just to be able to sit with somebody and allow them to openly discuss this- people don’t simply realize how incredibly helpful that is.”
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