How Doctors Die 646
Hugh Pickens writes "Dr. Ken Murray, a Clinical Assistant Professor of Family Medicine at USC, writes that doctors don't die like the rest of us. What's unusual about doctors is not how much treatment they get when faced with death themselves, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves because they know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. 'Almost all medical professionals have seen what we call "futile care" being performed on people,' writes Murray. 'What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, "Promise me if you find me like this that you'll kill me."' Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming."
The Sanctity of Life (Score:5, Insightful)
It's traditional to see life as a sacred thing that must be preserved at all costs--to a point. There was a balance. This has been true throughout human history, with the exception that in the past couple hundred years we seem to have collectively forgotten that in order for life to go on something else has to precede it in death. In an era of ever-increasing lifespans, global populations and expectations of one's quality of life, we are engaged in a losing game against the power of exponential arithmetic.
When it's time to go, it's time to go.
Re:The Sanctity of Life (Score:5, Insightful)
Re:The Sanctity of Life (Score:5, Interesting)
The catch is, some of those extraordinary treatments are as likely to hasten death as they are to prolong life. Even where that doesn't happen, would you rather have 8 good months mostly free of pain or would you like a year in agony confined to a hospital bed.
Re:The Sanctity of Life (Score:4, Insightful)
Sorry, no giggling due to the agony. You can have the remote, but the odds are you won't be able to follow what's on TV even if you try. We can crank up the morphine until the pain stops but you won't likely last more than a day once that happens (as pain increases the effective and lethal doses of opoids approach each other. Eventually the effective dose exceeds the lethal dose).
Sorry to be the bearer of bad news, but that's just the way it works.
Re:The Sanctity of Life (Score:5, Insightful)
Fine by me, as long as you pay for it all yourself.
Re:The Sanctity of Life (Score:5, Insightful)
haha, I can tell you that statistically the manner of your death will be that you won't have either the energy or you won't have the time to do any kicking and screaming. There will be no bionic help for you, either. You'll just die, badly. Have a miserable time dying, like the rest of us.
Re:The Sanctity of Life (Score:4, Insightful)
You don't know that. Nobody knows until they're actually faced with the situation. When you're old and tired and in pain you may well have an entirely different outlook than when you're healthy and strong. If at that point science can offer something that restores vitality rather than just prolonging life, of course everyone would like that. That's not a strong statement. It's the hanging on to a painful existence that's in question.
Re:The Sanctity of Life (Score:5, Insightful)
The problem is that you will not get painless "bionic body parts". You will be strapped to a bed with tubes in every orifice (plus a few new ones) giving you a toxic mixture of chemicals carefully designed to bring you just to the point of death but not beyond. This is a recipe for maximum pain. You will live out your last days as a medical experiment at maximum cost, maximum pain and no freedom.
Believe me. I have seen this and had patients and friends go through this... you do not want this to happen to you. (Yes, I am a doctor.)
Re:The Sanctity of Life (Score:5, Insightful)
I find it interesting that many people just substitute Heaven with Outer Space and God with science. I'm not saying I frown on this, just that it is interesting. I also find it odd that people want to live longer than 70 or 80 or even 100 years. Why? I am now in mid 30's and I find myself getting angry and bitter over the changes happening in society. Soon, I'll become the stereotypical angry old conservative. Given the nature of politics, power and money, the longer you are on top, the harder it is for the new generation to remove you. Do you really want a gerontocracy? I want to make my mark in my career, raise balanced functional kids, accumulate enough wealth to bequeath to them and then DIE in contentment. Mankind thrives on the random re-assortment of genes and on the new generation overturning the old. Give us immortality and we will stagnate.
Re:The Sanctity of Life (Score:5, Insightful)
will likely live for a very... very long time...
"People want to live forever, but they don't know what to do with a cloudy Saturday afternoon." — Don't really know who.
Re:The Sanctity of Life (Score:5, Insightful)
When it's time for you to go, it's time for you to go. When it's time for me to go, I'm going out kicking and screaming with every bionic body part science has to offer. I don't care if it's "Natural" to die. I'm going to do my very best not to. We do not have to perish, science has the answers. Maybe it's a bit too early for us, but my kid... or my grand kid will likely live for a very... very long time... Yes, we're running out of room, but there's always room in the rest of the solar system. The meek shall inherit the earth, the brave shall inherit the stars. Have fun dieing.
I'm a doctor myself and so I've been around a lot of death and disease - especially cancer. With all due respect, you won't really know what you'll do until you're faced with the actual situation. And what you will do depends ENTIRELY on your situation and your life experience. You're imagining a scenario where treatment results in a significantly longer survival with all your physical/mental abilities left intact and undamaged - essentially a cure. That's an easy choice. Unfortunately, this is NOT the case for many of the diseases that this author is talking about - particularly many types of cancer.
Your post makes me think that you are young and have not yet had someone close to you suffer from a terminal disease. It is particularly naive to state "We do not have to perish, science has the answers." Life experience will eventually teach you that this is just flat out wrong. You are perhaps forgetting that sometimes, the price to stay 'alive' (heart beating, lungs breathing) means sacrificing your actual *life* e.g. going outdoors and enjoying the sunshine, eating your favorite foods, traveling someplace you've always wanted to see, having some beer with some old friends, etc.
A slightly longer life is of little value if you end up living less. But perhaps you would make this choice regardless and that's fine too. Is it brave? After all, it's easy to be "brave" about something you haven't experienced. And I don't think it's braver than those who choose to accept their death and want to be able to do more with the time they have left.
Re:The Sanctity of Life (Score:5, Insightful)
There was not any balance. What was there an utter incapability to deliver any meaningful treatment to serious cases, so anyone who got seriously ill just died and they could not do anything about it. Now, we can do more: some can be cured completely, others can have a partial recovery, others can have their agony extended. It's - to a degree, mercy killing did exist, but it was not something that a common man would do - a new situation that previous generations did not have to deal with.
I want to die peacefully in my sleep like my Dad (Score:5, Funny)
But all kidding aside, I agree that the so called "futile care" exists for the patients loved ones and not the patient themselves.
Re:I want to die peacefully in my sleep like my Da (Score:5, Funny)
IT has something similar. Everyone of us has experienced it.
Poor bastard brings in a laptop with that forlorn look on their faces. "Dude... save my porn". You boot up and the drive is not recognized. Take it out, hook it up it for diagnostics and it is dead. No S.M.A.R.T status, nothing. You gently touch the drive and there are no RPMs .
You sit him down, and explain carefully, that the drive is dead. It could have been overheating from leaving the laptop on the bed while going to town with that whole bottle of hand lotion.
There is an outside chance, experimental even, that you could open the drive and transplant it into a working one. The transplant waiting list is not just long, but extremely expensive and not guaranteed. (I had one guy explain to me that the platters looked like an airplane came in for a hard landing and scratched the whole surface deeply).
He leaves laptop in hand, tears freely flowing, and you look to your buddy and tell him, "Dude if I ever lose my porn like that just kill me". Then you remember that you have knowledge and it is protected with ZFS and scrubbing. Thank God.
Re:I want to die peacefully in my sleep like my Da (Score:5, Insightful)
Well, I'm not entirely sure on that one. First, there are disputes over how to even perform CPR for maximum effectiveness, with some saying that chest compression alone produces better outcomes than a mix of chest and breathing. If the doctors aren't in agreement over what CPR should be done, and different methods are being rolled into a single line item, then the statistics for the outcome really don't mean anything useful. It tells you that *something* is ineffective, but it cannot tell you what that something is.
Second, all doctors either swear to the Hippocratic Oath or implicitly sign up to it by becoming doctors. Since the Oath is witnessed by an independent third party, it is arguably a legally-binding common law "gentleman's agreement"/"verbal contract". Technically, the Oath states that doctors should do no harm and minimizing suffering is technically doing just that. However, very few Western nations interpret things that way. If they did, assisted suicide under well-defined conditions* would be legal. It isn't because they don't. As such, doctors end up in a double bind. Do they do the clinical least harm or the legal least harm? Whichever one they do, they violate the other.
*I am not a fan of assisted suicide, but the only way to bring the ethics and law together is to have some cases where it is legal. IMHO, the Oath should move from common law to contract law and be the defining standard. It's a "floating" standard, since different levels of technology and understanding will alter what least harm is actually achievable, and it is a far more credible benchmark than the religious and political whims of the day.
Re:I want to die peacefully in my sleep like my Da (Score:5, Informative)
1) Not all doctors take the Hippocratic oath. I am a doctor, and while I appreciate the sentiment behind the oath, I did not swear it myself.
2) There a many different forms of the "oath". Nobody today takes the oldest know form, which of course is likely not the "original" (it is unknown if Hippocrates actually was involved in the original oath anyway). Did you know that the original oath prevents a physician from performing urological sugery, abortions, or assisted suicides? And did you know the original oath required the oath-takers to give free medical care and support to their teachers for life?
3) Medical ethics has moved way, way beyond this simplistic and confusing Oath as the end-all-be-all. Re-adopting it would be like swapping out the laws of England with sharia law, or even the ten commandments.
Bringing up "the oath" is entirely irrelevant to the discussion and is a red herring. It would also be a big step backwards to include it in physician training in the future, except as a historical curiosity.
Re:I want to die peacefully in my sleep like my Da (Score:5, Insightful)
You mean this one:
Taken absolutely literally, it only forbids one kind of abortion. I would interpret this, in light of "I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous" to mean avoiding any kind of abortion that is likely to be destructive to the patient, but that any kind that is likely to be helpful to be entirely legitimate. The requirement of being for the benefit of the patient is, IMHO, the ruling clause and all others are contextual interpretations of it.
Urological surgery, the Oath states, should be performed by a specialist. I don't see any technical problems with this -- I wouldn't want a GP to be performing it either. Surgery is best left to surgeons, as the Oath says. ("will leave this to be done by men who are practitioners of this work"). General Practitioners are not brain surgeons, heart surgeons, urologists, etc, and should indeed refer the patient to a specialist. (I don't consider surgeons to be doctors in the sense meant by the Oath. The Oath seems to make it clear that it is intended for village doctors making house-calls, or GPs in local practice, with similar but suitably-adjusted Oaths being required of those trained in highly specialized areas of medicine.)
Frankly, the Laws of England would be better served if attempts to revise or delete elements of Common Law were examined in light of the original intents of such law, and if both the Houses of Parliament and the practicing lawyers were familiar with the purpose of Alfred's Book of Dooms, the elimination of Sovereign Immunity in the Great Charter, and the reasoning behind the English Bill of Rights. Sure, nobody would want to revert to Saxon law, but the reasons for why it was what it was have changed surprisingly little. It was a careful balance of revenge, punishment and mercy, a balance a lot of modern laws don't have. We've progressed a lot in theory and can strike a much wiser balance today, but unless you start from the
Re:I want to die peacefully in my sleep like my Da (Score:4, Insightful)
Oh, and free education (as per Christ's Hospital in the UK, and universities prior to the abolition of the grant system) produced superior numbers of graduates with superior skills to the education produced by the "free" market of loans and deprivation. At this point in time, with the skills demanded by modern trades, there should be no such thing as paid tuition up to BSc level in most fields and MSc/MPhil in the medicines. 100% of students should be in school to 18 and 80%+ should remain in schooling until they complete either a university, technical college or trade school course of a "higher education" standard. What they learn would depend obviously on what they need, but you need to know more today, not less. There will always be a pyramid of employees, with people at the bottom working the hardest for the least rewards, and nothing can change that. Mechanization and technological improvements should raise that pyramid, though, not trim it. A greater population needs a greater range of opportunities and a greater set of skills to make use of them. Less is never more.
Re:I want to die peacefully in my sleep like my Da (Score:5, Insightful)
"First, there are disputes over how to even perform CPR for maximum effectiveness, with some saying that chest compression alone produces better outcomes than a mix of chest and breathing."
There is pretty close to ZERO dispute over how to perform CPR. Compression-only CPR is intended for untrained individuals who may be under stress; it's easier to just simply keep pumping than to keep track of "how many compressions have been done, oh, now it's time to take a breathe". The average person may be more reluctant to put their lips on a complete stranger; it's also more difficult to alternate between breathing and compressions if there's just one person available. Paramedics, EMTs, etc do both compressions and ventilation.
Re:I want to die peacefully in my sleep like my Da (Score:5, Informative)
http://www.webmd.com/heart-disease/news/20101005/chest-compression-only-cpr-saves-more-lives [webmd.com]
"There may be additional benefits to this method as well. The survival edge may occur because interrupting chest compressions --- even just for rescue breathing-- may further hamper blood flow, and it takes longer to get that blood flow back when it is time for more chest compressions, explains study researcher Bentley J. Bobrow, MD, of the Arizona Department of Health Services in Phoenix."
I'd call that a very reasonable dispute. If you have papers falsifying the hypothesis, please share the links. Otherwise, I think it is reasonable to maintain that there is a dispute over whether blood flow is more important than oxygen injection. You can achieve only both, to the satisfaction of the above hypothesis, if two people are involved (one involved in compressions, one doing the breathing on a periodic basis).
I'm not saying the doctor was right, wrong or purple, only that one of the researchers involved in the study disputes the interpretation that it is solely because of scare factor and that this makes it a significant hypothesis until disproven. It may have been disproven, and if so I'd like to see the evidence, but no amount of pointing to paramedics, St. John's Ambulance, etc, will convince me that a counter-claim by a knowledgeable person was not made and that it should not be taken seriously. Habits die hard and most paramedics were trained prior to 2010, so without actual hard medical evidence I cannot tell from modern practice whether practice is governed by the knowledge now or the knowledge of several decades ago.
Things change, things evolve, but not all practitioners change and evolve with them.
Re:I want to die peacefully in my sleep like my Da (Score:5, Informative)
I was told that applying oxygen along with chest compressions is better than compressions alone.
However...and this is important...911 operators who are trying to coax someone into giving CPR can usually get them to do the chest compressions, but all too often when the operator tells someone to breath into the dying person's mouth, the line goes dead, as does the person. When the EMTs arrive the person who was giving CPR will have faded back into the crowd. This was from an Austin EMT instructor.
Also, a nonskilled person might take too long switching from compressions to breaths and back, during which time overall blood pressure drops. It takes a while for pumping to boost blood pressure sufficiently to move it around to the brain, so the pauses to put more air in the blood can be worse than just moving around what little air is already there.
In other words, the science is pretty clear: oxygen with compressions is better than compressions alone. However, the sociology is in debate as to whether or not bystanders can be made to do things the better way, or if the less-good-but-better-than-nothing way is more likely to be implemented.
Re:I want to die peacefully in my sleep like my Da (Score:4, Insightful)
Well, I'm not entirely sure on that one. First, there are disputes over how to even perform CPR for maximum effectiveness, with some saying that chest compression alone produces better outcomes than a mix of chest and breathing. If the doctors aren't in agreement over what CPR should be done, and different methods are being rolled into a single line item, then the statistics for the outcome really don't mean anything useful. It tells you that *something* is ineffective, but it cannot tell you what that something is.
That's not actually quite correct. The current debate isn't about whether hands-only CPR is more effective than full CPR (It's not), the question is whether hands-only is more easily performed correctly than compressions/vents, and is, on average, going to be more effective as it gets performed in the field, add into that the fact that hands-only is easier and faster to teach, and maybe we'll have more of the population able to perform CPR, which means a decrease in time from arrest to start of CPR, which will always improve outcomes.
Second, all doctors either swear to the Hippocratic Oath or implicitly sign up to it by becoming doctors. Since the Oath is witnessed by an independent third party, it is arguably a legally-binding common law "gentleman's agreement"/"verbal contract". Technically, the Oath states that doctors should do no harm and minimizing suffering is technically doing just that. However, very few Western nations interpret things that way. If they did, assisted suicide under well-defined conditions* would be legal. It isn't because they don't. As such, doctors end up in a double bind. Do they do the clinical least harm or the legal least harm? Whichever one they do, they violate the other.
Well, here we get into bioethics, which is a tremendously involved field, but I'll just give the nickle tour of the applicable issue.
The big one is the notion of patient autonomy. The patient (or their appointed medical decision maker) gets to choose what happens, provided they are competent to do so. As a medical professional, it is my job to determine what course is most appropriate, explain it to the patient, and once they understand what's going on, what the pros, cons and risks of the treatment are, they give me consent and I do it, if they refuse consent, I find the next most appropriate thing...rinse and repeat. In cases where there are multiple courses which balance the pros/cons/risks, I present them all, and let the patient choose.
A couple of quick sidelines we need to explore here, in order to have a decent understanding of the beast.
First is consent, and the second is competency, and the two are very closely linked, so we're going to do them as one.
There are two forms of consent, implied and expressed, expressed is relatively easy, the patient says "Yes do that" or "No go away.", alternatively, actions can be interpreted as expressed consent, if I need to take someone's blood pressure, and when they see the cuff in my hand, they roll up their sleeve, that's expressed consent...this can, of course get a little murky, and is part of why I have to carry malpractice insurance, since if I do something a competent patient didn't want, even with the best of intentions and in the full faith that I had been given consent, technically, I've just committed battery.
Implied consent isn't nearly as clear cut as that. Implied consent is used when a patient for one reason or another is not capable of giving consent, it could be because they're unconcious (obviously not going to be telling me to go ahead), they're a child (You're not legally competent until you're 18, or a variety of rare loopholes), they're confused and disorientated (If you don't know where you are, you surely can't understand medical procedures) or they're in the midst of a psychiatric emergency (If you think I'm a giant talking turtle, you're not going to understand medical procedures.). In the care of implied c
What about their children? (Score:4, Interesting)
But what about when their child gets sick? Do they make the same decisions then? It is one thing to make those decisions on your own, but what happens when it is applied to someone else you care for?
I assume the results are different.
Re:What about their children? (Score:5, Insightful)
I am the son of a doctor, the grandson of a doctor and the brother of a doctor. I can assure you, physicians usually make similar choices for their family members' care as they would choose for themselves.
Unfortunately, they have to consider everyone else as a potential plaintiff.
Re: (Score:3)
IANAD, but I would hypothesize that doctors in general are smart people, and that smart people are more likely to be driven by reason and logic than make futile emotional efforts.
This is not true in the least part. Smart people are simply better at rationalizing their emotional decisions.
Re:What about their children? (Score:5, Insightful)
I am a physician.
I only take my children to another physician when I honestly think something is wrong with them. I argue with my wife constantly over it (I am not a pediatrician), as she wants them on antibiotics when they get the cold, etc. She wants to take them to a "real doctor". (FYI, I'm a cardiologist.)
My son has some medical issues and needs close care, but I stay out of the way of his team, and most of them (possibly all of them) don't even know I'm in the health care field.
I think you'll find my attitude towards my children's care to be fairly representative for my profession. Certainly it mirrors what I see in my colleagues and physician friends.
Re:What about their children? (Score:5, Interesting)
The only times i've been to a doctor outside serious injury was for mandated physicals and dental checkups.
Now I work in healthcare as well, and don't feel the need to take meds for minor problems that will clear up on their own.
-played in the mud my entire life
-never understood neosporin and band-aids (although i did need to use duct tape and paper towels to halt profuse bleeding on one occasion)
-never had an infection
-I get a cold/flu maybe once every 3-4 years and i don't take anything for it.
back to the original point
-I am not afraid of death
-I'm not going to need my organs once im dead
-I'm not going to need a $20000 coffin once im dead
When I die, take what you possibly can out of me, toss the rest into a pit in the ground, no need for the box, have a beer. <- that is how I want my funeral to go.
Re: (Score:3)
IANAD, but I would hypothesize that doctors in general are smart people, and that smart people are more likely to be driven by reason and logic than make futile emotional efforts.
It is more likely that doctors just have more experience understanding the consequences of excessive treatment on patients.
Regenerate? (Score:5, Funny)
I thought Doctors didn't die, they just regenerated? Unless of course they were killed while regenerating.
Re:Regenerate? (Score:5, Funny)
You're thinking of Doctor Who
Sadly, Doctor Who was not a documentary. Despite him being referred to as "the doctor" he is not representative of other doctors
Re:Regenerate? (Score:4, Informative)
1. Steven Moffat has officially declared that, when they get to the end of the 12th doctor, they will use a special esoteric procedure only professional writers know, called 'making something up'.
2. Did you never see Dr Who and the Curse of Fatal Death? That's four or five more doctors right there, so we're on #15 or so now. (My favorites among them are Rowan Atkenson and Joanna Lumley, both of which would have made great Doctors back then, but probably can't run nearly enough now.).
This is where western medicine has failed... (Score:5, Insightful)
Re: (Score:3)
The value that it seems you are seeking to describe is that life, being aware and conscious, is worth anything. What has slipped is that often awareness and mental faculty do not go hand-in-hand with physical homeostasis, and thus the Grandma scenario described. Modern medicine has concentrated on keeping our bodies alive without the same level of effort on keeping our minds sharp. In the extreme, we have wards full of comatose patients who are nominally healthy except that they lack the cranial capacity
Re:This is where western medicine has failed... (Score:4, Insightful)
The great majority of our insurance costs goes to support this type of 'care'.
It is a kind of financial suicide as well.
Re:This is where western medicine has failed... (Score:5, Insightful)
As a physician, I can tell you that many times I have faced patients that should have been given the chance to die peacefully, but the family have kept pressing me to "do something". Usually, I try to make them understand that at times like this it is best to just let Grandma die in peace and not prolong her suffering. Mostly I fail. And when after all the explaining the family keeps telling me to do something, I cannot disregard them (I do plan on keeping my license, you know?).
I don't think it's so much that western medicine failed, as it is that layman's expectations of medicine are unrealistic.
Had a personal experience on this one (Score:5, Insightful)
a patient suffers from severe illness, old age, or a terminal disease
Had one branch of the family that was real religious. Didn't believe in anything even *resembling* euthanasia. Insisted on keeping my aunt alive, no matter what. It was an ugly, sad end. Bad stuff.
Had another branch that had a much better attitude, IMHO. Had hospice care that was not afraid to push the painkillers well into the dangerous zone, a "do not resuscitate" understanding with the hospital, etc. My cousin's mother died a *much* more noble death.
Can't stop death from coming. And there is a time to fight for life, but also a time to recognize when the fight is over.
Re:Had a personal experience on this one (Score:4, Insightful)
Had one branch of the family that was real religious. Didn't believe in anything even *resembling* euthanasia. Insisted on keeping my aunt alive, no matter what. It was an ugly, sad end. Bad stuff.
Now I've never understood that. What happened to "God's will be done"?
Force a woman who has been raped to carry her attacker's child to term? Sorry, it's God's will.
Couple can't get pregnant? Well, it's God's will that they get IVF, hallelujah, it's a miracle!
Terminally ill relative? God's will is that they have to be pumped full of drugs until their body just plain gives up.
I don't get it at all.
Re:Had a personal experience on this one (Score:5, Insightful)
Now I've never understood that. What happened to "God's will be done"?
That's always bugged me too. I heard a joke once that best describes that attitude...
A man has slipped and fallen halfway down a cliff by the sea and the old branch he is hanging on to is the only thing preventing him from falling to his death. He prays to God for help. A helicopter comes along and the pilot calls out "I'll lower a rope down, grab hold of it and i'll save you". The man says "No thankyou. I'm a man of faith, God will save me", so the helicopter flies away. A boat comes along, and the captain calls out "Push off from the cliff and fall into the water, i'll save you". The man says "No thankyou. I'm a man of faith, God will save me", so the boat leaves. A hiker walking across the top of the cliff calls down to him "I'm a professional abseiler, i'll come down and rescue you.". The man says "No thankyou. I'm a man of faith, God will save me", so the hiker leaves. A few hours later the man becomes tired and falls to his death. He ascends to heaven and meets God, and expresses his disappointment that God had not saved him. God says "I don't understand what happened... I sent a helicopter, a boat, and a professional abseiler..."
It seems to me that in a lot of cases God gets used as an excuse to justify people doing what they were going to do anyway...
Re:Had a personal experience on this one (Score:5, Interesting)
I feel the need to respond to this as a person that would be viewed as 'real religious'. I have had to deal with a similar situation twice in the last few years, once in my own home.
My father-in-law had been fighting a rare form of cancer for 10 years, and finally succumbed to it in January, 2009, after going down hill very fast in the last week or so of his life. As a family we chose to have home hospice come in and take care of him (and us) for the last few days of his life. We could have chosen to fight for him, but we knew it would be pointless and only cause him pain for what little time he had left. Instead he died peacefully in his home, surrounded by his family.
Last year, my wife and I found out that she was pregnant with our second child. At 20 weeks we found out the baby had a rare and fatal form of dwarfism. We could have chosen to go to a hospital with a NICU, so that when our daughter came they'd be able to whisk her away, put her under a heat lamp, put her on a ventilator, and perhaps extend her life for a few hours or days. Again, she would die in the end and we would not have been able to hold her for the whole time. Instead we went to our local hospital, with doctors and nurses who knew what was going on. We were able to hold her and love her for the 15 minutes we had with her while she was still alive.
In both cases, we chose to NOT go through extraordinary means to 'save' our family members. As Christians, we know that both of them were safe and will be in Heaven waiting for us. We miss them both, of course. But as educated, intelligent people, we knew that we couldn't save them here on Earth. We understood the pain they would go through if we tried. We also understood that we would feel pain and loss ourselves once they were no longer here.
I believe that those who choose to do that to their own family have not thought things through, or are in such a state that they are unable to. Or they don't want to deal with the coming pain of loss. Or they are so afraid of death themselves that they can't understand deal with it even in others. Or any number of other things. I don't think this has anything to do with whether somebody is 'religious' or not. It is a human thing.
Please do not assume that all Christians think as your one family branch did. There is a whole spectrum of people in any group. We are all human, and flawed.
Food for thought (Score:5, Informative)
Over 50% of health care spending goes to pay for the last two weeks of life.
Re: (Score:3)
Over 50% of health care spending goes to pay for the last two weeks of life.
You're often in pretty poor health right before you die.
This reminds me.... (Score:5, Interesting)
Of a neurologist who had a stroke, and wrote an article about it later. It was really amusing how she wrote about it. She knew what was going on, she knew the signs, hell, she was an expert. She called for help of course, but, she talked about how during it, she was having a rich internal dialog about the process... thinking of what functions were broken, how it was manifesting and how she experienced it....
I think that is a lot of it. Other studies have found that the groups who spend the most on healthcare at the end, and spend the most time in hospital beds prolonging life are... the religious people. Atheists are much more in line with doctors. Why?
My own hypothesis, which fits my own experiences to is... that belief in an afterlife, in the absence of other experiences (like working in healthcare and seeing people die all the time), lets people ignore death. It happens later, there is life afterwards, everlasting life.
Atheists and people who deal with death on a regular basis have no such excuse. As an atheist, I came to terms with the lack of an afterlife early. I remember being maybe 14 years old when I realized that I was going to die, that was going to be it....and even that.... I didn't want to spend my time in a hospital bed. I knew...then...at 14, that when the time came, I would want to just die, even if it meant taking my own life. Not a desire to kill myself now or anything depressing like that, but an affirmation that life will someday not be fine, and never be fine again, and that when that happens, I know I can check out.
I have talked with some people who struggled with suicidal thoughts, serious ones, not attention whores. A few said that when they decided how they wanted to die, and put together a cyanide pill or some such.... just knowing it was there was enough. Knowing that they could end it provided a sort of final resolution, a comfort that allowed them to move past it and stop thinking about it.
On the other hand, I feel bad for the very religious. Doubt is common, almost inevitable. How can you not be on your death bed and wondering if those stories were true? For a religious person to be wrong, could mean so many things, hell, a different religions hell.... what if you chose the wrong god? For me as an atheist, whats to doubt? If there is an afterlife, great....but a heaven one seems just as unlikely as a hell. We literally have nothing to worry about.
Re: (Score:3)
I think that is a lot of it. Other studies have found that the groups who spend the most on healthcare at the end, and spend the most time in hospital beds prolonging life are... the religious people. Atheists are much more in line with doctors. Why?
I think you've been looking at false religions. In my experience, religious people believe they have victory over death, and don't fear it. In fact, keeping someone alive artificially is more of an affront to "God's Will" than anything else. Those who are the most afraid of death are those who would advocate suicide & euthanasia, because they want to get it over with. Religious people don't fear it, therefore they let nature take its course.
For me as an atheist, whats to doubt? If there is an afterlife, great....but a heaven one seems just as unlikely as a hell. We literally have nothing to worry about.
Unless you're wrong, of course.
Re:This reminds me.... (Score:5, Informative)
Of a neurologist who had a stroke, and wrote an article about it later. It was really amusing how she wrote about it. She knew what was going on, she knew the signs, hell, she was an expert. She called for help of course, but, she talked about how during it, she was having a rich internal dialog about the process... thinking of what functions were broken, how it was manifesting and how she experienced it....
You are probably thinking about Jill Bolte Taylor's "Stroke of insight". She even made a TED talk [ted.com] about it
CPR can be awful (Score:5, Interesting)
Some years ago when my grandmother entered the final stages of her illness--and her life--her longtime physician issued a "Do Not Resuscitate" order. He informed us one afternoon that her end could come at any time. Because she was a religious person, we ensured that she received the appropriate religious rites. Then we settled down, quietly, to watch and wait with her. It was somewhat inspirational and comforting, as she began to "see" friends and family who were long gone and to speak with whoever she was visualizing. She drifted in and out of consciousness. Late in the evening she appeared to fall asleep, we left to get some dinner, and that's when the whole thing went out the window. Her heart stopped, and instead of just letting her go, the DNR order was disregarded, the resuscitation equipment was brought in, and the hospital staff set to "work" on her. It's brutal. It can be like beating up on someone. Fragile old ribs can be broken, the body is bruised, and there is a great deal of noise and pain.
They succeeded in restoring her heartbeat, and she lingered for another two days in pretty severe discomfort. The doctor was livid and handed out appropriate reprimands, but by then it was too late for my grandmother. She was robbed of what had been a peaceful end-of-life interval, and we were left with a boatload of guilt for taking a break and leaving her unguarded from the people who were supposed to be following her doctor's instructions and taking care of her.
Do what you can to safeguard your elderly relatives from this. It's brutal, violent, pointless, and turns a quiet death into a three-ring circus of pain for the victim.
Re: (Score:3)
What you describe is assault. Hopefully you reported it to the police plus filed a civil suit.
Re: (Score:3)
In the US, Good Samaritan laws protect health care workers from being sued for performing CPR.
Advanced directives are a must (Score:5, Interesting)
My mom did not have an advanced directive specifying what kind of care she wished to receive if she were unable to choose for herself. This made my decisions very painful and difficult. I remembered the conversations I had with her about her caring for her own patients and how sometimes the families of her patients would request extreme measures at the end of life, and how this would contrast with borderline neglect during the patient's life.
My mom also was opposed to assisted suicide. That much I knew. She felt life was a gift that shouldn't be wasted or rejected.
In my mother's case, it was clear that if she were to survive she would need to be on the ventilator for an extended period of time, and enough time would pass that she would deteriorate physically due to being immobile in a hospital bed. Also, she was in the early stages of Parkinson's and it was almost a given that this violent shock to her system would result in an acceleration of its effects.
Knowing that if she did recover her quality of life would be greatly reduced, I made the tough choice to let her go. One advantage of this was that I was able to hold hand, stroke her hair, and sing to her as she died surrounded by family. She was 73. I encourage everyone regardless of age to set up an advance directive determining the level of care they wish to have. It wouldn't have prevented my situation, but it would have made it easier if I knew ahead of time what mom wanted.
Re:Advanced directives are a must (Score:4, Insightful)
Health as a business compounds the problem (Score:5, Insightful)
It's not only a problem of unrealistic expectations by patients.
There is also a conflict of interest between the doctor's duty in the best interests of his patients and in the best interests of the medical practice that employs him. A principled doctor can stay on the honest side to a large extent, but take transparent honesty too far and your career prospects are threatened.
It's not really all that different to how it is in other professions. However, other professions don't have the same direct effect on human life and suffering, so the problem stands out a bit more in this discipline.
It's especially bad in a country in which the medical industry is extremely lucrative which has the inevitable consequence that medical insurance is astronomically priced. That turns everything into a money game, and the result HAS to be bad medical practice: after all, a doctor cannot offer the same level of service to a person without money as to one who is rolling in it, because if he did, what would the rich person be paying for?
Money distorts everything, but the effect is particularly harmful in the health profession.
There was just an article (Score:3)
A doctor's opinion: TFA's got it right. (Score:5, Insightful)
I'm a board-certified physician (among other things). There is no way that I would allow my colleagues to inflict the kind of death on me that they are forced to inflict on so many. Part of this is certainly that I know full well that we all exit this mortal coil toes-up, and there's no getting around it. Part of this is the personal reluctance to experience the diminished autonomy, indignity, pain,and hopelessness that comes with fanatically-treated terminal illness.
But a big part of it, I think, is just that I know that there are so, so many things that are worse than simply dying. Dying in agony, for one. Dying after having bankrupted my wife or my children. Dying after being reduced to a stinking thing in a bed long enough that only those who loved me most even want to be near me, and that only because they feel they must. Physicians see these things all the time, and we see the road that leads to them. We're not (that) stupid, and we would rather exit early on that road, not at its terminus.
As long as I have the capacity for joy I will strive to remain alive to experience that joy. When the capacity - or the joy - is gone for good, I have given quite strict instructions not only to my family but to some other clear-headed and insistent people who will do their best to ensure that I too will be gone without further "heroic" intervention.
The only problem that I have with the article is that it pretends that everyone should make the same decisions. Everyone has their own decisions to make, and without my knowledge and experience I might not make the same ones. I think as physicians we owe it to the people for whom we care to educate as well as we can and help them to understand why we might personally decide one way or another. But I will never tell them how they "ought" to decide - it's really their choice. Taking that choice away from a person leads too easily to very real outcomes that are much nastier than simply a life that ends later than it ought.
Re:Ken Murray's blog (Score:5, Insightful)
Bitter and angry, maybe. But also correct.
Re:Ken Murray's blog (Score:4, Interesting)
Absolutely, if we take your point of observation to be a fixed point. However, once you factor in MORE observations, concerning the movements of the moon, planets and stars, we must revise the assertion.
Re:Ken Murray's blog (Score:5, Interesting)
How about one of the author's nurses turning him over to the police for obeying a patient's desires to not be put back on life support? You think that doesn't support his notion that doctors suggest treatment plans with the specter of a police investigation in the back of their mind?
How about him keeping his cousin in his home after his cousin was found to be terminally ill? You think there isn't a difference in the cost of the bottle of pills they sent him home from the hospital with as opposed to forcing him to stay alive?
Have you seen what chemotherapy does to people?
Do you know the monetary and emotional cost of forcing a piece of meat to keep on breathing long after it's expired?
There's plenty of food for thought in this article, and you think geocentrism has something to do with it.
What the hell is wrong with you.
Re:Ken Murray's blog (Score:5, Informative)
How about one of the author's nurses turning him over to the police for obeying a patient's desires to not be put back on life support?
Actually, that isn't what he claimed. Even with just his side of the story, we know it wasn't that; a nurse fulfilled her mandatory reporting requirements because the paperwork wasn't there with him, as it normally would be. The system worked, the paperwork was checked and his wishes had been followed.
Actually it seems to be a picture of the system working, regardless of the doctor's view.
Re:Ken Murray's blog (Score:5, Insightful)
At the heart of the debate, most people think they can live forever. They think that death is unnatural, and if you can stave off the attack then everything will be OK. Let's say you have cancer. With treatment, you have a 10% chance of survival, but a much lower quality of life during treatment. Without treatment, there's a 0% chance of survival. If you assume you'll live forever if you survive (which most people seem to do), the choice is trivial, even if your life expectancy barely exceeds the time you'd have without treatment. The real answer should be very different for a 30 year old and a 90 year old.
This is why the system is geared towards resuscitations. It *sounds* logical - of course you want to resuscitate, right? His point is that unless a patient is young (80) and fit (not otherwise terminal), it might not be such a great idea.
The last days of life after being resuscitated are not likely to be enjoyable, for the patient or their family. They can "go peacefully", or with broken ribs, hooked up to life support (assuming they can't , as their family debates whether to finally switch them off. Even on the tiny off-chance that they do survive, they aren't going to live forever.
Doctors need to balance cost, quality of life, and length of life. It sounds inhumane to say that cost should be a factor, but it is, and people have to face that fact.
Re: (Score:3)
Coffee is bad for you, apparently. I recommend a nice healthy cup of tea instead.
Re:Ken Murray's blog (Score:4, Interesting)
Evidence isn't that strong, but yeah, there seems to be some positive effect [webmd.com], though not necessarily due to caffeine (seems to happen with decaf coffee also).
Re: (Score:3)
The only study I've seen to suggest this was deeply flawed by its reliance on self reported alertness levels. There is nothing to suggest that people who are used to caffeine do not simply have a higher base level expectation of alertness. In fact the research boiled down to "people that haven't had coffee think they're as alert as people who have had coffee."
Re:Ken Murray's blog (Score:4, Informative)
Then here's a better study for you: http://www.sciencedaily.com/releases/2010/06/100602211940.htm [sciencedaily.com]
Approximately half of the participants were non/low caffeine consumers and the other half were medium/high caffeine consumers. All were asked to rate their personal levels of anxiety, alertness and headache before and after being given either the caffeine or the placebo. They were also asked to carry out a series of computer tasks to test for their levels of memory, attentiveness and vigilance.
In that study, they used placebos so they didn't know whether they were consuming caffeine or not and had them perform objective tests. Conclusion: regular consumption of caffeine provided no net benefit.
Re:Ken Murray's blog (Score:5, Insightful)
Even if that is true, there is no reason to think that addition is bad per se, as long as there are not negative health or social effects associated to it.
Re:Ken Murray's blog (Score:5, Insightful)
"it takes more and more coffee just to reach normal alertness"
that would explain why my 95 year old grandfather who has been drinking coffee for 84 years, now drinks seven thousand five hundred and twenty one gallons of coffee each morning.
He started with one cup, one fine morning in 1927. And from there it just took "more and more coffee just to reach normal alertness".
Without it, it's like he's preserved in carbonite.
Thank you for your helpful explanation of the dangers of coffee.
I'm addicted to coffee (Score:4, Interesting)
Re:Ken Murray's blog (Score:4, Informative)
No, he's just conscious, and right.
I drink coffee maybe 5 times a year, if that. It just isn't my thing, but I know caffeine addiction from the absurd quantities of pop I used to consume. It's as strong an addiction as any other drug. One day, I tried quitting cold turkey - big mistake! I would get these killer headaches that no painkiller could beat, so instead I had to wean myself off, very gradually. I still go through a cycle in the afternoon, just a few hours after waking up, where I get very sleepy for maybe a half-hour - that's caffeine withdrawal! I'm not actually tired, it's a programmed nervous response.
Moreover, caffeine doesn't perk me up at all. I could chug a gallon of Jolt cola before bed and sleep like a log. I even tried using coffee once, to power through a 48-hour death march... didn't work! That tells me that I've been consuming so much excess caffeine since childhood, that my brain's receptors are just fried from overstimulation. A lot of people are like this, so it's just not some random conjecture to say that caffeine has negative effects.
Re:Ken Murray's blog (Score:5, Funny)
Re:Ken Murray's blog (Score:5, Informative)
Give cold-turkey an actual try sometime-- it's worth it. It's about two days of headaches (a couple of ibuprofen cover this nicely) followed by three or four days of slight drowsiness. Then you're good. And when you do get around to starting back up, it's SUPER AWESOME. I do this every few months-- usually when I find myself going for a third cup of anything caffeinated in a single day.
Re:Ken Murray's blog (Score:5, Insightful)
You don't have to be Morman to understand how addiction works.
No, but it does take someone who understands addiction to understand how addiction works. And it's pretty clear to anyone who who has ever regularly used caffeinated substances the parent poster isn't one of them.
Re:Ken Murray's blog (Score:5, Informative)
What he said is based on several studies (not conducted by Mormons). Here's one, just for example: http://www.sciencedaily.com/releases/2010/06/100602211940.htm [sciencedaily.com]
The study, published online in the journal of Neuropsychopharmacology, reports that frequent coffee drinkers develop a tolerance to both the anxiety-producing effects and the stimulatory effects of caffeine. While frequent consumers may feel alerted by coffee, evidence suggests that this is actually merely the reversal of the fatiguing effects of acute caffeine withdrawal. And given the increased propensity to anxiety and raised blood pressure induced by caffeine consumption, there is no net benefit to be gained.
Caffeine is highly addictive, and you cannot simply quit without severe side effects if you drink coffee daily. My boss tried to quit once years ago, and had the worst headaches of his life.
You can quit, but you have to ease off of it, not simply stop unless you want to experience terrible pain.
Re:Ken Murray's blog (Score:5, Insightful)
You really should read the article. It isn't bitter at all, and is some serious food for thought. If you've not had a close individual diagnosed with a terminal disease and this isn't applicable, then you're a very lucky person. If you have, the article raises some interesting arguments for how you or your loved ones should approach such news.
It has been two weeks since my father passed away from lung cancer, so I am more sensitive to the topic than normal, but the idea that we should more carefully evaluate how we want to live our remaining days/weeks/months when faced with aggressive, difficult treatment, is one worth thinking about.
Re:Ken Murray's blog (Score:4, Interesting)
My mom died from cancer when I was in highschool and my aunt was diagnosed with Stage IV cancer about a month ago. Though nobody has said it out loud, I think everyone in the family understands that my aunt is also going to die.
I still don't really know how to talk to someone who's going to die. It's...weird to talk about the future (which they won't be a part of), or to ask "how are you doing? (because they obviously aren't doing too well). We want to communicate care and support, but we also don't want to burden and tire out the patient by repeatedly calling to remind them that they're going to die. Is it better to confront the elephant in the room? Or to ignore it? It's disturbing to voice out loud the certainty of death, but it's also galling to bullshit someone by saying everything's going to be ok, when it's not.
What do you guys do in these situations? I'd especially like to hear the prefences of anyone who is dying or at one point believed that they were going to die.
Re:Ken Murray's blog (Score:5, Insightful)
Well, my sister died less than a week ago, and was fighting her cancer for about a year and a half. The conversations were pretty normal actually. I would ask how she was doing, not to bring up the impending death, but to see how she was feeling at that time. The chemo may be giving bad results, or not so bad. If she didnt want to talk about it then she wouldnt. We never really spoke about how dire the situation was for a long time, as she always had the perspective that it would pass like a bad flu. I wished that she had less treatment sometimes, as the days of recovery from medication took away more good days then she could have had with nothing, but she was insisting on remaining active and alive for as long as possible, and actually made a lot out of the days that she had. I made sure to do the fun things that we liked to do together, partially to distract her, and partially so I could have the memories now that she is gone. The important thing for me was to just continue to be alive with her. We got to have a lot of time that was just like always, but she made sure to fit in as much as she could. Dont ignore the situation, but dont focus on death ... focus on being alive.
Re:Ken Murray's blog (Score:5, Insightful)
You have my condolences and sympathies. I have similarly wrestled with those issues and simultaneously had a strong desire verbally destroy bullshit, and the purveyors of the bullshit. Within the hospital there is no lack for this. To cope I read the literature on cancer, at first simply looking for a definition. What is cancer? To the best of our knowledge, after roughly a century of study, it is still a fairly abstract definition that nearly applies as much to weeds in your garden as the tumors of cancer in a body: a malignant and invasive proliferation (growth) that may metastasize (spread). I suppose we can thank the biologists for the lack of meaningful technical specifications as much as the fact that there are thousands of cancer variants, so conflicting evidence and mis-diagnosis is common. The whole situation is depressing. In the end I was not able to impact the situation technically but have retained the curiosity of picking experts' minds as I come across their paths.
What I have found in the mean time is that the placebo effect is too real to ignore. Suddenly the bullshit and the theatre have significance beyond our cultural ties to mysticism and ritual. Feeling good and positive about life is about as important as living it. Ignoring reality in pursuit of your dreams seems like the standard these days, so why not embrace it for a dying loved one? I am partly not being serious, but wondering aloud, why be realistic when reality sucks? Sure, take care of the obligations that you must, be responsible and all that, but that is not very much work. The rest should be spent enjoyably.
Re:Ken Murray's blog (Score:5, Interesting)
10 years ago, at the age of only 43, my Ex-wife was diagnosed with an advanced Stage IV Melanoma. The normal size for the primary tumor to be classed as stage IV at that time was 8 mm to 12 mm, and hers was about 20mm on discovery. The assumption is that a Melanoma that large has to have metastasized unless absolutely proven otherwise. The location was on top of her scalp, making it very likely by the standard model to have drained tumor cells into her lymph nodes just because of that location. The original physician diagnosing her gave her 3 to 6 WEEKS to live and was incredibly blunt about it. She is, however still alive, thank God. (And no, I didn't pull a Gingrich, she divorced me about 4 years later, then we found out the relationship could be saved, put it back together, and just never bothered to do another ceremony. We have great fun making my staid, conservative daughter roll her eyes at us.).
I don't like to tell people who are terminal about this. She beat odds that were quoted in the standard books on cancer as 10 Billion to 1 or worse, repeatedly. I'm not by any means totally convinced that it was a miracle, but her surgeon swears something guided him, literally forcing him to cut a small extra flap extending for about 2 inches along a scalp vein before it would let him put the scalpel down.
An experimental treatment program at Duke University got mixed results on a bunch of other people, triggered the weirdest side effects anyone ever saw in her (She was speaking with a foreign accent a few days after some sessions, spoke some fragments in recognizable languages and some that may have been a really exotic tongue or just some noises (and all she speaks normally is English and 1 year of Spanish, but there were times her German was excellent, and one where I recognized some Italian, but then, my own Italian is not that good), she had occasional weeks with feeling fantastic, not sleeping at all, and working like a fresh, new meth addict, while running a 103 fever and losing 10-15 lbs. a week, then other weeks with no other physical symptoms except where she slept for 33 to 48 hours at a time, and the program may or may not have been a factor in her survival - it's been dropped as inconclusive). She had other symptoms that would fit schizophrenia, things such as putting the car keys in the refrigerator's butter dish 'so they wouldn't melt'. None of those periods lasted more than a week or so before it was something else.
I've got no explanation for why any conceivable God would do such a thing as a miracle just for her, or wouldn't for so many other people, or why a miracle would be so strange. Worshiping some form of God for doing this almost seems irrelevant.
I know I prayed. I mean waking up at 2 am next to her with sweat pouring off of me and telling God how sure I was that there were things she was still needed for. I don't remember doing a lot of praying about how I would make this or that bargain with God if he would only change things, but as I understand it, a lot of people do pass through a stage where they offer bargain after bargain if God or reality or whatever will just fix the bad thing. I also felt a lot of anger at times, as did she. Whether you feel it and whether you express any of it to the dieing person, please understand, you are not there to vent. If admitting to your own fear or anger helps the patient tell you about theirs, then you do it - if it seems to make them even a bit uncomfortable, you don't.
Right now, I'm wondering what to say to her all over. Her older brother was just killed by a criminal on Christmas eve, Shot right after he opened a safe. The murderer had been out of prison for about 24 hours. She's basically in the shock stage right now, but she's seizing on some things in the news and starting to ask some very angry questions about how the authorities let this guy loose. So now I'm wondering what to do, not just for now, but every time the holiday season rolls around.
Re:Ken Murray's blog (Score:5, Insightful)
My wife passed away from a sudden illness so I didn't have this opportunity (she died from a pulmonary embolism while alone at home and was only 24 so we weren't prepared for either one of us passing away). However, I can tell you some things I would have loved to have been able to ask her before she died:
How would she want the funeral arrangements taken care of? You don't need details, just basics like if she wants to be cremated or buried and if she would prefer a big or small ceremony, etc.
How would she want her things disposed of.
I know those questions can be painful, but somebody needs to find that information out before she dies. In my case I had no idea and had to make many difficult decisions during the worst time in my life.
And, above all, be as open as possible with your feelings. Tell her how much she is loved. Ask her about some old stories. Talk about good times and family.
Re:Ken Murray's blog (Score:5, Insightful)
A bit more than 30 years ago my mother was diagnosed "terminal" cancer. To the point where she was told to go home and die, less than 6 months to live. Instead she signed up for at the time totally experimental neutron radiation therapy (specifically her doctor lied to get her into the program, and when she got to the university running the experiment she was told "if we had known your condition we wouldn't have accepted you")...
Her life was shit for years because of that treatment.
So here we are, 30 years later, and she's still alive. The shit she went through is mostly forgotten, the health issues she lived with from the radiation therapy have mostly been replaced by more typical "60+ year old American" health issues. She has has now spent half her life as a cancer survivor, and while it hasn't been chocolate and unicorns she seems happy to be alive.
That sort of colors my view, I'll admit, but it seems to be a point that gets lost in a lot of this discussion.
Re:Ken Murray's blog (Score:4, Insightful)
That's what I think everyone dreams of-- that their parent, or spouse, or, worse, their child, will defy the odds and come out somehow stronger, and better able to deal with death on his or her own terms.
Christopher Hitchens recently poured water over this sentiment. [vanityfair.com]
However, in the essay, Charlie's survival odds were five percent, or fifteen percent with treatment, and he was able to understand that for him, several months to wrap up his life were better than a few years of futile struggle. Perhaps he understood that the "fifteen percent" rate was a cold equation, and it did not matter whether he was morally worthy, or lucky, or "fought hard." Unfortunately, this isn't "the fragile reality of Discworld, [where] the gods [] like to play games, [where] a million-to-one chance succeeds nine times out of ten."
Perhaps someone has already written a paper studying responses to cancer treatment among the innumerate and among those who understand statistics.
I enjoy "House," on television, and the conceit of the episodes is that every case is a puzzle, and it's a race against time to solve this puzzle, and if the doctor is brilliant enough, the patient will be saved and life will go on. That sound like a theme that appeals to a lot of people, and perhaps the illusion for the loved ones who have to deal with the impending death of a patient is that if even a faint glimmer of life is sustained, that gives the doctors time to figure it all out.
Re:Ken Murray's blog (Score:5, Insightful)
Why wait until you're faced with aggressive, difficult treatment? How do you want to live your remaining days now? Your life is already terminal enough to carefully evaluate that.
Re:Ken Murray's blog (Score:5, Insightful)
Re:Ken Murray's blog (Score:5, Insightful)
It's a little maudlin - it's hard not to be with this topic - but it does bring up something that most people explicitly don't want to deal with. He points out that the people who do explicitly deal with death and dying tend to do things quite differently than 'normal' people. It isn't a scientific discussion, it's a personal, anecdotal essay.
You're perfectly welcome to muddle through life - it is exactly what we all do. But I thought it was a reasonable essay and one that's been covered many times in the past. It is clearly written as a counterpoint to the "do everything, medicine will solve all our problems" view that is quite prevalent in this world. The big problem is it is damned hard to tell people what to expect especially when they are faced with a fatal illness. It's hard to tell someone how hard chemotherapy would be for that individual. It's hard to know how to balance a few months or years of 'additional' living with the downsides of frequent hospitalizations, invasive procedures, dangerous drugs and additional pain.
At least in the US, overtreatment is a huge issue. Anyone but a trained biostatistician is really not in a position to intellectually tease out how effective treatments for most diseases really are (or in reality, how ineffective). So, when you are unable / unwilling to think a problem through, you emote it. Then it gets complicated.
Re: (Score:3)
From what I know his interpretation is completely wrong. The usual interpretation of the unusual high mortality of doctors, is that they are trying to self-diagnose themselves before going to another doctor, and when they go to another doctor they go to one they know. Due to the inherent nature of cognitive bias, they or their friends would usually diagnose themselves much more optimistically than the unbiased diagnose they give themselves. The lesson is: Never trust the diagnose of yourself or a dear frien
Re: (Score:3)
The usual interpretation of the unusual high mortality of doctors
Doctors have the same mortality rate as lawyers, beekeepers and hobos: 100% over a long enough span.
Re:Ken Murray's blog (Score:4, Insightful)
Wow. Obviously you didn't RTFA. My wife is a nurse on the ventilator unit at a local rehabilitation hospital, and shares this sentiment. So many of their patients are comatose, totally unresponsive, but their families insist on keeping them alive at any cost. They've had patients there for 10 years or more on a vent, comatose, zero chance of ever coming out of it, and only kept alive by the machines. What sort of existence is that? My wife and I have had "that talk" and neither of us want to be kept alive by machines. Sure, if something bad happens and there is a good chance of full or nearly full recovery, go for it. But kept alive by a feeding tube and mechanical breathing? Hell no. I'd much rather spend that extra time with my Creator in Heaven.
Re:Ken Murray's blog (Score:5, Insightful)
Hell man, I'm an atheist (nothing but organ donation / apple tree fertilizer / medical room decoration in my "after-life") and I wouldn't want to live like that.
Re:Ken Murray's blog (Score:4, Insightful)
Me, on the other hand- I always want to be kept alive. I don't care how much pain I'm in, how humiliating it might be, how "unresponsive"; I only get the one life, and I intend to make it last. And while we're on the subject, if I ever turn up dead, look for my killer- I'm telling you now, it's not suicide.
I've been in pretty terrible pain before with a few different illnesses, and I'd still be happy being alive in that state rather than dead in no state. And on the subject of "unresponsiveness"- there have been a number of studies showing the brains of "vegetative" patients can respond to speech in exactly the same way as normal conscious people, which would make unplugging the machine little better than murder.
Re:Ken Murray's blog (Score:4, Insightful)
Given that damnation is supposedly eternal, the plus or minus few extra years isn't going to make much of a difference.
Re:Ken Murray's blog (Score:5, Insightful)
What morons rated this '5 insightful'? Ken Murry is not bitter and angry, he is thoughtful and kind. PCM2 has done the typical thing of morons: he assumes his imagination = reality. Give us all a break and don't post if you don't even read the article.
Re: (Score:3)
Re:This is what's wrong with private healthcare. (Score:5, Interesting)
Re:This is what's wrong with private healthcare. (Score:5, Insightful)
Ok, and how do you propose we fix it?
Couple of ideas:
1) Ban pharmaceutical company reps from hospitals.
2) Limit hospital administrator pay to the median salary of their employees.
3) Criminalize the practice of outrageous markup on medical procedures and equipment; The one time I had surgery, I was charged full retail price for every implement present in the OR at the time, as well as $25 for the fucking Sharpie they drew on me with... and they wouldn't even let me keep the tools (scalpels, forceps, etc.) I payed for!
Should the medical profession community be forced to absorb the insane cost of education only then be forced to accept a salary they themselves do not want?
If so, that would put them more in line with the real world in terms of compensation versus cost of education [msn.com]. Do you think they deserve a better post-college shake than the rest of us, simply by virtue of the fact they chose to spend more on said education?
Re:This is what's wrong with private healthcare. (Score:4, Interesting)
Do you think they deserve a better post-college shake than the rest of us, simply by virtue of the fact they chose to spend more on said education?
Yes. They invested more time, effort, and money, so they deserve at least the opportunity to have a better return on that investment.
Re:This is what's wrong with private healthcare. (Score:5, Insightful)
Should the medical profession community be forced to absoborb the insane cost of education only then be forced to accept a salary they themselves do not want? Perhaps you feel they should be like monks or other holy men and not live for material wealth?
I absorbed similar cost and took years longer in my education in order to earn one third what a doctor makes. I did it because it's what I wanted to do. There's nothing about cost or training time that entitles you to a high salary. The salaries in medicine are high because the medical profession controls the number of doctors that are trained each year. That number is kept artificially low. If a public university wants to start a medical school, it's other medical schools that will lobby against it. It harms their ability to keep costs high while they reject most of the capable applicants.
If your doctor went into medicine to make money, do you really want that guy to be your doctor? I'd rather have one that wants to be a doctor and doesn't give a damn about the money.
Re:This is what's wrong with private healthcare. (Score:5, Interesting)
And you think that profit is to blame? And not the fact that letting someone die with dignity would land a doctor in court? How about the fact that one doctor who merely attempted to help people who actually WANTED to die was hounded and imprisoned by the government?
It's not a problem with profit, it's a problem with American society. We've become a bunch of coddled pussies, afraid of even the mildest of discomforts, much less death.
Re:This is what's wrong with private healthcare. (Score:4, Informative)
If the Dr. is profit motivated. This stuff usually isn't the best use. Too much expensive gear to run, patients who are mostly on Medicare getting a reduced rate for their services, then you will need to fight with the insurance companies and the documentation to try to get your money.
Specialists is where they make money. The patient comes in (often with better Insurance) you cure their particular problem, schedule a few follow ups. And get them out and you get a bunch more people in. I haven't seen any doctor (and I have worked with really stupid, mean and greedy ones) that would allow a patient to suffer just to make extra money.
For these cases it is often the family trying to extend the life of their love ones or there a request to be kept alive. If the Doctor lets them die, then they get law suits.
Re:This is what's wrong with private healthcare. (Score:5, Informative)
Troll?
I'm a physician that works for a hospital.
I have the futility talk with patients and their families quite frequently. It kills a little bit of me when I hear a family say they want everything done. And a little more dies every time I run a "mega code", lasting over an hour trying to save someone who if by some miracle they survive, will have no quality of life and be dependent on machines for breathing and feeding and urinating (hemodialysis) for the rest of their life.
"Where there's life, there's hope" is a common saying in the community I work in. Every time I hear that, I cry a little inside.
I have never had a hospital administrator even hint at anything that would extend suffering. If anything, the administrators like us to call the local hospice services, to free up beds for individuals who will survive.
Re:This is what's wrong with private healthcare. (Score:5, Informative)
Often the effort to extend the terminally ills life another day/week/month is written off and not paid back in full. The profit margin at that point of life is very slim. Even procedures that aren't lifesaving and are becoming more routine have slim margins. For example, there is no (ie, zip, zero, nadda) profit on total knee or hip replacements at the hospital where I work. We have to do them because of legal requirements, but insurance won't pay more than a certain amount.
Profit could be maximized much better if the vast quantities of manpower and resources dedicated to saving those already dead were instead allocated to those who will live to pay.
As a healthcare worker, it pisses me off to see people ranting about the costs/quality of the US healthcare system without knowing anything about it other than their own pocketbook.
Re:This is what's wrong with private healthcare. (Score:5, Insightful)
In the US, healthcare isn't about getting people better, it's about maximising profits. So, on that basis, it's perfectly okay to keep people alive and suffering terribly as long as there's still a few dollars to be squeezed out of them. Patient dignity and welfare doesn't come into it - the hospital administrator needs a new Jaguar!
In my opinion it's not hospital administrators that keep people alive indefinitely, it's patients and their families. I base this on what I've heard from my wife, who has been an oncology nurse for 37 years in a variety of hospitals. She's literally cared for hundreds of people as they were dying. Many were her patients for weeks and months and she got to them and their families quite well. There are just some people that even when told there's no hope still want everything done. Either they can't let go or they think they're the one who will experience a miracle. My wife has not seen a miracle in 37 years. If a person is not a DNR - Do Not Resuscitate - if they code it sets in motion an incredibly expensive process to revive and stabilize them. All so they can die in the ICU in a semi-lucid state a week later. She's had any number of people tell her they never would have pressed for all the care and the DNR status if they thought it would end like it did. They were told, but they couldn't accept it. On occasion she's had to deal with angry relatives who want to know why more couldn't have been done.
One thing she's noticed is that people who are the most reluctant to let go tend to be the most religious. Not always, but more likely. They have faith that God is going to deliver a miracle. They've prayed and they've heard it can happen. I've always wondered why they think God needs the intervention of all that medical technology to work a miracle. One time she was caring for a woman who was dying. Her husband and brother would show up daily to pray at the woman's bedside. One evening they asked if they should be asking for God to rescue specific organs. One of the reasons I couldn't do my wife's job is I would have started laughing at that point. My wife didn't. She thought about which organs were failing and suggested they pray for the kidneys. The husband and brother set to praying for the kidneys. Before leaving the room my wife noticed that the catheter tube was kinked. She unkinked the line and urine started flowing into the bag. The husband and brother heard the trickle of urine flowing into the bag, but they were unaware why it started flowing. They were sure God had answered their prayer. My wife didn't have the heart to tell them her role in the miracle. They prayed and prayed, but no other organs were rescued.
So, while I'm sure there are cases of mean cruel hospital bureaucrats keeping people on life support just for profit, in most cases I think think it's the patients and their families. Oh, and my wife, she's a saint.
Re:This is what's wrong with private healthcare. (Score:5, Informative)
Your uncle needed someone with medical power of attorney to be there with him. It sounds like, had he chosen to arrange that with you, you could have helped him suffer less. I say this with the hope that anyone else reading this could arrange things now, before their elderly relatives aren't capable of signing such legal documents.
My wife had medical POA with her 94-year-old grandfather when he got sick and died in 2010. She literally had to sit by his bed to be there when a random doctor would come in and try to intubate or give him something the legal paperwork he'd signed years ago said he would refuse, and she had to tell the doctor NO and wave the POA and No Heroic Measures paperwork at him. She had to do the same thing when the social workers would come by to try to plan his treatment. each new care provider would make or take a photocopy of all the paperwork. (My wife had like 40 copies made.) This took a few weeks until eventually he was transferred to hospice. Even there one of the regular care nurses was furious when they stopped all treatment. In this case, though, the hospice nurse told the regular nurse to STFU and stay out of the way while my wife watched her grandfather die.
With a medical POA and No Heroic Measures paperwork, not only would the paper exist but there would be a family member there with the legal authority to enforce it.
Re:I for one (Score:5, Insightful)
Think about living in constant pain, mental confusion, maybe even in a coma which you a guaranteed to never come out of. And you know you're not ever going to get better--only worse. And all you're doing is adding more and more onto the medical bills that your family may end up being be stuck with. Would you really want one more day of pain, or one more day of not even knowing where you are, or one more day of simply breathing and nothing more? To what end? That's not "life."
Re: (Score:3, Insightful)
It depends. If you're trying to compile multiple projects simultaneously in Xcode then, yeah, get the new machine. If they're just running Word, IE, etc, that 10 year old machine can still do the job. And why not use an otherwise perfectly serviceable machine? One of my cars - Toyota Rav 4 - is going on 10 years. I have no intentions of replacing it just because it's 10 years old.