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."
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: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.
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.
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: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:This is what's wrong with private healthcare. (Score:5, Interesting)
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: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: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: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:What about their children? (Score:3, Interesting)
Tell your wife about my wife. She was clinically dead for a short while because she took an antibiotic -- even though she did have a very painful bacterial sinus infection where taking that antibiotic was not out of line. Things got bad not due to a direct reaction to antibiotic, but due to a c-diff infection in her gut that got triggered, apparently, by the good bacteria getting decimated by the antibiotic. She can't take that particular antibiotic (nor its "cousins") anymore, because that problem seems reproducible. When it reoccured, we both saw knew what the symptoms meant and she could take the IV stuff to get rid of the c-diff (confirmed in both cases by stool cultures). C-diff, if you're unlucky, can well get you into septic shock, and from there it's a short walk to going into cardiac arrest.
Never mind that even if you won't ever hit such serious complications, you're contributing to the MRSA problem by taking antibiotics unnecessarily. I do know that some people, if they're sick with upper respiratory viral stuff, may pick up secondary bacterial infections. But even so, you only take antibiotics when it's obvious that you in fact have a secondary infection. Viral stuff doesn't give shit about antibiotics, it's stupid to take them without a good reason.
I'm addicted to coffee (Score:4, Interesting)
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:Ken Murray's blog (Score:3, Interesting)
I still don't really know how to talk to someone who's going to die.
Fact: You and everybody you know is going to die.
Knowing that, how do you want to be spoken to...?
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: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: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.