How Doctors die

[bluedeathray]

Can we discuss ALL the issues concerning health care? Thought provoking, even if you disagree.

Short article. Five minute read.

" 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."

http://thehealthcareblog.com/blog/2012/08/06/how-doctors-die/

[Warpy]

1. Doctors need to drop the crusading role

and while some good outcomes happen from drastic surgeries and chemo, there are some cancers where palliative (comfort) treatment should be offered as an option. It's not.

I've already told my docs that I won't be doing dialysis when my kidney failure worsens to that point. I just don't want to live that way. It's a personal choice and that's something that should be informed about and offered to everyone.

Unfortunately, they're not adequately informing anyone about the option of less treatment instead of more. The focus of medical school lies in trying to cure everything, not help people make their peace with it. It's now up to patients to ask "what will happen if I do nothing?" and get them thinking about palliative care.

However, what is really needed is a complete change of focus starting in med school. Instead of fighting a disease, they need to focus on helping the patient in the best way possible.

And sometimes, that means do nothing.

[Aristus]

7. Not all doctors are "crusaders", crusading for longer lifespans at the expense of quality of life.

I read a book by an Emergency Medicine doctor (I'm afraid I forgot the title) in which he describes the anguish providers go through in trying to convince a grieving family that no more can be done to prolong a loved one's life, unless drastic, painful, unnecessary steps are taken that will likely lead to a worsened quality of life for the patient.

The example the author provided included a detailed consultation with the family members over the importance of palliative comfort care for the dying patient, and the likely effects of full-code measures.

The family ignored sound medical advice and insisted that the medical team undertake "all possible life-saving procedures".

What followed was a harrowing account of the brutal measures the medical team took, very reluctantly, at the insistence of an upset, grieving family who were not making sensible decisions, and the suffering the patient was subjected to, very unnecessarily.

When grieving over a loved one, it's common to put the blame on doctors and other medical personnel. But not always fair to do so.

[Warpy]

8. yes, we see that in ICUs all the time

but only after the patient has been put through earlier heroics that left him/her much worse off. Grieving families are often guilty families who didn't pay much attention to the body in the bed while it was still fully functional. They don't realize they're only prolonging death at great cost to the poor patient.

I'm talking mostly about oncologists and surgeons having the crusader complex, but it could also apply to docs who push other heroics onto old folks. They just don't work too well and they obliterate much of the quality of life the patient would have had had s/her simply been offered comfort measures.

[LiberalElite]

2. Thank you for this post

I did read it. I didn't know that patients in hospice care often live longer than those who are actively treated. A very good friend died in April 2011 of ovarian cancer after having taken out two home equity loans to pay for chemo. (Yes, she had insurance!) She chose treatment till she ran out of money in March 2011 despite having been told by her oncologist in March 2010 that she would need hospice within six months. All that treatment and money spent bought her perhaps an additional six months of increasing suffering. If she could come back today I'd only have one question for her - Were those six "extra" months worth it?

[KurtNYC]

6. We went the other route. Had a relative in hospice care

and some of her friends would scream at us that "she should be in a hospital!" I forgave them all because they said it out of love and because they couldn't believe that a person who was living independently, driving, keeping appointments and outwardly healthy could be terminally ill and there is nothing that modern medicine could do to stop it.

In hindsight, I would recommend hospice for anyone in a similar situation and I would want it for myself. A hospital is a terrible place to live your last days -- beeping machines, nurses waking you up constantly to take your temperature, the risk of complications from contagions, no dogs, no good food, and no comfort.

She passed with her dog at her side and with the breeze carrying the scent of the lavender and sage in her garden into the room. No chemo and no radiation.

Another friend, who was a nurse practitioner was insistent on not dying in a hospital (with leukemia). She knew better than most what that is like and she also passed at home, in the comfort of her own bed.

[Warpy]

9. A coworker did die in the hospital

but only because her pain was bad enough for a morphine drip. it was only a matter of a few days and everybody understood it was terminal care.

She had elected not to bother treating her cancer and sold her house and went traveling. They'd given her three months. She lived eight doing what she'd always wanted to do.

[Wilms]

3. ^

[Heddi]

4. I think it's because MD's and RN's and other health care professionals

SEE the reality of CPR. The reality of intubation. The reality of no oxygen to your brain for long periods of time. The reality of years of dialysis and chemotherapy and cutting off your toes one by one by one by foot by leg....

I am an RN and so is my husband. We are very clear in our wishes to each other and to our families--NOTHING. NOTHING is to be done. I don't WANT cpr. I don't WANT the resulting anoxic brain injury. Whatever caused me to go into cardiac arrest isn't REMOVED by CPR... it's still there and will probably still kill me.

My mom's got end stage kidney disease and is who knows how long away from Diaysis. There's not much she can do to reverse her course, but there's a lot she can do to halt its progression, but her attitude is "oh that's okay, a lady I work with's mom had dialysis for thirty years and did just fine"....mom, you have NO idea what dialysis is. 3-4 sessions a week WITHOUT FAIL. 4+ hour sessions WITHOUT FAIL. Only able to start IV's in the non-fistula arm> Go to the hospital, you're gonna be admitted. And then the resulting health issues from bad kidneys...heart, lung, brain, strokes, diabetes....she has no idea.

I try to explain to her. I see this EVERY. FUCKING. DAY. Dialysis from kidney failure from diabetes or other things. HOrrible way to live. And 30 years on...please....someone who's been on dialysis for 30 years is hardly in the prime state of health. She hates going to the Dr every few months as it is....there's no way she can keep up the schedule with dialysis WITHOUT FAIL and the more frequent MD visits.

Nope...when it's my time, it's my time. No vents, no tubes, no compressions. I'm 37...I don't care if I'm 40 or 90. Let me go. Don't let me be a vegetable. Don't do that to me, and don't do that to my family. It's much harder to unplug than to never plug in to begin with.

it kills me...we get these 95 (no shit) year old people from nursing homes. Full codes. They have multiple strokes, are incontinent, haven't spoken since the mid 1990's, contractured limbs, frequent seizures, tube in their belly for feeding, tube in their ass for shitting, tube in their wang for pissing, tube in their throat for breathing...but please, full code. Do everything. That's what mom wanted. Really? Mom wanted to be covered in bed sores and wasting away and fed liquefied emulsion for nutrition and weekly hospital visits and falls and inoperable broken hips and broken ribs from CPR? When she's 95??? That's what mom wanted??? I don't think that's what Mom wanted at all....

[CrispyQ]

5. Thanks for posting.

I hope others read it, too.

[CrawlingChaos]

10. This is propaganda, and it's complete crap

Trust me, when you bring your sick, elderly relative to a hospital, you will NOT have to worry about crusading doctors taking heroic measures to prolong a terminal patient's life. You SHOULD worry about whether they will receive even a modicum of adequate care.

This same article keeps appearing over and over and over and over. Don't be fooled, this is not about CPR. The people behind these articles just want you to die as quickly and inexpensively as possible once you start to get old.

[magical thyme]

12. Consider the possibility that the nurses and lab techs who have posted

have a clue of what we are writing about.

[CrawlingChaos]

13. My comments are based on my actual experiences

I've been through this a number of times when acting as an advocate for older relatives. I've had to fight like hell, often unsuccessfully, for just ordinary therapeutic treatment (nothing remotely heroic). I've had to fight for adequate palliative care. The very idea that hospitals will do TOO MUCH for elderly patients is laughable.

Healthcare workers often become hardened and indifferent to these issues. At times they even radiate a thinly veiled hostility toward patients and their families (see post #4 in this thread). Fortunately, that's not everyone - but it's very common.

Please note: I have never, and would never, have an elderly relative put on full code status. This is not about that. These articles have a clear agenda -- once you reach a certain age, don't ask for treatment. Please be a sport and die as quickly and cheaply as possible.

[magical thyme]

14. I'm sorry you've experienced such a terrible hospital.

if you actually read the article, it is written by an MD, about fellow MDs, family members, and patients he's cared for. It is specifically about facing terminal illnesses, not ordinary therapeutic care.

The hospital where I work caters specifically to the elderly, sharing its campus with a nursing home, a skilled care unit, and an alzheimers home. If anything, we overtreat here, and I am speaking from direct experience.

I have also, in my personal life, long before I started this career, witnessed an entitled yuppie melt down and throw a tantrum because her very elderly mother's doctor suggested that although her tumor was cancer, the biopsy showed that it was a very slow growing type and that surgery would be extremely traumatic to her, so it probably was best to leave it alone.

Some people just refuse to face that fact that we do not live forever; they refuse to face their own mortality. And, as one poster mentioned above, oftentimes their behavior when a loved one is dying is due to guilt over having ignored them while they were living.

A lot of Americans seem to live in a bubble. They don't take care of themselves and then when their body breaks down, expect a magic pill to make it all go away. Or they neglect their loved ones, and then expect somebody else to waive a magic wand and make that person young again. This is something we witness every day working in a hospital.

This article is about facing our own mortality. It's something that a lot of people refuse to do. I don't think this article is part of some agenda. It is a thought provoking piece intended to encourage people to consider their own mortality, to consider how they want to die...which incidentally pushes them to think about how they want to live.

[magical thyme]

11. My anatomy professor was a 37 year nursing veteran with masters from Yale

On our 1st day of class she announced, "If I go down, do NOT call 911. Just step over my body and go out for a cup of coffee or something. I do NOT want some young intern breaking all my ribs doing CPR. I am serious. If I go down, just leave."

I've had versions of this conversation with any number of co-workers. The lab assistants, when I was doing my phlebotomy rotation, while we were headed up to or back from ICU.

And having to go up there at 5 in the morning at the end of a 13 hour overnight shift, having to wake up a dying person to stick them in a blackened arm in a fruitless search for a functioning vein....

No way.

[Maeve]

15. I'm dealing with a family member with a terminal disease

My husband and I have talked about this several times--we aren't going to extend our own misery like we're seeing happen.

[bluedeathray]

16. My respects to your family

And a big hug for having to go through life's hard times.

My wife and I have discussed this issue too, and reached the same conclusion as you.