How Doctors Die

[Iowa Lizzy]

Read this article this morning and found it very interesting. I know we have quite a few members in the medical community, so I thought I'd share.

http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/

Thoughts?

 

[tammy77]

Very good article. My grandmother passed this year and it was heartbreaking to see (well, hear because I wasn't able to be there) my mother struggle with not knowing when enough was enough. It makes a very good point for making sure that we have documentation in place so our loved ones won't have to suffer through the most difficult decision to ever have to make while they're already suffering enough.

As I read the article I thought about how I wouldn't want all of the intervention etc., but on the other hand, if my child or my husband was the one that was dying it would be extremely hard to not fight until there was no more fight to be had. It's just human nature to not want to let go of the ones we love, even if we know without a doubt that it's the right decision.

Very heavy topic!

 

[LtlFirecracker]

I could write a book about this. It is kind of funny this came up. I just had a long conversation with a doctor who has very a very different world view than me. He has a very religious background, and is very pro life when it comes to abortion issues. But when it comes to end of life, he felt the same that I did, which really surprised me. We were talking about chidren, as that is who I have seen with end of life issues, and I see a lot of parents who want everything done when we can do very little. Many times I think, if this were my child, I would pull the plug as I would not want to put them though that suffering when I know the outcome will be death or a very poor quality of life. I spoke with a neonatologist and asked him if my views were weird, and he told me most pediatricians and NICU nurses have the same view as I do.

I realize that children add a whole other level of complexity to this issue. I think part of the issue is that with immunizations, antibiotics, and IV fluids (IV fluids make dehydration easier to treat, diarrhea is the number 1 killer of children in the developing world) we just don't see children get sick anymore like our parent's or grandparent's generation did (depending how old you are). And of course, when a child is in trouble, a parents gut instinct is to do everything without thinking through what they are actually doing to their child. A lot of those "heroic" situations described in the article, I have seen and done on children with no chance of living. And it is heartbreaking, especially when they are babies who born with conditions that have almost zero chance of survival and they are awake though the whole thing. In many of these situations, this was very well explained to the parents and they still asked that "everything be done."

I can't tell you that when doctors put their foot down and say this is futile, at least in the US, the courts have not supported them. But in medical school, I learned that 90% of health care costs are spent on the last year of life. We as a nation that has to face our fear of death and realize that it is a natural part of life. Now there are a lot of conditions that we can save a person from, and it very rewarding for me when I recognize a child is in trouble, transfer them out, and find out a day later I had a roll in saving their life. I am all for aggressive medical care when it is a condition we can treat. But doctors and modern medicine do not have it all figured out.

It is a really complex issue that has multiple layers. As I said, this barely touches on the surface. Of course, these are my opinions, and I hope I do not offend anyone.

 

[soocool]

Thank you for posting this. I am emailing it to my sister.

 

[Echidna]

Thanks so much for posting this, TG. It's given me lots of food for thought. I would like to think that I'd choose quality of life over aggressive treatment, but who knows in the heat of the moment? I should send this to DH to read too...

LtlF, I can definitely see how parents would want to go all the way when someone they love was suffering so early in life (babies, children, young adults even). Such a complex issue I can't even wrap my head around it. Thanks for sharing your thoughts.

 

[diamondseeker2006]

Very good article. I am dealing with elderly relatives at this time and it is tough. My dad died of Alzheimer's about 3 years ago with no real medical intervention, although he was in a hospital at the end. My aunt had some minor surgery and had a stroke as a result, and was wheelchair bound and finally ended up in a nursing home for a few months before she died. Then my mother last November was going to have some leg surgery to help the circulation in her leg, so they took her off her blood thinners the week before the surgery and she had major stroke before she had the surgery and is now paralyzed on one side and has some brain damage. Both my mother and aunt declined significantly BECAUSE of the medical treatment they received. We got my mother to sign "DO NOT RESUSCITATE" papers so that we wouldn't have to go through extreme measures that could easily result in her ending up in worse shape than she already is.

As for me, my objective is to stay as far away from hospitals as possible. I do believe certain treatments can kill a person quicker than just doing nothing. I think it is vastly different when the person is younger and there is much greater hope of the person being cured. My daughter's best friend works in a NICU, and it is an amazing and wonderful thing that most premature babies are able to eventually be healthy children. I am pro-life and do not believe in deliberately killing someone in a medical situation. However, refusing extraordinary treatment when the person has no possibility of survival is completely reasonable, in my opinion. Being hooked to a machine that keeps bodily functions going in a brain-dead person, for example, is pretty pointless.

 

[Prana]

I was very happy to read this. It rings so true for most medical professionals that I know.

I'm a registered nurse myself, and I can tell you some of the things that go on as far as life saving and treatment haunt me on a daily basis. I'm a firm believer that we over treat illnesses, and I do not really care for the way medicine is practiced in our country (America). I think a lot of times it comes down to a knowledge deficit on the patient and family side. But sometimes, especially in teaching hospitals, you get interns and doctors that think they are God (literally) and who have unrealistic expectations, and the patient becomes an experiment of sorts. Some are not capable of differentiating between a person and a lesson.

A few years ago a young intern had a patient in her care who was obviously dying. He was young, in his 50-60's and just very ill. This patient had nobody to really speak for him, he hadn't made his own wishes clear, but his decline was fast approaching and this intern would not listen to the nurses' suggestions to make this patient comfort care so that he could just die in peace and live peacefully for his last few days. Well, this patient ended up dying with tubes being shoved down his throat and his ribs being broken from CPR. After the death, this intern was crying in the hallway because she was upset. She had lost on her promise to herself that a patient would never die in her care

For me, personally, I want to die in peace. If I get diagnosed with a terminal illness I'm staying as far away from hospitals as I can. I'd rather live one month doing and eating what I want than a year in and out of hospitals getting pumped with meds.

My mission is to be honest with my patients and their families about what to expect, and to educate them to the extent that my own scope of practice will allow, and let them make decisions based off that.

And not all doctors are horrible. Many are very realistic and honest with their patients.

 

[zoebartlett]

Interesting article. I'm not in the medical field, and I hadn't really thought of this before. I had no idea that for CPR to be done correctly, someone's ribs are actually broken. That surprised me. I think most people just don't know what effects "do everything possible [to save someone's life]" really means for the patient. I had no clue until I read the article, for example, that someone undergoing medical treatment could actually be making their quality of life worse. Do doctors explain to patients and their families what it will actually mean to do everything possible vs. doing everything reasonable? I'm not sure I'd know the difference, and if faced with this, I'm not sure I'd know enough to ask. I'd think (maybe not now that I've read the article), "my family member's sick. You're a doctor. You'll fix him or her." There's a lot more to it that I hadn't thought about before.

 

[Iowa Lizzy]

I've been thinking about this article a lot since I originally read it. It prompted me to have a conversation with my husband about not keeping me alive for the sake of keeping me alive. He feels the same way. Though I can see how it would be so hard as a relative to not say "do absolutely everything you can."

 

[MsP]

Thank you for posting this-- it's a point of view that my family of many health professionals has had in recent years with the passing of several elderly members. It's a difficult topic and this article I felt was fairly compassionate and succinct.

 

[Skippy123]

Oh wow, this is very interesting. I feel the same way; I don't want a lot of intervention if I find out I am going to die. thanks for posting this!

 

[princesss]

I'm about halfway through the article, but I'm not going to lie - I find myself reading it and agreeing with so much of it that I'm reminded why my ex is still my emergency contact. I tell people that it's because we're still good friends, and he knows how to contact my family. But really? It's because we've had several long discussions about what kind of care we'd want, and I trust him to let my family know what I'd prefer if I'm not able to. I can't stand the thought of being kept on life support for months at a time. Give my family time to come and make peace with it, and then pull the plug. Please.