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Thread: How Doctors Die

  1. #11
    Senior Member rdf's Avatar
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    Quote Originally Posted by stephen212 View Post
    That really stings.

    But you make me smile.
    I'm available to tattoo DNR on any female CC members', um, bosom(s), for one price. A two'fer if you will.

    No Stevie, you can't get in on da deal, but you do make me laugh!
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    Thanks!

  2. #12
    Bravo, Stephen! Thank you for sharing that!

  3. #13
    Quote Originally Posted by stephen212 View Post
    How Doctors Die
    It’s Not Like the Rest of Us, But It Should Be

    by Ken Murray
    Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

    It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, 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. 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. But they go gently.

    (continued)
    http://zocalopublicsquare.org/thepub...ie/read/nexus/
    Stephen,

    Thanks for posting this. The next paragraph after the two that you posted are the most revealing...

    Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).
    I agree with what is said here. However, I found the article to be one-sided. From the writing, this is an old man writing about other old men dying. Most of what he said may be less applicable to somebody who is young and at the prime of their lives. In my opinion, there are times when the doctors give up too early.

    For example, I knew a family where the mother, in her 50's, had suffered a brain hemorrhage. She became comatose. Within a week, the neurologist in the case was pressing the family to go beyond a "do not resuscitate" order. Within a month, the neurologist had convinced the family to unplug by telling them that she will not have quality of life even if she were to awaken.

    I have also seen cases of high quadriplegics getting less than aggressive care in hospitals because the doctors could not themselves imagine life like that and therefore convinced the families to let their loved ones go, based on the opinion that life is not living for somebody with quadriplegia. Whether life is worth living is not and should not be the decision of the doctor but the decision of the patient.

    Of course, doctors do get sick and die. Yes, they are human and have feelings, just like all patients. In fact, the medical knowledge that doctors have is not always helpful in decision-making. In fact, the doctor who is a patient has a serious conflict of interest and may have only limited objectivity concerning both the prospects of recovery and therapy. One can perhaps even argue that doctors may be inappropriately biased by their medical knowledge.

    In the particular case that was described here... pancreatic cancer was what Steve Jobs had and he chose to pursue therapies. I guess that I am glad that he did because we probably won't have the ipad or perhaps the iphone if he did what the orthopedist in the story did and just went home to die in a few months instead of surviving over 5 years. Was it worthwhile for him. I suspect that it was.

    Recently, a close friend of mine died of glioblastoma multiformans. Sometimes referred to by its acronym GBS, this is one of the most devastating tumors in human. I think that he was only about 55 years old. Only 25% of patients survive 2 years. Very few survive 5 years, probably less than 5%. My friend decided to fight with everything that he had. He survived for a little more than a year. I am glad that he gave his family that gift.

    Wise.

  4. #14
    Quote Originally Posted by Wise Young View Post
    For example, I knew a family where the mother, in her 50's, had suffered a brain hemorrhage. She became comatose. Within a week, the neurologist in the case was pressing the family to go beyond a "do not resuscitate" order. Within a month, the neurologist had convinced the family to unplug by telling them that she will not have quality of life even if she were to awaken.
    You left us hanging here. What was the outcome for this woman?

    Quote Originally Posted by Wise Young View Post
    I have also seen cases of high quadriplegics getting less than aggressive care in hospitals because the doctors involved could not themselves imagine life like that and therefore convinced the families to let their loved ones go, based on the opinion that life is not living for somebody with quadriplegia. Whether life is worth living is not and should not be the decision of the doctor but the decision of the patient.
    I agree that this predetermination to limit the extent of medical intervention based on the anxieties and personal projections of the doctors crosses an ethical line. To make matters murkier, the patient and his/her family may not be in a position to communicate intervention preferences prior to receiving life-saving care, assuming they've ever been formulated.

    When I imagine receiving a dire diagnosis my current inclination leans toward opting for minimum intervention. That is, of course, a very personal decision and a mindset not unlike the physician referenced above that "can't imagine life like that." Life-battling illness on top of paraplegia is not for me. As I like to tell myself, the end of the world isn't the end of the world. I have no illusions of an afterlife to succor me, nor do I long for one, but life (without me) will go on.

  5. #15
    Thank you for that balancing second opinion, Dr. Young. I am very sorry about the loss of your friend, and certainly understand why he gave himself 100% to the fight for life. Such intimate decisions...and no clear answers from external sources. May we each receive the wisdom we need, and the help to enact it (wherever that may lead) when our own moments of decision arrive.

  6. #16
    You have to be careful letting philosophy guide your health care decisions. My wife and I did online wills w end of life directives involving no extraordinary measures. Several years ago she came down w pneumonia and her doctors recommended a trach shortly after admission. She would be on a vent post trach. I knew what our direcives said but there was no question but that I would be 100% in favor of the recommended treatment. Post trach, my wife picked up C diff and other medical issues prevented her from making any progress in getting off the trach. Hospital social workers asked me to bring in the medical directives paperwork for their records, I stalled. At some point my wife signed a DNR request I think shortly after she stopped breathing once and had to be "bagged" (resuscitated using ambu bag). She was depressed and feeling she would not get off the vent, get rid of the C Diff or get stronger. She eventually was transferred from a 2nd hospital to a nursing home w a respiratory wing. The DNR request was repeated. Despite this, my wife was bagged again when she stopped breathing one night - by this time she still had trach and just room O2. The nursing home actually had a better handle on dealing with her C Diff and other issues than either hospital. Shortly after being bagged there one of her respiratory therapists asked if she might want to reconsider the DNR. My wife agreed and a social worker was in the room within 10 minutes to rescind the DNR. After 160 days of hospitalization my wife recovered from C Diff and was discharged home w O2 and nasal canulla. She got stronger and stronger post discharge, came off all O2 and now only needs a BIPAP for sleeping.

    As 2 people w long term disabilities and chair users we had formulated our wills based on our philosophies about not wanting decreased quality of life, prolongation of suffering in some terminal condition or facing life in a nursing home. As it turns out when reality burst our balloon, we actually encountered better care in a nursing home than in the acute care hospital or in the pulmonary rehab hospital that followed. I never supplied copies of my wife's medical directives although these were requested at two separate facilities. As soon as my wife saw some glimmer of hope of making improvement she rescinded her DNR order. At the nursing home they ignored the DNR order and bagged her when she needed it.

  7. #17
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    Thanks for sharing. Being 69 years old gives me cause to think about these things. My dad, my mom, many of my aunts and uncles are gone. Many of them, especially my dad, went through pointless treatment before the end. Living through this, plus 45 years in the chair with my own share of medical encounters, leaves me feeling that I want nothing to do with a hospital. But this blanket denial is certainly not fair to my wife. It is easy to say No Code, or DNR, and be perfectly sincere in the abstract. Not be so easy when faced with a situation where there is not a clear outcome.
    T4 complete, 150 ft fall, 1966. Completely fused hips, partially fused knees and spine, heterotopic ossification. Unsuccessful DREZ surgery about 1990. Successful bladder augmentation using small intestine about 1992. Normal SCI IC UTI problems culminating in a hospital stay in 2001. No antibiotics or doctor visits for UTI since 2001: d-mannose. Your mileage may vary.

  8. #18
    If I was told tomorrow, that I had cancer that would require surgery, radiation and or chemotherapy, I'd settle up all my end of life preparations, go through all my material stuff and sell anything family didn't want and try to get to the Keys for a few days so I could watch the sun rise and set over the ocean. Then I'd come home and live out my remaining days as best I could. Not to sound morose, but as much as "I don't want to die" it would actually be a bit of relief.

  9. #19
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    I hear you completely and have similar sentiments. Funny, I was born and raised around Charleston. Long time ago.
    T4 complete, 150 ft fall, 1966. Completely fused hips, partially fused knees and spine, heterotopic ossification. Unsuccessful DREZ surgery about 1990. Successful bladder augmentation using small intestine about 1992. Normal SCI IC UTI problems culminating in a hospital stay in 2001. No antibiotics or doctor visits for UTI since 2001: d-mannose. Your mileage may vary.

  10. #20
    Quote Originally Posted by Wise Young View Post
    I have also seen cases of high quadriplegics getting less than aggressive care in hospitals because the doctors could not themselves imagine life like that and therefore convinced the families to let their loved ones go, based on the opinion that life is not living for somebody with quadriplegia. Whether life is worth living is not and should not be the decision of the doctor but the decision of the patient.

    Wise.
    Sadly, a patient cannot even decide to die with dignity, though.

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