Mt Whitney Zone Forums The Chat Room No code -- How Doctors Die

Dr. Ken, a member on this forum has written an excellent article. Quite telling about the state of medical care.

No code for me, too!

Here's the article:

                  How Doctors Die
    It's Not Like the Rest of Us, But It Should Be
                                by Ken Murray
 

Thanks, Steve. And thank you Ken! Well written, insightful and meaningful to me.

Ken that was such an honest and candid article. I really appreciated it.There are not many doctors that would spell out the end of life issues like you did.
I for one, by occupation, tend away from the over utilization of drugs and surgery, Certainly there are cases where it is indicated.

It is paradoxical though when my own father became ill with congestive heart failure,pneumonia and kidney failre at age 86.He also had a large abdominal aneurism that was deemed too high risk to repair.My father was admitted into an ER and placed in a CCU. The care was amazing. Too amazing. Through dialysis and meds they got the fluid out of his lungs, got his heart and kidneys functioning. They were ready to release him when his abdominal aneurysm burst while in CCU. He underwent a 6 hour proceedure to fix the aneurism.4 more weeks of CCU and a regiment of dialysis 3 times a week for the rest of his life.
Ken my dad would never had wanted to be " saved" to live the next two years in a steady pathway of deteriorating health to the loss of self reliance and ultimately loss of dignity in a nursing home.The doctors saved my dad with their amazing treatments to live 2 years in a miserable state of dementia,dialysis and bed ridden hell on earth.

My dad should never had any of the heroic proceedures that kept him alive in a poor quality of life existence.The paradox is I was right there helping to make the health care decisions that ended up giving him a poor quality of life that my dad would have never agreed to. The problem is that when you admit your aging eldely parents to an ER they automaticaly do the things they are trained to do.They "save" lives. They keep rescuing the dying for every emergency they encounter.You as a family member are caught up in the care offered to your loved one and can't stand back far enough to see the big picture.

If I knew back then what I knew after the treatments I would have opted to let my father pass the way his body had intended for him to die.No heroic measures to keep a sick dying body alive.There are worse things than death. Watching your father suffer in a nursing home in a diaper unaware of the world is horrible.
Ken I couldn't agree more with why a doctor knowing the inevitable outcome would opt out of end of life treatments.

Rod, I am sorry to hear about your father's long-term suffering.

It is so difficult, maybe impossible, to recognize that point at which someone's life will begin that downward spiral. And unfortunately for some like your father, it is a slow agonizing process.

Ken's article is an interesting one, and I agree with the points he makes. My own Advance Health Care Directive reflects this.

As a practical matter, should you or your loved one find yourself in a U.S. hospital and want to have your wishes in this area followed, it's important that you make your wishes known often and emphatically. Better yet, make sure you have an advocate, and that that person be able to vigorously make your wishes known. Hospitals are immensely powerful entities, and once within their clutches many forces come into play.

European hospitals operate somewhat differently. Many countries realize that health care expenses are not infinite, something U.S. society is not ready to recognize yet.

Quite to my astonishment, this article has gone "viral". It has been cited on over 25,000 websites, and has been read by over 400,000 people.

I'm being interviewed on monday on NPR (Patt Morrison Show), will probably be interviewed on another in NoCal, and have been asked to speak at a conference in Wash, DC.

I am emotionally numb, and absolutely stunned. What I thought was a particular interest and passion of mine, that interested few others, apparently has touched a national chord.

I only post this, because I had absolutely no concept of this happening. It shows that you can't tell what can happen if you follow your passions.

The dilemma that Rod so eloquently spelled out above is affecting almost every family I know -- in one form or another. I have screamed at my family, friends, neighbors, strangers.... the walls, as to why oh why did they "save" my father yet again, so that what would have been an instant death is transformed into a slow, agonizing living death for both the patient and those around him/her.

Yeah, to say that it is a timely article is the understatement of this year.

Ken,
Its been the elephant in the room for decades. Might this turn out to be a turning point for our approach to treating those in their final days?

Movements have to start somewhere. Look at the OWS, and now the phrase "99%" has taken on a life of its own.

Ken,

Upon reading your article, I can certainly understand why it has gone viral. Excellent article -- well written, personal, and very timely and relative. It touches where a lot of people are at, I think, esp. since our baby boomer generation is now aging en masse.

It was also nice to read some of your personal history and stories beyond what we see here. I knew you were a doctor, but in that specific area, not much more than that. To hear about Torch and your other interactions with people was very touching. I think your article made people think, and it did so in a compelling and disarming way.

Congrats on such a good article, and on the upcoming publicity surrounding it.

CaT

Bee is so right it is a dilema. It is also a tough decision when you know what is best for a loved one but you have doctors doing what they were trained to do.You as a family member are usually taken out of the equation once you take them to the ER.
Ken it was a very well written article and provoked an amazing emotional response from us all.

Ken, your well-articulated observations deserve viral attention. My wife's grandfather died with no warning. We are watching the agonizingly slow, freedomless, degrading decline of her grandmother. I'll never mourn the suddenness of an older death again.

Which brings this to mind...

On or about 17 March, Oates, while apparently lucid, stepped outside the tent, saying, by Scott's account, "I am just going outside and I may be some time."

for more on Ken's article and Ken himself:

http://newoldage.blogs.nytimes.com/2011/12/30/when-doctors-face-death/

I usually avoid "The Chat Room", but this thread caught my eye. Ken, your article was right on the money. It was also very timely, since I've resolved to find the time and money in 2012 to do a proper job with all that will, trust, advance directive, and power of attorney paperwork that I've been putting off.

I can just add one point: As an atheist, I see the hand of the religious pro-lifers contributing to the problem you so forcefully describe.

Bob, I respectfully disagree. No 'hand' of pro-lifers (for the unborn, the very young, or the old) or any other conspiracy. Ken and I are 59 and 61 years old and have seen a lot in our medical careers. I have never ever had a end-of-life decision presented to me by a family as a religious choice, only a personal choice (and damn the government - keep them out of it, except, wait, Medicare pays for this stuff , and ....what is ObamaCare gonna do?). The only thing closest to it might be a Jehova Witness/other and whether or not they will take blood or be an organ donor/recipient.

Perhaps we would be stick plainly to the thoughts in Ken's original post.

From my perspective -- after the patient dies -- I can really see how the comfort/care of the patient was the number one priority with the family/decision makers. I deal mainly with religious families (the cemetery is owned by congregations) from mildly observant to Orthodox, and hands down, very little of the end of life decisions were dictated by anything other than raw emotion. Now, when it comes to burial rituals.... suddenly everyone is Orthodox!!

I cannot stress how timely this topic is, due to the fact that it asks a person to re-define what a merciful -- in a non-religious definition -- death really is(current psyche holding it counter-intuitive to "deny" prolonged life care)

Bingo!!! Nail on the head once again Bee.Raw emotion interferes with rational decision making about what is really in the best interest of the dying patient.It is counter-intuitive to "let one die" as nature would have it.We hold on to the "hope" science provides.As Ken so aptly said doctors have seen the outcomes and tend to choose natures exit strategy rather than to artificially extend life only so briefly and sometimes miserably.
I had prostate cancer in 2007 and had a radical prostatectomy.4 years later I experienced a recurrance . I had 40 radiaton treatments from December 2010 to Feb 2011. Eight months later (now) I have my 3rd case of prostate cancer. Medical treatment for this cancer has failed me. This time after being diced and nuked I am treating my cancer with alternative care.I will also exit this life on my own terms.There will be no more slicing, radiation or chemo. I will live as long as my body can do so on its own ability.I plan on a long natural life with many more trips up Whitney.Exercise as medicine in my 2012 mantra when i start my re-hab for my shouder surgery I am having Tuesday Jan 3rd 2012.I am totally OK with the way things are.C'est la vie.Que sera sera, whatever will be will be.
I hope to climb MW with some of you this year. I am excited for my future.I plan on being in the best shape of my life in 4 months.

Thanks, all, for the comments. One of the absolutely humbling aspects of this experience, is people posting about their incredibly personal experiences that relate to the issue. I can rarely read one of the many forums/blogs, without being emotional. Some of the stories are just anguishing.



Bob, one would think that might be the case, but it has not really been my experience "on the ground", in individual cases. I practiced most of my career in a fairly conservative Catholic hospital (I'm not), but I never felt any pressures on these decisions, nor felt that I was being "watched" by the institution.

Another issue that relates to the difference, is that docs talk about this to our families and friends all the time. There is no unclarity as to our feelings. This has not often been true of the general public. The problem comes when a patient can no longer make their own decisions, and the family is stuck doing so, in the absence of written directives. They will often do what they think is right, even if that is NOT what the patient thought. Is this common, or just conjecture?

J Clin Oncol. 2003 Feb 1;21(3):549-54.

"In the near-death condition in patients without LWs (Living Wills), there was disagreement in 46% of patient-caregiver pairs about CPR, in 50% about mechanical ventilation, and in 43% about tube feeding.

CONCLUSION: Although most patients and families endorse the primacy of the patient in decisions at end of life, the majority do not take supporting actions. Disagreements between patients and families about the use of life-sustaining measures in patients without LWs may result in patients' preferences being superseded at end of life."

Sadly, this has also been my experience.

Most of my adult life, the most common after the fact query has been "Did we do enough" (life saving procedures). After witnessing the harrowing outcome from a Pancreatic cancer treatment known as The Whipple Procedure, I began to ask the new query, "Did we do too much?".

I continue to ask this new query each and every time they miraculously "save" my father.

Rod, with all my heart, I hope for the best of all you deserve for the rest of your life.