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How Do Doctors Want to Die? (ETA: Link made clicky to radiolab short)

Posted by on Mar. 8, 2013 at 11:38 PM
  • 10 Replies

January 17, 2013 9:55 am

How Do Doctors Want To Die?

We all have to die at some point. Most of us would prefer for it to be as painless as possible. And yet we can’t seem to let our loved ones go, often prolonging their stay amongst the living for as long as we can.

But what about those who attempt to keep us alive? How do doctors want to die? A recent Radiolab short tackled this very question:

Joseph Gallo, a doctor and professor at Johns Hopkins University…discovered something striking about what doctors were not willing to do to save their own lives. As part of the decades-long Johns Hopkins Precursors Study, Gallo found himself asking the study’s aging doctor-subjects questions about death. Their answers, it turns out, don’t sync up with the answers most of us give.

Ken Murray, a doctor who’s written several articles about how doctors think about death, explains that there’s a huge gap between what patients expect from life-saving interventions (such as CPR, ventilation, and feeding tubes), and what doctors think of these very same procedures.


Essentially, what doctors would want for themselves and what they provide to patient is quite different. They don’t want CPR or dialysis or chemotherapy or feeding tubes—treatments they themselves prescribe regularly.

Atul Gawande, a doctor himself, tackled this same question in The New Yorker two years ago:

These days, swift catastrophic illness is the exception; for most people, death comes only after long medical struggle with an incurable condition—advanced cancer, progressive organ failure (usually the heart, kidney, or liver), or the multiple debilities of very old age. In all such cases, death is certain, but the timing isn’t. So everyone struggles with this uncertainty—with how, and when, to accept that the battle is lost. As for last words, they hardly seem to exist anymore. Technology sustains our organs until we are well past the point of awareness and coherence. Besides, how do you attend to the thoughts and concerns of the dying when medicine has made it almost impossible to be sure who the dying even are? Is someone with terminal cancer, dementia, incurable congestive heart failure dying, exactly?

And that’s not what doctors should do, Gawande says:

The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.

More often, these days, medicine seems to supply neither Custers nor Lees. We are increasingly the generals who march the soldiers onward, saying all the while, “You let me know when you want to stop.” All-out treatment, we tell the terminally ill, is a train you can get off at any time—just say when. But for most patients and their families this is asking too much. They remain riven by doubt and fear and desperation; some are deluded by a fantasy of what medical science can achieve. But our responsibility, in medicine, is to deal with human beings as they are. People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come—and to escape a warehoused oblivion that few really want.

Humans aren’t good at dealing with death. We don’t like to talk about it; we don’t like to think about it. We talk a lot about what happens after we die (this Radiolab tackles that question) but in the months or years just before we die, things suddenly get fuzzy and irrational.  Michel de Montaigne (whose own story about death is quite interesting) says:

“If you don’t know how to die, don’t worry; Nature will tell you what to do on the spot, fully and adequately. She will do this job perfectly for you; don’t bother your head about it.”

Unfortunately, Montaigne’s Nature does not speak to doctors, or to the non-dying, so we’re stuck floundering until we can cope with death a little bit better.

More from Smithsonian.com:

When I Die: Lessons from the Death Zone



Read more: http://blogs.smithsonianmag.com/smartnews/2013/01/how-do-doctors-want-to-die/#ixzz2N0vsbcNp 

http://blogs.smithsonianmag.com/smartnews/2013/01/how-do-doctors-want-to-die/


by on Mar. 8, 2013 at 11:38 PM
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Replies (1-10):
stringtheory
by Platinum Member on Mar. 8, 2013 at 11:42 PM

If you get a chance to listen to the Radiolab short, the most intriguing aspect is the CPR thing - the recent news story of the retirement community with the policy to not perform CPR reminded me of this Radiolab episode and then I found this article. 






LindaClement
by Thatwoman on Mar. 8, 2013 at 11:42 PM

When you get to experience (day in and day out) the result of 'heroic' efforts ... you're naturally less likely to think they're a good idea.

Ever seen a 91yo with several broken ribs, who was 'saved' by CPR, so they can disintegrate in tremendous pain, lying in a cozy and warm hospital bed surrounded for most of the month with total strangers as they wait to contract pneumonia from not being able to move around?

Yeah. I'm not at all surprised by this result.

Sisteract
by Whoopie on Mar. 8, 2013 at 11:45 PM

Working in HC, this does not surprise me.

Cancer treatments and chemo- they kill you and then try to rebuild your structure- the worst, IMO.

Isn't it something like 90% of your life long health care dollar is spent in the last 3 mos of life (for most folks)? What a miserable 3 mos-


stringtheory
by Platinum Member on Mar. 8, 2013 at 11:46 PM

It made sense to me after I heard the episode on radiolab...then I was a little taken aback by the outrage sparked by the story of the retirement community that had a policy of not performing CPR...and then they didn't on a resident, which the daughter of the resident was (I believe) ok with in the end. I wonder how many people realize the physical damage CPR can do with a very low success rate (overall).

Quoting LindaClement:

When you get to experience (day in and day out) the result of 'heroic' efforts ... you're naturally less likely to think they're a good idea.

Ever seen a 91yo with several broken ribs, who was 'saved' by CPR, so they can disintegrate in tremendous pain, lying in a cozy and warm hospital bed surrounded for most of the month with total strangers as they wait to contract pneumonia from not being able to move around?

Yeah. I'm not at all surprised by this result.


jllcali
by on Mar. 8, 2013 at 11:46 PM
I am going to make an advanced directive that will ensure I have a DNR if I get dementia or am, in a persistent vegetative state.
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Sisteract
by Whoopie on Mar. 8, 2013 at 11:48 PM
2 moms liked this

Comfort care is often the most compassionate treatment available-

muslimahpj
by Ruby Member on Mar. 9, 2013 at 12:03 AM

We had CPR training at work the other day, I told the one girl sitting next to me that most who have to have CPR end up not making it in the end.

I dont want 'heroic' efforts, I dont want to spend the last of my life hooked up to machines. 

We need to really start being open and honest in our discussions on death. I think so many people are terrified of it and that is why they fight it so hard.

stringtheory
by Platinum Member on Mar. 9, 2013 at 12:07 AM
1 mom liked this

Agreed.

Quoting muslimahpj:

We had CPR training at work the other day, I told the one girl sitting next to me that most who have to have CPR end up not making it in the end.

I dont want 'heroic' efforts, I dont want to spend the last of my life hooked up to machines. 

We need to really start being open and honest in our discussions on death. I think so many people are terrified of it and that is why they fight it so hard.


eema.gray
by on Mar. 9, 2013 at 12:18 AM
1 mom liked this
I have seen both my maternal grandparents pass peacefully and with relative gentleness thanks to hospice care and thoughtfully written end of life directives. I watched my paternal grandfather pass far less easily, in a hospital, struggling with aspiration pneumonia. His wife is refusing palliative care now, in her 90's somehow thinking the doctors can save her from bone cancer.

I think I would rather go by the former than the later. "Do not go gently into that good night" makes for beautiful poetry but with today's technology is not nearly so sentimental and romantic now.


Quoting Sisteract:

Comfort care is often the most compassionate treatment available-


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LindaClement
by Thatwoman on Mar. 9, 2013 at 12:23 AM
1 mom liked this

Yes.

A very great lot of 'heroic' care is better called 'catastrophic.' 

People who are blinded by loyalty and grief have a very hard time seeing that.

Quoting stringtheory:

It made sense to me after I heard the episode on radiolab...then I was a little taken aback by the outrage sparked by the story of the retirement community that had a policy of not performing CPR...and then they didn't on a resident, which the daughter of the resident was (I believe) ok with in the end. I wonder how many people realize the physical damage CPR can do with a very low success rate (overall).

Quoting LindaClement:

When you get to experience (day in and day out) the result of 'heroic' efforts ... you're naturally less likely to think they're a good idea.

Ever seen a 91yo with several broken ribs, who was 'saved' by CPR, so they can disintegrate in tremendous pain, lying in a cozy and warm hospital bed surrounded for most of the month with total strangers as they wait to contract pneumonia from not being able to move around?

Yeah. I'm not at all surprised by this result.



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