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(AlterNet)   Doctors on death: you're doing it wrong   (alternet.org) divider line 70
    More: Interesting, palliative, living wills, terminal illness, Ewan McGregor, brain disease, physicians  
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8504 clicks; posted to Main » on 25 Oct 2013 at 11:10 AM (25 weeks ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-10-25 11:13:26 AM
I do tech support for a suicide hotline and you would be surprised at how stupid people are when it comes time to kill themselves.
They really do need help.
 
2013-10-25 11:14:26 AM
NO, I AM NOT.
 
2013-10-25 11:16:56 AM
We can go full-court press, or we can aggressively manage your symptoms and keep you comfortable

Or you can keep your paycheck out of my death process and leave my body the hell alone. That would keep me comfortable.

Dicks.
 
2013-10-25 11:19:13 AM
Doctors do not "save lives." At best they delay the inevitable. They are aware of this, so often choose to go quietly.
 
2013-10-25 11:19:37 AM
Every single person I know in the field has chosen the calm comfort route for the end.  It is dramatically opposed the general public's decisions even when given the same data.  Experience tempers decision making in the experienced which is something that apparently cannot be communicated via patient education alone.
 
2013-10-25 11:21:01 AM
Ars Moriendi
 
2013-10-25 11:21:40 AM
A lot of doctors and hospitals make a lot of money trying to keep people, who should just be allowed to die as painlessly as possible, alive for as long as possible.
 
2013-10-25 11:30:21 AM
Another way to look at it is that doctors routinely order procedures for patients near the end of life that they would not choose for themselves.

Because they have lawyers that will take any opportunity/opening to sue them if they do not offer every option available to the patient and family.  Patients and families make emotional decisions based off their knowledge, which is based off of TV dramas and half understood articles on the internet.  Physicians have realistic expectations based on expertise.
 
2013-10-25 11:30:27 AM

Pincy: A lot of doctors and hospitals make a lot of money trying to keep people, who should just be allowed to die as painlessly as possible, alive for as long as possible.


Because the patients and/or their families demand it, or else no written directives are there to say otherwise. Living wills, medical power of attorney... everyone needs those.

I've threatened everyone around me, and I will threaten my son when he's older... if you keep me alive by artificial means, when I finally do pass, I'm going to make Poltergeist seem like a Disney flick.
 
2013-10-25 11:36:58 AM

The My Little Pony Killer: We can go full-court press, or we can aggressively manage your symptoms and keep you comfortable

Or you can keep your paycheck out of my death process and leave my body the hell alone. That would keep me comfortable.

Dicks.


If you don't want either why are you even at the hospital talking to the doctor?

When the Popeye's chicken lady asks you if want spicy or mild and you scream "fark you I want a cheeseburger!" she isn't the one being a dick.
 
2013-10-25 11:42:12 AM
My grandfather choose comfort.

Rather than spend a painful year on dialysis after his kidneys failed, dying anyways, he chose chocolate, a good stout and being surrounded by family, and passed away about a week after refusing more treatment, around Thanksgiving two years ago.
 
2013-10-25 11:50:17 AM
Straighten up and die right?

vudukungfu: I do tech support for a suicide hotline and you would be surprised at how stupid people are when it comes time to kill themselves.
They really do need help.


"It's across the tracks, not down the street."
"No, the rope goes around your neck."
"It won't work unless you turn the gas on...well, I suppose you could light it.  Might be a bit quicker."
 
2013-10-25 11:51:28 AM
I've already told my wife and kids every day past 80 will be a miracle, so don't be surprised if I deny all treatments if I get a strong cancer.

/up to 70 I'll fight tooth and nail to get treatments
//70-80, treatment only if it's something low-grade, like prostate.
 
2013-10-25 11:52:03 AM
End of life counseling like this is the same as death panels.

//This will be Poe'd unless I do a dead giveaway
 
2013-10-25 11:56:54 AM

The My Little Pony Killer: We can go full-court press, or we can aggressively manage your symptoms and keep you comfortable

Or you can keep your paycheck out of my death process and leave my body the hell alone. That would keep me comfortable.

Dicks.


You realize the option 2 is the option of letting you die but treating things like pain so you stay calm and peaceful and die in some comfort right? The author of TFA shouldn't have used "aggressive" there since they were using aggressive treatment throughout to refer to the typical full court press, do everything we possibly can try style of end of life treatment, but still. Reading comprehension.
 
2013-10-25 11:58:54 AM

fickenchucker: I've already told my wife and kids every day past 80 will be a miracle, so don't be surprised if I deny all treatments if I get a strong cancer.

/up to 70 I'll fight tooth and nail to get treatments
//70-80, treatment only if it's something low-grade, like prostate.


My grandmother is dying of Alzheimer's. While most of my family has already had the "we don't want to be vegetables" conversation, watching her and caring for her has caused a lot of us to have a more in-depth discussion about end of life matters.

There's a difference between quantity of life and quality of life.
 
2013-10-25 11:59:02 AM
Patient's family: DO WHATEVER YOU CAN TO SAVE MY MOM I DON'T CARE EVEN IF SHE'S BASICALLY A VEGETABLE
Lawyers: If it even looks like you let someone die without doing everything humanly possible to "save" them you're getting a letter from me.
Hospitals: Policy is do these x procedures because it's just what we do. Failure to comply is a hazing at the M&M conference.

And doctors are the dicks.
 
2013-10-25 12:03:52 PM

vudukungfu: I do tech support for a suicide hotline and you would be surprised at how stupid people are when it comes time to kill themselves.
They really do need help.


A good # of my sisters ER horror stories are about people who farked up suicides (like shooting off their jaw/face/sinus cavity and just clipping the brain).  She's said she gets very tempted to just tell them how to do it right, to save them the pain and the ER the horror of dealing with it (as quite often they are back in a month later after another attempt).
 
2013-10-25 12:05:55 PM
Sad Story Bro time...

So, last week, my wife and I dropped everything and flew down to New Orleans to be with her dying grandmother.  Her grandma had put together the appropriate paperwork to be allowed to hospice at home instead of aggressive hospital treatment...BUT had neglected to put money aside for full time hospice.  This left my wife's aunt to be the primary caregiver in her last weeks.  She was required to feed/clean/medicate an agitated, confused, and aspirating patient with zero training.

Moral of the story: If you do what the article says and put together advanced medical directives to give yourself comfort in your terminal situation, make sure you also think of your family and put money aside for significant hours of hospice care.  I'd rather my family WANT to spend time with me as I'm dying, as opposed to what happened last week where people stayed away because they were understandably unwilling to help in a bad situation.
 
2013-10-25 12:12:48 PM
I wanna go like a half eskimo/half Viking.  If i'm old and sick, put me on an ice flow and then set that biatch on fire.
 
2013-10-25 12:13:18 PM
I would prefer not to do it at all
 
2013-10-25 12:14:44 PM
This is particularly relevant to me today, so thanks subby.
 
2013-10-25 12:15:53 PM

Ned Stark: The My Little Pony Killer: We can go full-court press, or we can aggressively manage your symptoms and keep you comfortable

Or you can keep your paycheck out of my death process and leave my body the hell alone. That would keep me comfortable.

Dicks.

If you don't want either why are you even at the hospital talking to the doctor?

When the Popeye's chicken lady asks you if want spicy or mild and you scream "fark you I want a cheeseburger!" she isn't the one being a dick.


Well put.
 
2013-10-25 12:15:56 PM

bessyglass: I would prefer not to do it at all


I plan to live forever.  So far, so good.
 
2013-10-25 12:20:19 PM

PhDemented: vudukungfu: I do tech support for a suicide hotline and you would be surprised at how stupid people are when it comes time to kill themselves.
They really do need help.

A good # of my sisters ER horror stories are about people who farked up suicides (like shooting off their jaw/face/sinus cavity and just clipping the brain).  She's said she gets very tempted to just tell them how to do it right, to save them the pain and the ER the horror of dealing with it (as quite often they are back in a month later after another attempt).


My wife (an ICU Rn) works with a Chinese doctor/hospitalist who after treating several suicide attempts, told her that in China, when you attempt it, they just put you in the corner until you've died.  If you call them after you took a bottle of pills, they'll just tell you they'll be there tomorrow to pick up your body........
 
2013-10-25 12:31:28 PM
We send our pets to the Rainbow Bridge to end their suffering.

And we call that 'Humane'.

We fight tooth and nail against the inevitable and make people suffer horrendously to stay alive another five minutes.

And we call that 'Humane'.

Clearly, we are screwing something up.
 
2013-10-25 12:31:58 PM

basemetal: PhDemented: vudukungfu: I do tech support for a suicide hotline and you would be surprised at how stupid people are when it comes time to kill themselves.
They really do need help.

A good # of my sisters ER horror stories are about people who farked up suicides (like shooting off their jaw/face/sinus cavity and just clipping the brain).  She's said she gets very tempted to just tell them how to do it right, to save them the pain and the ER the horror of dealing with it (as quite often they are back in a month later after another attempt).

My wife (an ICU Rn) works with a Chinese doctor/hospitalist who after treating several suicide attempts, told her that in China, when you attempt it, they just put you in the corner until you've died.  If you call them after you took a bottle of pills, they'll just tell you they'll be there tomorrow to pick up your body........



It's not an completely irrational policy.
 
2013-10-25 12:32:59 PM

The My Little Pony Killer: We can go full-court press, or we can aggressively manage your symptoms and keep you comfortable

Or you can keep your paycheck out of my death process and leave my body the hell alone. That would keep me comfortable.

Dicks.


Guess how I know you've never experienced real pain before?


/cancer specialist.
 
2013-10-25 12:34:05 PM

The My Little Pony Killer: We can go full-court press, or we can aggressively manage your symptoms and keep you comfortable

Or you can keep your paycheck out of my death process and leave my body the hell alone. That would keep me comfortable.

Dicks.


I think you're mistaking "aggressively manage your symptoms" which refers to pain and discomfort, as "aggressively pull out all the stops to keep you alive", which isn't what that sentence meant. If I'm in the process of dying, I really DO want the doctors to give me meds for the pain and other discomforts like coughing or insomnia.

What I don't want is them giving me CPR if my heart stops, or cracking open my chest cavity, or jamming me full of needles. I don't want to die anytime soon, but when the time comes I'm not afraid of dying. Keep me comfortable and let me slip away peacefully.
 
2013-10-25 12:39:23 PM
Also, the default action for doctors and nurses is to do everything in their power to keep you alive. If you don't want that, make sure you get a Do not resuscitate/No code legal order and sign that shiat. Get it notarized, and get a dog tag or medical bracelet to let them know. I think I remember hearing that some people even get DNR/No Code tattoos, but I don't know where they'd place it. Somewhere on the chest, probably.
 
2013-10-25 12:54:09 PM

Pincy: A lot of doctors and hospitals make a lot of money trying to keep people, who should just be allowed to die as painlessly as possible, alive for as long as possible.


Funny, I've rotated through several major hospital systems in Miami.  This has never been the case.  Most of the time it's explaining 5 different ways to family members that this is not the way to go.  Patient is brain dead..."but what are the chances he'll get better??  How do you know??" etc etc
 
2013-10-25 12:56:50 PM

Outlawtsar: Sad Story Bro time...

So, last week, my wife and I dropped everything and flew down to New Orleans to be with her dying grandmother.  Her grandma had put together the appropriate paperwork to be allowed to hospice at home instead of aggressive hospital treatment...BUT had neglected to put money aside for full time hospice.  This left my wife's aunt to be the primary caregiver in her last weeks.  She was required to feed/clean/medicate an agitated, confused, and aspirating patient with zero training.

Moral of the story: If you do what the article says and put together advanced medical directives to give yourself comfort in your terminal situation, make sure you also think of your family and put money aside for significant hours of hospice care.  I'd rather my family WANT to spend time with me as I'm dying, as opposed to what happened last week where people stayed away because they were understandably unwilling to help in a bad situation.



I'm sorry that her grandmother didn't have the money for it. I will say this, though - as a hospice worker myself, it does pay to look around at all the different hospices in the area, because although we all carry the name hospice, we're not all affiliated with one another (some people do carry that misconception, and we have to clarify fairly often). Non-profit hospices, IMO are the way to go, especially ones that have their own inpatient hospice units - often, they will do whatever they can to manage the patient's symptoms regardless of cost or inability to pay. We often will take in patients with no real expectation that they will be able to pay us, and we just write it off.

My $.02, anyway.
 
2013-10-25 12:59:59 PM
Don't waste time stating what you would or would not choose.
Just like underwear, depends.

When you get there, just hope you will have a choice.
 
2013-10-25 01:00:40 PM
When my grandmother was diagnosed with late-stage, untreatable cancer, she and the family got very good at asking the doctors this question: What information are you hoping to learn from this test, and how will it affect my treatment plan? Turns out many of the (invasive) tests wouldn't change a thing about her treatment, just satisfy the doctors' curiosity (she had a very rare form of cancer). So she declined them.

She would have liked to die at home, but the doctors talked her out of it and she went in the hospice attached to the hospital. Like someone upthread mentioned, dying at home sounds nice in theory, but it can do a number on the relatives.
 
2013-10-25 01:02:02 PM
A sad fact is that no matter how sick or old someone is you always hear the refrain "well I don't want to be on life support if it is going to be prolonged". WTF are we fortune tellers? Listen if you are over 70 and you need to be intubated in an emergency (ie CPR) there is no way in hell of knowing if you are going to be lucky enough to come off the vent in 2-3 days or if your family is going to have to face the choice to pull the plug. If you don't want to have to force them to make that call then don't ever take the damn tube
 
2013-10-25 01:05:44 PM

TheChaosPath: I'm sorry that her grandmother didn't have the money for it. I will say this, though - as a hospice worker myself, ... We often will take in patients with no real expectation that they will be able to pay us, and we just write it off.


You are awesome. You are awesome TWICE.

/Thank you
 
2013-10-25 01:10:59 PM
When my Grandpap was in the hospital and was basically told he was going to die. He told them to unplug his tubes he was going home. He went home, my Grandma watched over him for a few weeks, the old bastard didn't want to die quite yet. Grandma arranged for a nurse come by 2 times a day for an hour to help her. Everyone in the family made a trip to see him because his last wish was to see his grand kids so we had a big family reunion and party for 2 weeks while he was dying (sounds terrible, but that is what he wanted). Everyone got ready to leave since parents had to return to work. He died 1 day after everyone left with my Grandma holding his hand.

If i have the choice, I want to go out like him. Spend the last days surrounded by the whole family basically having a party and vacation.
 
2013-10-25 01:11:21 PM

NuttierThanEver: A sad fact is that no matter how sick or old someone is you always hear the refrain "well I don't want to be on life support if it is going to be prolonged". WTF are we fortune tellers? Listen if you are over 70 and you need to be intubated in an emergency (ie CPR) there is no way in hell of knowing if you are going to be lucky enough to come off the vent in 2-3 days or if your family is going to have to face the choice to pull the plug. If you don't want to have to force them to make that call then don't ever take the damn tube


Or one could just communicate their wishes with the family and have pre-prepared documents that outline what one defines as acceptable and what choices are to be made based on available data.  Of course if the family is full of precious snowflakes, find someone else to have power over medical decision authority.
 
2013-10-25 01:12:26 PM

CWeinerWV: Pincy: A lot of doctors and hospitals make a lot of money trying to keep people, who should just be allowed to die as painlessly as possible, alive for as long as possible.

Funny, I've rotated through several major hospital systems in Miami.  This has never been the case.  Most of the time it's explaining 5 different ways to family members that this is not the way to go.  Patient is brain dead..."but what are the chances he'll get better??  How do you know??" etc etc


Hey there, how are rotations going?
 
2013-10-25 01:12:59 PM
My mom (late 70's) was diagnosed with pancreatic cancer last winter.  Oncologist was all excited to do a whipple procedure (look it up, it's ghastly).  She was firm on the pallitative / Hospice route, so instead of either dying on the operating table or a nursing home, she had 6 months at home with a decent quality of life until the end at a hospice inpatient facility for the last month.  Hospice is a true blessing, and she was comfortable, enjoying time with her friends and family.  Heroic end of life measures just expensively postpone the inevitable, and often worsen the end of life.

/Medical marijuana is also a major plus. Kudos to states that have the basic human decency to allow it.
 
2013-10-25 01:23:48 PM

basemetal: PhDemented: vudukungfu: I do tech support for a suicide hotline and you would be surprised at how stupid people are when it comes time to kill themselves.
They really do need help.

A good # of my sisters ER horror stories are about people who farked up suicides (like shooting off their jaw/face/sinus cavity and just clipping the brain).  She's said she gets very tempted to just tell them how to do it right, to save them the pain and the ER the horror of dealing with it (as quite often they are back in a month later after another attempt).

My wife (an ICU Rn) works with a Chinese doctor/hospitalist who after treating several suicide attempts, told her that in China, when you attempt it, they just put you in the corner until you've died.  If you call them after you took a bottle of pills, they'll just tell you they'll be there tomorrow to pick up your body........


Yeah, that wouldn't fly in the states though.  Certainly not that she'd like the person to die, but after seeing so many people maim themselves attempting it, it just seems practical to get them to do it in the least painful way possible if they are set on doing it.
 
2013-10-25 01:33:56 PM
If it is almost time for me to go, I hope I have the balls to do it right...to refuse all treatment and to go into some war zone on a peace-keeping effort by myself or something.  Or go sea kayaking without a plan to come back.  Or just march out into the Alaskan wilderness to see how far I could make it.  Actually...freezing to death sounds like a pretty good option...you start feeling warm and drowsy, and then you never wake up.
 
2013-10-25 01:59:11 PM
My mom (nurse) was diagnosed with lung cancer long after it had metasticized. The oncologist told her six month if they do nothing - a year if she fought it. She chose not to fight. I actually think she feared the treatment more than death. While I certainly agree with her decision I am sad that she died 45 days before her first grandchild was born. Maybe she would have made it that far? Regardless, my daughter has her name.

/fark cancer
 
2013-10-25 01:59:48 PM

daisygrrl: When my grandmother was diagnosed with late-stage, untreatable cancer, she and the family got very good at asking the doctors this question: What information are you hoping to learn from this test, and how will it affect my treatment plan? Turns out many of the (invasive) tests wouldn't change a thing about her treatment, just satisfy the doctors' curiosity (she had a very rare form of cancer). So she declined them.


Speaking as someone who does a little bit of cancer work (genetics) there is an element of altruism that I would hope many patients would have, if things were explained to them clearly and the test wasn't horribly invasive, in terms of data collection. Some of what we can get in terms of longitudinal tumour sample over time (to keep sequence and monitor the genetic changes) may not benefit a patient directly, but have made huge breakthroughs possible that help the treatment of future patients.

My grandfather currently has prostate cancer for which he has elected no treatment (other than some hormone injections which are mostly to treat symptoms) as he is in his late 70's and figured the risk of quality of life reduction due to surgery and going through radiation/chemo wasn't worth it.
 
2013-10-25 02:18:16 PM

A Leaf in Fall: If it is almost time for me to go, I hope I have the balls to do it right...to refuse all treatment and to go into some war zone on a peace-keeping effort by myself or something.  Or go sea kayaking without a plan to come back.  Or just march out into the Alaskan wilderness to see how far I could make it.  Actually...freezing to death sounds like a pretty good option...you start feeling warm and drowsy, and then you never wake up.


I don't get the freezing thing. I get the shakes so bad when I'm cold, and it's dreadfully painful. So how do you die peacefully freezing to death?

/want to go like my granddad. Spent the day before doing all the normal things he enjoys, had a romp with the wife, massive coronary in the middle of the night that the docs said they couldn't have saved him from if the EMTs had been waiting on the doorstep
 
2013-10-25 02:19:33 PM
Doctors did my family no favors.  While allowed to inject an animal to quicken its passing, we simply can only allow our loved ones to languish in a hospital bed and starve/dehydrate to death while pumped with painkillers.

Seven family members in a year and a half taught me that the only way to die well is to be rich which my family is not.

Watching my dad, my grandmother and my sister die horribly was no fun.  Luckily (?) the others died of heart attacks except my uncle who died of pancreatic cancer.  Even his was quicker, though.
 
2013-10-25 02:25:27 PM
I think blaming the patients is cowardly. Something like half of all medical spending is performed in the last two years of life... that's a lot of money. The health system (as it functions now) requires that money to maintain itself. These things do not happen on the scale they happen because patients are ignorant despite the heroic efforts of doctors to convince them not to elect to undergo life prolonging treatments.

Just look at the anecdotes in this thread... many describe a doctor who suggested aggressive treatment. I'm sure this occurs at least in part because of the money.
 
2013-10-25 02:43:40 PM

entropic_existence: daisygrrl: When my grandmother was diagnosed with late-stage, untreatable cancer, she and the family got very good at asking the doctors this question: What information are you hoping to learn from this test, and how will it affect my treatment plan? Turns out many of the (invasive) tests wouldn't change a thing about her treatment, just satisfy the doctors' curiosity (she had a very rare form of cancer). So she declined them.

Speaking as someone who does a little bit of cancer work (genetics) there is an element of altruism that I would hope many patients would have, if things were explained to them clearly and the test wasn't horribly invasive, in terms of data collection. Some of what we can get in terms of longitudinal tumour sample over time (to keep sequence and monitor the genetic changes) may not benefit a patient directly, but have made huge breakthroughs possible that help the treatment of future patients.

My grandfather currently has prostate cancer for which he has elected no treatment (other than some hormone injections which are mostly to treat symptoms) as he is in his late 70's and figured the risk of quality of life reduction due to surgery and going through radiation/chemo wasn't worth it.


While I agree in general, her cancer was in/on her heart and they wanted to biopsy under general anasthetic. Given the location and size of the tumor, there were elevated risks involved in the whole process. In her position, I would have asked if it was possible to sample the tissue after I died. Hell, even she would have liked to know more about how in the heck she got cancer in her heart - she just wasn't willing to be put under to satisfy her curiosity.

If I were to be diagnosed today with what she had, I would chose a very different course of action and treat as agressively as possible. Of course, I'm about 50 years younger now than she was when she died, so that has a lot to do with it.
 
2013-10-25 03:08:04 PM
Good article.  This needs to be talked about more. This is one of the major reasons health care is so expensive. Contrary to popular belief the largest federal budget item is healthcare. A good portion of that goes to end of life care, extending lives that make no sense in extending -- pain and major disability. If we don't tackle this, healthcare for all is gonna struggle; there just isn't enough money.

Take care of yourself today and live a longer life with less pain. And when the time comes you die
 
2013-10-25 03:13:09 PM

PhDemented: Yeah, that wouldn't fly in the states though.  Certainly not that she'd like the person to die, but after seeing so many people maim themselves attempting it, it just seems practical to get them to do it in the least painful way possible if they are set on doing it.


Well, I said I worked at a suicide hotline. Not a suicide prevention hotline.
 
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