Posted on 02/27/2012 8:01:31 AM PST by rhema
Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. It was diagnosed as pancreatic cancer by one of the best surgeons in the country, who had developed a procedure that could triple a patient's five-year-survival odds—from 5% to 15%—albeit with a poor quality of life.
Charlie, 68 years old, 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 his family. 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 something that we like to talk about, but doctors die, too. What's unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.
Doctors don't want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don't want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).
In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the
(Excerpt) Read more at online.wsj.com ...
“procedure that could triple a patient’s five-year-survival odds—from 5% to 15%—albeit with a poor quality of life”
I’m not a doctor but I wouldn’t hang around and go through hell for odds like that. Maybe I was a doctor in another life? More likely I’m just the typical, normal guy.
I’ve been saying this for years. MIL is 93 and has 7% kidney function and probable leukemia. But she doesn’t want to die—I can feel dialysis and chemo knocking on my door. What a loon!
Unfortunately, it’s just one small step from you making this decision for yourself and the the Obamacare government bean counters making the decision for you.
Doctors know their industry intimately and are making decisions with information that is usually not available for patients or their families. With a recent cancer scare in my life, I told my wife I would not be breaking the bank to chase every last possibility. Fortunately for me, it turned out the tumor was not cancerous but it did cost me my left kidney through a surgical removal of both the kidney and the tumor.
There are a lot of doctors — well, OK, two or three that I know, that I respect. Most doctors are going to tell patients, especially patients with the means to pay, about all the new techniques and all the advances and all the treatments. Most doctors are going to encourage those patients who can afford to do so to try the advanced treatments. Doctors themselves will not be fooled by this tactic.
Our house is all brick veneer. The bricklayers made a few mistakes and bobbles here and there, especially on the gable ends, which are hard to do. My wife, who is a little bit obsessive-compulsive could see nothing except the mistakes. She called a couple of bricklayers out to see if they could correct it. The guys looked at the work and began to tell her how awful the job was and how the first crew had just screwed up everything.
I said, “What do you expect them to tell you when they can make money on it?” Of course, one of the guys still got a job, and I had to write a check.
IIRC, the average doctor dies at 48.
That is correct. My husband was in a situation where he had to perform CPR. when the guy got to the hospital later my husband was informed that he broke the guys ribs but that was normal when CPR is done correctly.
As a former Emergency Medical Technician, I can tell you this is covered during training so that the ambulance/rescue personnel will know what it takes to properly compress the heart and circulate the blood. I’d recommend you seek out a local source of your acquaintance like a fire/rescue crewman or EMT. They know...
it’s a very misleading comment that leaves one wondering about the veracity of the rest of the article. If one has a valid case, it’s better to stick with the unvarnished truth. If not, one must resort to other means
This is a subjedct that my wife and I have given a lot of thought to. I am a cancer survivor, having lost my left kidney to renal cell carcinoma. I now have stage 4 kidney disease in my remaining kidney. No big deal, really. I’m taking care of myself and may never progress beyong stage 4. But IF I do I’ve decided that I will not rely on dialysis to keep me alive. My mother was on dialysis for the last 2 years of her life. Years that she spent dying, not living. No thanks. Not for me. Ditto with the cancer. If RCC ever metastasizes treatment options are limited, brutal and largely ineffective other than surgery. Therefore I’ve decided that if I’m faced with that and surgery isn’t successful I’ll do what the Dr. in the articel did. Go home and live for as long as I have left.
So sorry for you. My son has strict orders - no chemo, no intervention. I’ve had a great life and when I can’t function at something close to normal and care for myself, it’s time to get on to heaven, the good Lord willing. Prolonged illness in a family member is always so hard on the caretakers. Prayers for you all.
Breaking the ribs is a possibility, but not the rule. You do have to push the chest relatively hard. CPR trainers tell you not to worry if you do break a rib, it’s not like you are going to do any harm. The patient is dead unless you resuscitate them.
I’m not sure what you have in mind, but it’s true. I myself have had EMT training, and CPR training countless (ok it’s countable, probably a dozen or so) times. Also, both my folks have had heart attacks and CPR was needed on mom, twice, dad got hospital quickly IIRC. If CPR is performed correctly you must break the ribs in order to get your breastbone/sternum to deviate/compress enough to squeeze the heart. Otherwise, your heart wouldn’t be very protected if a little pushing could do it.
There are few circumstances where it may not be true, say small children with more flexible or perhaps infants without bones (they have cartilage until ossification takes place, which converts cartilage to bone), but if you’re a teen or adult, it’s pretty well guaranteed that your ribs will be broken. Not 100% but pretty darn close. In fact I cannot remember a singe CPR class where I wasn’t told the ribs would crack initially (except it was stated as a toss up for small children), and as I’ve said, I’ve had training from many companies, over many, many years.
Yes, my mother was in a nursing home until she died at 102. Several doctors warned me that CPR would almost certainly break some ribs, because at her age they were very brittle.
I wanted to be careful about taking advice, because some of the doctors I met when she went into the hospital from time to time frankly just wanted to kill these very old patients and just get them out of the way, and I had to refuse their suggestions every time my mother went into the hospital with pneumonia or something similar.
But I did finally agree, no CPR, although I made it clear that they should use normal care such as oxygen mask, intravenous feeding if she couldn’t keep food down, antibiotics, and so forth, when called for.
The important thing is whether you can trust the nurses and doctors in charge. I was fortunate to have put her in a really good Catholic nursing home. And the hospital doctors were constantly trying to persuade me to hurry her death, but at least they never did anything on their own when I refused.
What are you talking about? Breaking of the ribs is virtually guaranteed on any adult receiving CPR. I assume you are completely unrelated to the medical field. See my post @#15.
Do you have a source for that, please?
There is an upside but several downsides for doctors with this.
The upside is the obvious, that they know what the prognosis is, the damage done, and the quality of life if they survive for a while.
But the downside is that they are often just as ignorant about medical breakthroughs as ordinary people. These breakthroughs are often extraordinary, and can sometimes completely arrest or nullify previously terminal illnesses relatively quickly and easily.
And ironically, even if they are still experimental, doctors have enough “pull” to get in on the “new stuff.” Often they would be well greeted in such an experiment, because it can be assumed they will keep their objectivity, and give a learned opinion as to treatment effectiveness.
The other downside is all too human.
People think they empathize with others, imagining how they would feel in their situation. And they, even doctors, are almost universally wrong.
The best example of this was of two green soldiers, call them Privates Smith and Jones, sent into combat for the first time. In the heat of battle, Jones is grazed by a bullet on the top of his head, knocked out cold by the force, and is bleeding profusely all over his head and upper body as is common with even minor head wounds such as this.
Smith is horrified by how his friend Jones looks, and imagines that he is barely alive and in horrible pain, his brain destroyed, and otherwise gone already. So Smith decides to “do the honorable thing” and put Jones “out of his misery”.
About to shoot his friend, he is startled when Jones comes to, and seeing a rifle pointed at him, takes off running, with Smith hot on his heels, trying to get him to hold still so he can shoot the poor wounded man who is at death’s door and doesn’t even know it. But Jones *does* know it, which is why he is running as fast as he can to get away from the pseudo-empathetic dummy with a rifle.
Doctors are far too often in the same position as Smith.
They see people suffer. Or at least they think they do. But like anyone else, they can’t really scale how much someone else is suffering. But they assume they do, and they say to themselves that they don’t ever want to suffer like that.
“I would rather die than suffer like that.”
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