How Doctors Die

[JaneV2.0]

http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/

According to this article, many doctors reject extensive therapies or heroic end of life measures, preferring to let nature take its course. "Less is more" is my philosophy of medical intervention, so this really doesn't surprise me.

[San Onofre Guy]

I saw this some time ago. Ken Murray is a frequent poster at the Mt. Whitney Portal Store message board. Ken is a wonderful human being.

[oldhat]

I read this article a while back. Although it's based on anecdotes, it has a ring of truth about it. I expect that doctors, who see so much unnecessary suffering and know better than anyone what can and can't be done by way of treatment, tend to be less inclined toward measures that pursue quantity of life over quality.

Nevertheless, it's one thing to say, "I'd never want to live that way" when it's an abstract concept, but quite another when you're actually staring into the abyss. I guess most of us will find out how we'd react, eventually.

[Selah]

My father was a doctor and by the time he discovered he had prostate cancer, it had spread to his bones and he was diagnosed as terminal stage 4. He chose to have no treatment whatsoever other than palliative care: pain medication, and eventually, as he became completely bedridden, 24/7 nursing care for help with eating, drinking, and hygeine.

He immediately signed DNR documents and a living will. He lived for about six months after the diagnosis, and spent the last few days of his life in a hospice facility so he could get better pain management and have more help in being turned and other personal matters. Like oldhat said, he was quite aware of the realities of cancer treatment at that stage of the game, and neither wanted to go through it himself, nor put my stepmother through that particular trauma. Watching him slowly die at home, in great pain and anxiety for much of the time, was hard enough on her.

Still, before it got to that stage, he used his time wisely. Literally hundreds of people called, wrote, and visited him, telling him how much he'd meant to them, how grateful they were to him for being his doctor/teacher/friend/family member, and how much of a positive influence he'd been on their lives. He honestly had no idea how many people loved and cared for him, so, despite the pain, it was, for the most part, a "good" death. Ironically, the very man who volunteered for the hospice organization, and befriended my father before he passed away, ended up also being diagnosed with cancer shortly after he met my father. He passed away last year.

[bunnys]

Good points. I was just thinking about this the other day. Pushing 50 and I know that I'm entering the age when the diseases are more likely to hit. I have recently decided that I am not going to spend the remainder of middle age and my old age on pins and needles waiting for "the" illness to strike by chasing after them with annual test after annual test. Maybe I'll miss something, maybe I'll die early because of it but I'd rather miss an illness and die early than to spend the next 40 years or so fearful that something terrible is lurking. Quality of life is everything.

Additionally, if I do get the diagnosis and it's not good, I'm not (hopefully) going to start chasing after some elusive cure for the remainder of the time I have left. What's the point of that?

[San Onofre Guy]

Bunny's the majority of people living in the Western world die of natual causes at old ages. There are a number of people who die early due to disease and cancer, but for the most part we are a very healthy society and even those with disease get chests cracked open or are giving mass quantities of drugs to manage disease. The cancer issue is anothe story. While lifestyle choices do impact the likelihood of contracting cancers, there are very healthy people who do contract cancers. About 15 years ago my employer began to sponsor via group discount body scan imaging services. Very few took advantage of this service and most doctors advise against such screenings without an indication of a need. This is similar to women who have mastectomies at young ages to avoid breast cancer when their mothers and aunts died of the disease early in life.

If you have a family history, well then be alert, but if not live life.

A friend of mine had four bypasses at age 44, his father died of a heart attack in his 40's. Guess what, my friend is married to a doctor, they now eat a plant based diet. My dad had bypass at age 80, my doctor says that doesn't make me have a family history of heart disease but I say so what, I'm still changing my diet to keep my cholesterol low.

[bunnys]

San Onofre Guy--no family cancer history--I mean none. Brain aneurysms, well that's another story. That I will get checked out bc it can be fixed.

As far a healthy living, I am so big into that. Happy to say I literally can't do anything more than I'm doing besides stop drinking coffee and start lifting weights and I LIKE COFFEE and HATE WEIGHTS!

Don't want to worry about it and won't!

Thanks for the validation!

Also, I eat a plant based diet and LOVE IT! I can't encourage you enough to keep moving in that direction. I feel so great because of it.

[RosieTR]

Thanks for the article, it was really interesting. After the Terry Shaivo business, DH and I got a lawyer friend to draw up a will, living will, power of attorney, etc to make sure that sort of junk didn't happen. In some ways, it's like the American ideal of sometimes pathological optimism manifests most terribly in these sorts of situations. I had a friend whose 90 yo grandmother had a pretty bad stroke, but lived. The Drs were talking to this friend (the closest nearby relative) about physical therapy and such! The friend was incredulous. Thankfully, the grandmother died peacefully after most of the family had a chance to fly in and say their goodbyes, and she was lucid enough for some of the time to comprehend that family members were there to give their last goodbyes. If I had to choose, that's probably the type of death I'd pick. Short enough of a period of knowing you're going to die not to ruminate on it, but long enough for loved ones to connect. That same year, DH's father died but he'd been fighting cancer for years and some of it was unpleasant. I don't think there was a way to do extreme heroic measures or if so, MIL knew his wishes from the long fight and didn't agree to that.

[ToomuchStuff]

With nurses in my family and several Doctor friends, I would agree that there is a lot they do differently. (including how they talk to one another as the professional coldness/indifference requirements come down) I also know how hospital administrations, put doctors in the line of fire for medicare/medicaid fraud, by passing on their negligence to them (bill this to x without the doctor knowing the whole story). Having other family that was in the funeral industry, I know we as a society, don't get our wants/wishes about that down enough as well. I have seen a lot of people fighting different things, some with odds that made no sense. This whole thread made me think of a book that I read a few years ago, called Tuesdays with Morrie as well as "The Last Lecture" by Randy Pausch.

Here is his lecture: http://www.youtube.com/watch?v=j7zzQpvoYcQ

Morrie's interviews with Ted Koppel: http://www.youtube.com/watch?v=dcnL2o385Gw


Remember folks, it isn't how you die, it is how you live!

[iris lilies]

My father was a doctor and by the time he discovered he had prostate cancer, it had spread to his bones and he was diagnosed as terminal stage 4. He chose to have no treatment whatsoever other than palliative care: pain medication, and eventually, as he became completely bedridden, 24/7 nursing care for help with eating, drinking, and hygeine.

He immediately signed DNR documents and a living will. He lived for about six months after the diagnosis, and spent the last few days of his life in a hospice facility so he could get better pain management…..

I am reading this old thread for reasons you can probably guess.

I’ve been working my way through Atul Gawande’s book “ Being Mortal” for many months. He is a physician who has been thoughtfully studying death and how his fellow medical officers deal with it ( poorly.) In the middle of the book his own father, also a physician, comes down with a cancer. The father puts in place what you would expect, directives for no heroic measures, hospice at the right time, etc.

One incident in his death journey was maddening. He was in great pain, so much that he even called someone out of state about pain med protocol*. Later he got pain meds that knocked him out. His wife advocated for not so much pain medicine because she wanted him to wake up and “pain would cause him to wake, he has so much life left.”

argh. Awful. Fortunately, the author of this book, made sure his father got the medicine he wanted.

The lesson here is that people close to you may not serve you well in your last days due to their own panic and fear.

* I do not understand why massive amounts of morphine cannot be given. I just don’t understand.

[jp1]

This thread reminds me of my cousin's husband, a doctor, and his end of life story. In his early 60's he came down with some terrible disease that left him completely paralyzed for many months. Then it went into remission and he got his life back. Eventually, a couple of years later, the disease started to resurface and he got permission to fly his airplane one last time before the disease took over again. (They lived in a small town in remote western Kansas and for years pre-disease he had flown to the various towns where there were clinics at which he provided care.) He took off and flew up a few thousand feet and then his plane nosedived and smashed to the ground, killing him instantly. Apparently he chose suicide by airplane over going back into the the complete helplessness of a repeat paralysis situation that was expected to be permanent this time. If that's in fact what he did I can totally understand the decision.

[ApatheticNoMore]

Reading this death thread is oddly comforting. RIP Jane 2.0. But also my sibling may have cancer (not confirmed yet). They are in their early 40s. I guess being in your 40s is when people around your age start dropping off (dying that is). I'm not so accepting of it really though, I'm not accepting of it at all really. In your 90s sure, but I'm not so accepting of this at all. They smoked.

[gmiller]

I'm in my 40s too, and reading about deaths can be a sobering reminder of how fragile life is. I'm so glad my partner made me quit smoking two years ago. For now, try to focus on staying hopeful and supporting each other. My thoughts are with you during this unsettling time.

[Rogar]

I went back and forth a few times with Jane, hopefully in a friendly way, over nutrition and her lack of faith in medical institutions and big pharma. There are extremes on either end where we deny any sort of common treatments, including preventative medications like statins and vaccinations, and then over treating a person when the quality of life is questionable. There is a middle ground that makes the most sense to me, but it's a choice we each make and try to make peace with the possible outcomes. We have long term care facilities filled with people who's lives are prolonged with modem medicines, but have little quality of life. Once you get into those systems you lose some treatment choice and it's like the Hotel California. You can check out any time you want but you can never leave. I can respect choices that avoid that inevitability, and who is to say what is absolutory right or wrong.

[catherine]

I've always wondered if we "let" my mother-in-law die when we refused the choice of surgery on her gangrenous bowel at age 85. We were heavily influenced by the doctor, an older doctor in a Vermont hospital. He said the recovery--if she even made it through--would be prolonged and painful and that if it were his mother, he would not subject her to that. That made sense, but our skeptical side wondered if he said that but was really thinking--"it's Friday night and I'm not into doing a surgery." You can bet if she had experienced this acute event back home in NJ, she would have been whisked into the OR. Instead, life and death took its natural course and she died.

I still battle sometimes on whether or not we did the right thing. Fate had it that she landed in a Vermont hospital and not one of the academic hospitals in New Jersey. When I told my brother's wife about it, she clearly gave me the impression she would not have done what we did--she would have pulled out all the stops. But you look for the bigger picture and you see my MIL over the preceding months getting more and more despondent, less interested in activities, in more chronic pain from arthritis, with very little interest for all the things she liked to do, and her true purpose in life (work) evaporated, added to her acceptance of our decision at her bedside, and I can confidently say we did the right thing.
"

[happystuff]

My mom just died a few days ago. We were all there to say our good-byes. Grateful that she went out the way she wanted, but still wasn't easy.

[iris lilies]

My mom just died a few days ago. We were all there to say our good-byes. Grateful that she went out the way she wanted, but still wasn't easy.

Sorry for your loss, happystuff. Was she ill for a while? How old was she?

[Tybee]

Oh, happy, I am so very sorry for your loss! Sending lots of love and healing your way. So glad she was able to go with loved ones there to say goodbye. What an incredible blessing.

[catherine]

My mom just died a few days ago. We were all there to say our good-byes. Grateful that she went out the way she wanted, but still wasn't easy.

Oh, my sincere condolences, happy. It is a blessing that you and the rest of her loved ones were there at her side. May you find peace in your memories of her.

[happystuff]

Thank you, everyone. No details, but will simplify to age, tired body, etc.

To have that "constant" in one's life suddenly be gone... definitely an adjustment.

[catherine]

Thank you, everyone. No details, but will simplify to age, tired body, etc.

To have that "constant" in one's life suddenly be gone... definitely an adjustment.

You may find that she is not really gone--you will talk about her, think about stories and sayings that defined your relationship with her, do things that remind you of her, hear her voice in your head...in short, she will always be a constant in your life.

[frugal-one]

So sorry happystuff! Thankfully you were able to be with her at the end!

[pinkytoe]

Condolences happy stuff. One of my only regrets in life was letting the medical establishment keep my mother alive in a vegetative state (at least I hope she didn't know what was going on) way past her end date. She deserved a better ending.

[rosarugosa]

I'm so sorry for your loss, Happystuff.
Catherine, I absolutely think you did the right thing with your MIL.

[Simone]

To have that "constant" in one's life suddenly be gone... definitely an adjustment.

So true! Sorry!

[happystuff]

Again, thank you, everyone.