Why doctors die differently

[TPFKA@W]

I hope you all will take time to read this. I further hope that you will send a link to everyone you know and care about. I promise you that there is more truth in this article than in anything else you will read on the internet today.

http://www.wsj.com/articles/SB100014240 ... 1242833962

[rubato]

That jibes with my experience. My cousin by marriage was head of pathology at a medical school and when he saw the biopsy of his own tumor said "I'm a dead man" and died at home. The other physicians in the family, wife included, have all said they don't want any heroic treatments. They understand the limits of treatment and the physical costs.


yrs,
rubato

[Guinevere]

Maybe it depends on the specialist. The cardiologists I've known -- and there are many --- go crazy, at the idea of losing a patient and do a whole lot of stuff to keep them from dying. Should they? Maybe not. But they are the control freaks of the highest order.

On the other hand, the palliative care docs (aka the ghouls), pretty much went through the whole spiel laid out in the article.

Where do the patients wishes come in (assuming they have truly informed consent, and I'm not sure all of them (or many of them) do?

[Big RR]

The saddest thing is that some physicians won't give others the same choice they might make for themselves. I still recall the doctor who came in again and again (3 or 4 times) when we decided to let my mother pass rather than instituting heroic measures, inquiring if we still felt the same way. It's hard enough to watch someone you care for die without having a jerk like that trying to manipulate you into following his will. We knew what she wanted, and her internist supported us, but the ER doctor had to keep bugging us until I threatened to pick him up and throw him out bodily if he came in with the same question again. And he's not the first doctor I saw like that.

The funny thing is, I wouldn't be at all surprised if he would have done the same thing for his own mother or even himself, but some doctors are not content to do nothing for a patient, seeing the death (or even the refusal of their advice (called doctor's "orders") as a personal affront, failure, or loss.

The other thing that bothers me is that, at least in my state (and I'd bet most others), there is no way to put in a binding directive of what sort of care should be avoided and when; the next of kin can, and often do, overrule it. You can designate someone as a proxy, but even your proxy is not bound by your wishes.

[Gob]

Interesting article. Though I've worked with doctors for the past 30+ yrs, I cannot hand on heart say I know of any who have made that choice. Known a couple who have topped themselves though. Retweeted it.

[TPFKA@W]

Maybe it depends on the specialist. The cardiologists I've known -- and there are many --- go crazy, at the idea of losing a patient and do a whole lot of stuff to keep them from dying. Should they? Maybe not. But they are the control freaks of the highest order.

On the other hand, the palliative care docs (aka the ghouls), pretty much went through the whole spiel laid out in the article.

Where do the patients wishes come in (assuming they have truly informed consent, and I'm not sure all of them (or many of them) do?

As with anything there are many different dynamics involved in making choices for yourself and your loved one. Add to the pot an infinite mix of opinions, different religious beliefs and personalities of those involved in the decision making plus the laws, which make no sense to me whatsoever, and you get the messy state of modern medicine we have today.

To a certain degree, I do believe we should go with the final wishes of the patient. One problem is- when is care too much and when might it be not enough. Your remark about the ghouls I pretty much take exception to. If you are dying a miserable death those ghouls will be your best friends and advocates. Unfortunately a person really does not realize that up and until it is way late in the game. My husband's mother, who never lived long enough to become my MIL, fell ill in 1999. Really, really ill she lay in a hospital bed in a coma on a vent. She was weaned off the vent. Out of her head she pulled at the trach and had to be restrained. She developed a massive bed sore on her coccyx that I could have put my fist in. I was not in their lives then, had I been I would have been clambering for those palliative ghouls to close ranks around us. To me the quality of her life had slipped into the negative integer zone and I would have been screaming for the appropriate doses of morphine to ease her exit. Instead more tests were performed. They found a tiny tear in her large bowel that was the cause of the whole mess. They operated on her and fixed it. Slowly she got better, her bed sore healed and her mind cleared up. She went on to live and actgive and quality life til 2005, got to see @hub well matched with me and died the day after New Years 2006. That was a mess and fiasco, she contracted pneumonia then her gall bladder went wonky and she was in bad pain, they operated to take that out and she died 2 days later. Still she had those years because her family are ones who will put the loved one through a whole bunch of things I would not want to be put through in a million years. I maintain there are worse things than death, things that are more horrible than you can put together with your imagination. Am I right though? Who is to judge? All I can do is try and make the best possible decisions for those I care about. It is sad though, I can say what I want for me and some stupid sibling I haven't seen in years who I don't like gets an equal share in chosing what happens to me, if I am unable to say, as @hub does, which is BS in my opinion. Damned lawyers are to blame I say. A lawyer ranks way worse than a ghoul in these matters.

As to Jim's remark, I am guessing that ER doc has a history of being sued by patient's family who swore they had no idea of their options. People hear what they choose to in those situations. He wanted to make sure you could never say you didn't know. Again, lawyers are to blame.

[BoSoxGal]

Great article, @w, thanks for posting it.

I've seen others like it in the past and most shocking to me are the stats on CPR; having taken the course a few times in my life, it made me frustrated to realize of how little benefit those skills are. (However, I suppose to the small percentage who are revived by CPR and go on to live long lives, it's everything.)

When I was hospice caregiver for my friend who was dying of breast cancer, I learned a lot about what some people will struggle through in hopes of just a little more life - or maybe in unrealistic hopes of a lot more life. Had I been my friend, I would have spent those last few months seeing things and people and enjoying those things and people, rather than sitting in my house drinking experimental poison in the hopes that it would prolong my life any wee amount.

BUT, that's what I thought on my side of it - without cancer eating me alive. I guess I really don't know what I'll do when that time comes, but given what I've seen of cancer and chemotherapy, I'm not likely to accept treatment depending on the stage and type of cancer - like the MD in the article, I'd rather have a few good months with family/friends than be in further agony because of the treatment.

[MajGenl.Meade]

[Guinevere]

Maybe it depends on the specialist. The cardiologists I've known -- and there are many --- go crazy, at the idea of losing a patient and do a whole lot of stuff to keep them from dying. Should they? Maybe not. But they are the control freaks of the highest order.

On the other hand, the palliative care docs (aka the ghouls), pretty much went through the whole spiel laid out in the article.

Where do the patients wishes come in (assuming they have truly informed consent, and I'm not sure all of them (or many of them) do?

As with anything there are many different dynamics involved in making choices for yourself and your loved one. Add to the pot an infinite mix of opinions, different religious beliefs and personalities of those involved in the decision making plus the laws, which make no sense to me whatsoever, and you get the messy state of modern medicine we have today.

To a certain degree, I do believe we should go with the final wishes of the patient. One problem is- when is care too much and when might it be not enough. Your remark about the ghouls I pretty much take exception to. If you are dying a miserable death those ghouls will be your best friends and advocates. Unfortunately a person really does not realize that up and until it is way late in the game. My husband's mother, who never lived long enough to become my MIL, fell ill in 1999. Really, really ill she lay in a hospital bed in a coma on a vent. She was weaned off the vent. Out of her head she pulled at the trach and had to be restrained. She developed a massive bed sore on her coccyx that I could have put my fist in. I was not in their lives then, had I been I would have been clambering for those palliative ghouls to close ranks around us. To me the quality of her life had slipped into the negative integer zone and I would have been screaming for the appropriate doses of morphine to ease her exit. Instead more tests were performed. They found a tiny tear in her large bowel that was the cause of the whole mess. They operated on her and fixed it. Slowly she got better, her bed sore healed and her mind cleared up. She went on to live and actgive and quality life til 2005, got to see @hub well matched with me and died the day after New Years 2006. That was a mess and fiasco, she contracted pneumonia then her gall bladder went wonky and she was in bad pain, they operated to take that out and she died 2 days later. Still she had those years because her family are ones who will put the loved one through a whole bunch of things I would not want to be put through in a million years. I maintain there are worse things than death, things that are more horrible than you can put together with your imagination. Am I right though? Who is to judge? All I can do is try and make the best possible decisions for those I care about. It is sad though, I can say what I want for me and some stupid sibling I haven't seen in years who I don't like gets an equal share in chosing what happens to me, if I am unable to say, as @hub does, which is BS in my opinion. Damned lawyers are to blame I say. A lawyer ranks way worse than a ghoul in these matters.

As to Jim's remark, I am guessing that ER doc has a history of being sued by patient's family who swore they had no idea of their options. People hear what they choose to in those situations. He wanted to make sure you could never say you didn't know. Again, lawyers are to blame.

Like any experience, YMMV. I had really really good experiences with the docs at Yale the last year -- with a huge exception of the palliative ghouls. I know they provide a very valuable service, and I know we will take advantage of their services one of these days, but in the case of my Mom, they screwed up so very badly I can't even go into it all ---- except to say they told a woman who wasn't terminal and who was improving that she should turn off her pacer (she is pacer dependent) and give up all hope, when that was EXPRESSLY the message they were NOT supposed to give. The head of the department eventually had to come crawling to me on his hands and knees to apologize, and the cardiologists kicked them off her team. Yep, I blame the Docs

It is key to have good advocates, or be able to advocate for yourself. That includes declining care. It also means that the family, or whoever has the power of attorney/medical directive has to have some very explicit and very direct conversations with the patient and with the physicians. You can only be empowered yourself if you have good information. Again, the docs we worked with last year were pretty good about providing information, and I'm pretty good (as is my sister) about asking questions.

None of it is easy. I've had many days of melt downs and I'm sure there are many yet to come. We've even started to try and have the "what if there is a next time" conversation with my Mom and we haven't gotten through it yet. So onward we all muddle, trying to do the best that we can do. Such is life, and the human condition.

[TPFKA@W]

Maybe it depends on the specialist. The cardiologists I've known -- and there are many --- go crazy, at the idea of losing a patient and do a whole lot of stuff to keep them from dying. Should they? Maybe not. But they are the control freaks of the highest order.

On the other hand, the palliative care docs (aka the ghouls), pretty much went through the whole spiel laid out in the article.

Where do the patients wishes come in (assuming they have truly informed consent, and I'm not sure all of them (or many of them) do?

As with anything there are many different dynamics involved in making choices for yourself and your loved one. Add to the pot an infinite mix of opinions, different religious beliefs and personalities of those involved in the decision making plus the laws, which make no sense to me whatsoever, and you get the messy state of modern medicine we have today.

To a certain degree, I do believe we should go with the final wishes of the patient. One problem is- when is care too much and when might it be not enough. Your remark about the ghouls I pretty much take exception to. If you are dying a miserable death those ghouls will be your best friends and advocates. Unfortunately a person really does not realize that up and until it is way late in the game. My husband's mother, who never lived long enough to become my MIL, fell ill in 1999. Really, really ill she lay in a hospital bed in a coma on a vent. She was weaned off the vent. Out of her head she pulled at the trach and had to be restrained. She developed a massive bed sore on her coccyx that I could have put my fist in. I was not in their lives then, had I been I would have been clambering for those palliative ghouls to close ranks around us. To me the quality of her life had slipped into the negative integer zone and I would have been screaming for the appropriate doses of morphine to ease her exit. Instead more tests were performed. They found a tiny tear in her large bowel that was the cause of the whole mess. They operated on her and fixed it. Slowly she got better, her bed sore healed and her mind cleared up. She went on to live and actgive and quality life til 2005, got to see @hub well matched with me and died the day after New Years 2006. That was a mess and fiasco, she contracted pneumonia then her gall bladder went wonky and she was in bad pain, they operated to take that out and she died 2 days later. Still she had those years because her family are ones who will put the loved one through a whole bunch of things I would not want to be put through in a million years. I maintain there are worse things than death, things that are more horrible than you can put together with your imagination. Am I right though? Who is to judge? All I can do is try and make the best possible decisions for those I care about. It is sad though, I can say what I want for me and some stupid sibling I haven't seen in years who I don't like gets an equal share in chosing what happens to me, if I am unable to say, as @hub does, which is BS in my opinion. Damned lawyers are to blame I say. A lawyer ranks way worse than a ghoul in these matters.

As to Jim's remark, I am guessing that ER doc has a history of being sued by patient's family who swore they had no idea of their options. People hear what they choose to in those situations. He wanted to make sure you could never say you didn't know. Again, lawyers are to blame.

Like any experience, YMMV. I had really really good experiences with the docs at Yale the last year -- with a huge exception of the palliative ghouls. I know they provide a very valuable service, and I know we will take advantage of their services one of these days, but in the case of my Mom, they screwed up so very badly I can't even go into it all ---- except to say they told a woman who wasn't terminal and who was improving that she should turn off her pacer (she is pacer dependent) and give up all hope, when that was EXPRESSLY the message they were NOT supposed to give. The head of the department eventually had to come crawling to me on his hands and knees to apologize, and the cardiologists kicked them off her team. Yep, I blame the Docs

I work with hospice people all the time and have never had that experience, but it makes me wonder if the person is some kind of psychopath who gets off watching people die, an angel of death serial killer type. Of course I never used to think like that til I started watching criminal minds. @hub and his ex used to play euchre with Orville Lynn Majors and his partner. There are likely more of that type out there than you want to think about. I am sorry your experience was bad because I would hate to think of you hesitating to use hospice because of a bad experience.


http://en.wikipedia.org/wiki/Orville_Lynn_Majors

[Guinevere]

That's why i refer to them as ghouls . . . .

[TPFKA@W]

That's why i refer to them as ghouls . . . .

Well it sounds like you lump them all together. Sort of like calling all lawyers ambulance chasers.

One bad apple....

[Guinevere]

Exactly.

Like I said, I know palliative care is important and I know it will be the right choice eventually. But I cannOt imagine using these particular doctors again. They have totally breached our trust.

[rubato]

Must have been a for-profit hospital/medical group.

They're nightmares.


yrs,
rubato

[Guinevere]

No rube -- it was Yale New Haven Hospital - one of the best in the country.

[liberty]

Some years ago a friend that I loved very much die of cancer. Let me corrected that; she actually died of the pain medication. The doctor allow her access to the patches and allowed her to use as much as she pleased. Of courses I don’t know any of this as legal fact it is just what I gather form the situation, but I completely agree. No one should suffer pain to that degree. She in effect killed herself in order to avoid pain and I support her decision. I have heard people say that should never have been allowed; well, I can’t politely tell you what I think about those people except to say perhaps someday they will be in a position to make the same decision. I wonder what decision they will make? I don’t feel that God held it against; she was a good Christian.

[TPFKA@W]

Hopefully you wouldn't hold it against a good Muslim or Jew or Hindu etc either. Or those of us who identify as agnostic.

[TPFKA@W]

Or WesW for posting like this.

[liberty]

I don’t get it: What I said was that I feel that God did not hold it against her for ending her life early instead of continuing to suffer. There are those Southern Baptist that feel that suicide is an unforgivable sin. I don’t feel that way; have not found any mention of suicide in the Bible.

What does that have to with me holding anything against anyone?

[BoSoxGal]

Catholics also share that tenet of faith, liberty - that suicide is a mortal sin.