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How doctors die

Ohiosam

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From the Wall Street Journal.

By KEN MURRAY

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.


What's unusual about doctors is not how much treatment they get compared with most Americans, but how little.

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 general public. (As one might expect, older doctors are more likely than younger doctors to have made "arrangements," as shown in a study by Paula Lester and others.)

Why such a large gap between the decisions of doctors and patients? The case of CPR is instructive. A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life.

Unlike previous eras, when doctors simply did what they thought was best, our system is now based on what patients choose. Physicians really try to honor their patients' wishes, but when patients ask "What would you do?," we often avoid answering. We don't want to impose our views on the vulnerable.

The result is that more people receive futile "lifesaving" care, and fewer people die at home than did, say, 60 years ago. Nursing professor Karen Kehl, in an article called "Moving Toward Peace: An Analysis of the Concept of a Good Death," ranked the attributes of a graceful death, among them: being comfortable and in control, having a sense of closure, making the most of relationships and having family involved in care. Hospitals today provide few of these qualities.

Written directives can give patients far more control over how their lives end. But while most of us accept that taxes are inescapable, death is a much harder pill to swallow, which keeps the vast majority of Americans from making proper arrangements.
It doesn't have to be that way. Several years ago, at age 60, my older cousin Torch (born at home by the light of a flashlight, or torch) had a seizure. It turned out to be the result of lung cancer that had gone to his brain. We learned that with aggressive treatment, including three to five hospital visits a week for chemotherapy, he would live perhaps four months.

Torch was no doctor, but he knew that he wanted a life of quality, not just quantity. Ultimately, he decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months having fun together like we hadn't had in decades. We went to Disneyland, his first time, and we hung out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He had no serious pain, and he remained high-spirited.

One day, he didn't wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

As for me, my doctor has my choices on record. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like so many of my fellow doctors.

—Dr. Murray is retired clinical assistant professor of family medicine at the University of Southern California. Adapted from an article originally published on Zocalo Public Square.
 

Ohiosam

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To say that article hits home with me would be an understatement...

I'm sure it does.
My wife has been a registered nurse in a hospital for over 30 years. She sent me the article, it pretty much reflects her opinions especially after losing her father and a good friend in the last year.
 

Jackalope

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I guess it really depends on how old you are... Cancer at 70 is far different than cancer at 30... If I live to see my elder years I would agree 100% with this article..

My coon hunting buddy has Leukemia.. Diagnosed about a month ago.. The doctors wanted to start him on this and that, chemo etc right away.. Scheduled test after test and assured him they we're going to do all they could... He simply said.. You aren't doing a damn thing... I'm 76 years old, this will kill me when I'm supposed to die.. Till then I'm going home... He takes medicine to get his White blood cell count down to normal levels so his pancreas doesn't swell.. But other than that he's the same guy he always was.. Best case he has 7-10 years. By then he'll be 83-86... A good life and his last years spent healthy and happy..

Now If I had Leukemia that same plan of action wouldn't make much sense for me.
 
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Jackalope

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dam joe that sucks...he's been good to ya..


Yeah... But he's at peace with it.. Hasn;t slowed him down any.. But it was a rough week when he was in the hospital and the week after awaiting results..
 

CJD3

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Thanks Sam

When my wifes grandfather (a general family Dr. for many many years) passed away at home, he was very specific to wait 20 min before calling an ambulance.
Syndi was a nurse and was there. She waited the 20 min before calling however the "hero wannabe" EMT was getting into her face for not calling calling right away. He was trying to make it out she had done something wrong. We all knew Doc's wishes. No heroics.
 
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Gern186

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I'm sure it does.
My wife has been a registered nurse in a hospital for over 30 years. She sent me the article, it pretty much reflects her opinions especially after losing her father and a good friend in the last year.

If everyone had this theory Sam, then there wouldn't be a need for nurses and doctors. This is nothing more than one persons opinion. Do you think that modern medicine is no better today than it was 10 or even 5 years ago?
 
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CJD3

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I believe the tone of the article is more directed to terminal situations. Everyone is entitled to their own.

Although they could have kept my wife alive with a pacemaker,breathing assist and feeding tube for "another 20-30 years" , she could not move any her arms, legs, speak or even open her eyes by request due to the severe damage to the brain stem... Well hoo-fu*ken-raa for improved modern medicine.
Thats no way to live. She was adamant about the terms of her living will and had the same belief as her grandfather, and as I do.
She was a RN (high risk OB) all her adult life, her mother was to for over half hers.

I'll stop here.
 
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hickslawns

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Understand completely CJD. I am sure many of us would feel the same in those shoes. There is some amazing stuff medicine can do now. When it is terminal, I think our choices are much more limited than some of the smaller issues modern medicine can treat or prevent. I would have to say I agree with the doctor's opinion that wrote the article later in life. At this stage of the game, (3 kids at home to raise), might have to explore more options first. When you get to that point where your number is up, then I do think your number is up. Why piss away the rest of your pennies to live 3 more weeks or 3 more months? I don't get that.
 

"J"

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My wife like Sam's wife has been in nursing her whole life and is of the same mentality as the author.... no heroics just go peacefully.... and if that's not possible then put her meds close to her bed she'll take care of the rest.... I don't know if I could honestly grant her wish if the time came though....

Watched my dad wither away just so he could see his first grandchild... that was difficult too take.... but that was his wishes....
 

Dannmann801

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These are the kind of discussions people in our culture need to be having, instead of "what did Kim Kardashian have for breakfast Tuesday?" or "did you see the chubby chick on American Idol?"
Good article and discussion.
 

Ohiosam

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If everyone had this theory Sam, then there wouldn't be a need for nurses and doctors. This is nothing more than one persons opinion. Do you think that modern medicine is no better today than it was 10 or even 5 years ago?

I think the point is that doctors in the case of there own terminal illness, armed with more knowledge of their prognosis and of what the treatments entail, often make decisions differently then the general public.
 
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aholdren

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I think the point is that doctors in the case of there own terminal illness, armed with more knowledge of their prognosis and of what the treatments entail, often make decisions differently then the general public.

I agree, it's an educated decision.
 

rgecko23

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at 35 or 85, if I had some life threatening illness that they say I have 3-4 months to live ,I don't want any of that crap. I want to take whatever it is to keep me going for how ever many weeks or months I have and spend the time with my family. I dont want to be hooked up to anything, or go through all that chemo stuff... I dont want my kids or wife to have to deal with going to the hospital everyday and watching me just lie there and wondering what to do. I want to hold my babies, and kiss my wife, I dont want to do it in a hospital...no way, thats not my idea of how its gonna be. I will pray to God that he heals me, and have faith in him that what happens after that is in his hands.
 

Ohiosam

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I'll admit it's easy to say what I would or won't do right now. May God help anyone in that situation that they make a wise decision.