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How Doctors Die
Hugh Pickens writes "Dr. Ken Murray, a Clinical Assistant Professor of Family Medicine at USC, writes that doctors don't die like the rest of us. What's unusual about doctors is not how much treatment they get when faced with death themselves, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves because they know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. 'Almost all medical professionals have seen what we call "futile care" being performed on people,' writes Murray. 'What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, "Promise me if you find me like this that you'll kill me."' Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming."
It's traditional to see life as a sacred thing that must be preserved at all costs--to a point. There was a balance. This has been true throughout human history, with the exception that in the past couple hundred years we seem to have collectively forgotten that in order for life to go on something else has to precede it in death. In an era of ever-increasing lifespans, global populations and expectations of one's quality of life, we are engaged in a losing game against the power of exponential arithmetic.
When it's time to go, it's time to go.
and not screaming in terror like the passengers in his car.
But all kidding aside, I agree that the so called "futile care" exists for the patients loved ones and not the patient themselves.
"Have you ever thought about just turning off the TV, sitting down with your kids, and hitting them?"
It's also a shame that "futile care" is what so many expect in near-end-of-life treatment. These costs can add up to significantly more than all the health care costs up to that point. So our insurance costs are loaded with the costs of futile care.
To put the IT spin on this... it somehow reminds me of when people show up with the 10 year old computer and want to see if it can be upgraded to last a bit longer. The IT professional will be fast to tell them to just bite the bullet and get a new computer already! They know when it is time to give up.
"Never give up, for that is just the time and place when the tide will change." -Harriet Beecher Stowe ^_^
Of course physicians can make better informed decisions, they are pragmatic and know the results and outcome of disease
But what about when their child gets sick? Do they make the same decisions then? It is one thing to make those decisions on your own, but what happens when it is applied to someone else you care for?
I assume the results are different.
I thought Doctors didn't die, they just regenerated? Unless of course they were killed while regenerating.
It's better to burn out than to fade away
Bitter and angry, maybe. But also correct.
Give me Classic Slashdot or give me death!
...almost completely. There is a point, and we can certainly debate just where that point is, beyond which we are no longer "healing" and are merely prolonging the suffering of our patients. The common layman's expectation is that anything that could be done, should be done, regardless of the likely outcome. Pointing out that Grandma's time has come, so to speak, and that the "right" thing to do is to make her passing as comfortable as possible, is something that western medicine does not do, generally. That needs to change.
a patient suffers from severe illness, old age, or a terminal disease
Had one branch of the family that was real religious. Didn't believe in anything even *resembling* euthanasia. Insisted on keeping my aunt alive, no matter what. It was an ugly, sad end. Bad stuff.
Had another branch that had a much better attitude, IMHO. Had hospice care that was not afraid to push the painkillers well into the dangerous zone, a "do not resuscitate" understanding with the hospital, etc. My cousin's mother died a *much* more noble death.
Can't stop death from coming. And there is a time to fight for life, but also a time to recognize when the fight is over.
SJW: Someone who has run out of real oppression, and has to fake it.
I work in a hospital (nurse) and the sentiment from all the staff is identical to the article.
It seems we have so far done a great job of extending the old-age and dying years of life.
Never subscribed to the whole "if I'm that bad, pull the plug" stuff.
Maybe I'd feel differently if I'm ever actually in that situation.. but my gut reaction has always been as George Carlin would put it "screw that, save my ass!".
Coffee is bad for you, apparently. I recommend a nice healthy cup of tea instead.
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
You really should read the article. It isn't bitter at all, and is some serious food for thought. If you've not had a close individual diagnosed with a terminal disease and this isn't applicable, then you're a very lucky person. If you have, the article raises some interesting arguments for how you or your loved ones should approach such news.
It has been two weeks since my father passed away from lung cancer, so I am more sensitive to the topic than normal, but the idea that we should more carefully evaluate how we want to live our remaining days/weeks/months when faced with aggressive, difficult treatment, is one worth thinking about.
>For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves because they know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want.
Many people are absurdly clinging to their lives spending too much money on doctors in the dusk of the lives. I am reserved right now not spend more than 10K for my health. Forget about heart surgery etc. If my deductible (or whatever the part I am paying after insurance payment) is more than that, I'd rather die and leave this money to my dependents.
I do not believe in karma. "Funny"=-6. Do good and forbid evil. Yours, Oft-Offtopic Flamebaiting Troll.
It's a little maudlin - it's hard not to be with this topic - but it does bring up something that most people explicitly don't want to deal with. He points out that the people who do explicitly deal with death and dying tend to do things quite differently than 'normal' people. It isn't a scientific discussion, it's a personal, anecdotal essay.
You're perfectly welcome to muddle through life - it is exactly what we all do. But I thought it was a reasonable essay and one that's been covered many times in the past. It is clearly written as a counterpoint to the "do everything, medicine will solve all our problems" view that is quite prevalent in this world. The big problem is it is damned hard to tell people what to expect especially when they are faced with a fatal illness. It's hard to tell someone how hard chemotherapy would be for that individual. It's hard to know how to balance a few months or years of 'additional' living with the downsides of frequent hospitalizations, invasive procedures, dangerous drugs and additional pain.
At least in the US, overtreatment is a huge issue. Anyone but a trained biostatistician is really not in a position to intellectually tease out how effective treatments for most diseases really are (or in reality, how ineffective). So, when you are unable / unwilling to think a problem through, you emote it. Then it gets complicated.
Faster! Faster! Faster would be better!
What is the evidence for coffee being bad? From what I've read coffee is likely to be healthful.
Ok, and how do you propose we fix it? Should the medical profession community be forced to absoborb the insane cost of education only then be forced to accept a salary they themselves do not want? Perhaps you feel they should be like monks or other holy men and not live for material wealth?
I'll tell you what the problem is. It's the extremely high barriers to entry in the workforce for this industry. As it should be. But you can't skirt around an inconveniant truth of a concept known as supply and demand.
Life is not for the lazy.
And you think that profit is to blame? And not the fact that letting someone die with dignity would land a doctor in court? How about the fact that one doctor who merely attempted to help people who actually WANTED to die was hounded and imprisoned by the government?
It's not a problem with profit, it's a problem with American society. We've become a bunch of coddled pussies, afraid of even the mildest of discomforts, much less death.
In the US, healthcare isn't about getting people better, it's about maximising profits. So, on that basis, it's perfectly okay to keep people alive and suffering terribly as long as there's still a few dollars to be squeezed out of them. Patient dignity and welfare doesn't come into it - the hospital administrator needs a new Jaguar!
Do you mean "private healthcare" as in "healthcare from non-government-owned institutions" or do you mean "private healthcare" as in "healthcare from for-profit institutions"? If the former, that's not, in the developed world, unique to the US. (I'm not sure the latter is, either, although other countries might have a higher percentage of government-run and private-but-nonprofit hospitals than the US.)
Unless the doctor officiously attempts to prolong life, no matter how painful or futile that prolongation is for the patient, the patients relatives are going to sue that doctor to the hilt for not doing their utmost for the patient. Ease the patient out and its a murder rap. "Ars Longa Vita brevis", but not if you're talking to a litigeous lawyer!
Which is why my wife and I worked this out LONG ago:
Pull the damn plug.
Don't tell me to get a life. I'm a gamer; I have LOTS of lives!
I have worked in health care, I never saw such behavior.
If the Dr. is profit motivated. This stuff usually isn't the best use. Too much expensive gear to run, patients who are mostly on Medicare getting a reduced rate for their services, then you will need to fight with the insurance companies and the documentation to try to get your money.
Specialists is where they make money. The patient comes in (often with better Insurance) you cure their particular problem, schedule a few follow ups. And get them out and you get a bunch more people in. I haven't seen any doctor (and I have worked with really stupid, mean and greedy ones) that would allow a patient to suffer just to make extra money.
For these cases it is often the family trying to extend the life of their love ones or there a request to be kept alive. If the Doctor lets them die, then they get law suits.
If something is so important that you feel the need to post it on the internet... It probably isn't that important.
Why is "letting go" always the compassionate, noble, or dignified choice? Everyone has his own preferences and I won't begrudge anybody theirs. But death is death. What I know for certain is that I do not welcome it. When I'm given the option of a prolonged five months of agony leading to the inevitable end or a quick relatively painless couple of weeks, I know for a certainty that I'm taking the pain and the time. Hey, if you or anyone else makes the opposite decision, that's your thing. But let's not pretend there's something more dignified about being accepting vs struggling to the end. They're preferences not absolutes. As for compassion, well, what's compassionate for a person is up to him to decide.
So Anonymous was right? I should just kill my self now? Everyone told me it was trolling? I feel so empty inside, how could they lie like that. I don't think I'll even go to the rest of my marketing meetings today.
From what I know his interpretation is completely wrong. The usual interpretation of the unusual high mortality of doctors, is that they are trying to self-diagnose themselves before going to another doctor, and when they go to another doctor they go to one they know. Due to the inherent nature of cognitive bias, they or their friends would usually diagnose themselves much more optimistically than the unbiased diagnose they give themselves. The lesson is: Never trust the diagnose of yourself or a dear friend. When it comes to important lifethreatening conclusions you need an unbiased mind.
and not screaming in terror like the passengers in his car.
But all kidding aside, I agree that the so called "futile care" exists for the patients loved ones and not the patient themselves.
Ugh. I LOLed (unfortunately). Well done.
Over 50% of health care spending goes to pay for the last two weeks of life.
"To those who are overly cautious, everything is impossible. "
Of a neurologist who had a stroke, and wrote an article about it later. It was really amusing how she wrote about it. She knew what was going on, she knew the signs, hell, she was an expert. She called for help of course, but, she talked about how during it, she was having a rich internal dialog about the process... thinking of what functions were broken, how it was manifesting and how she experienced it....
I think that is a lot of it. Other studies have found that the groups who spend the most on healthcare at the end, and spend the most time in hospital beds prolonging life are... the religious people. Atheists are much more in line with doctors. Why?
My own hypothesis, which fits my own experiences to is... that belief in an afterlife, in the absence of other experiences (like working in healthcare and seeing people die all the time), lets people ignore death. It happens later, there is life afterwards, everlasting life.
Atheists and people who deal with death on a regular basis have no such excuse. As an atheist, I came to terms with the lack of an afterlife early. I remember being maybe 14 years old when I realized that I was going to die, that was going to be it....and even that.... I didn't want to spend my time in a hospital bed. I knew...then...at 14, that when the time came, I would want to just die, even if it meant taking my own life. Not a desire to kill myself now or anything depressing like that, but an affirmation that life will someday not be fine, and never be fine again, and that when that happens, I know I can check out.
I have talked with some people who struggled with suicidal thoughts, serious ones, not attention whores. A few said that when they decided how they wanted to die, and put together a cyanide pill or some such.... just knowing it was there was enough. Knowing that they could end it provided a sort of final resolution, a comfort that allowed them to move past it and stop thinking about it.
On the other hand, I feel bad for the very religious. Doubt is common, almost inevitable. How can you not be on your death bed and wondering if those stories were true? For a religious person to be wrong, could mean so many things, hell, a different religions hell.... what if you chose the wrong god? For me as an atheist, whats to doubt? If there is an afterlife, great....but a heaven one seems just as unlikely as a hell. We literally have nothing to worry about.
"I opened my eyes, and everything went dark again"
They won't have sentiment or 'feelings'. They'll fight to save our lives and won't be burdened with any negatives, such as ethics or morals ... as long as our credit is good.
Wow. Obviously you didn't RTFA. My wife is a nurse on the ventilator unit at a local rehabilitation hospital, and shares this sentiment. So many of their patients are comatose, totally unresponsive, but their families insist on keeping them alive at any cost. They've had patients there for 10 years or more on a vent, comatose, zero chance of ever coming out of it, and only kept alive by the machines. What sort of existence is that? My wife and I have had "that talk" and neither of us want to be kept alive by machines. Sure, if something bad happens and there is a good chance of full or nearly full recovery, go for it. But kept alive by a feeding tube and mechanical breathing? Hell no. I'd much rather spend that extra time with my Creator in Heaven.
'What it buys is misery we would not inflict on a terrorist." Not only is he not American, but he clearly has never met one, either. Strange how he works in Southern California....
IT has something similar. Everyone of us has experienced it.
Poor bastard brings in a laptop with that forlorn look on their faces. "Dude... save my porn". You boot up and the drive is not recognized. Take it out, hook it up it for diagnostics and it is dead. No S.M.A.R.T status, nothing. You gently touch the drive and there are no RPMs .
You sit him down, and explain carefully, that the drive is dead. It could have been overheating from leaving the laptop on the bed while going to town with that whole bottle of hand lotion.
There is an outside chance, experimental even, that you could open the drive and transplant it into a working one. The transplant waiting list is not just long, but extremely expensive and not guaranteed. (I had one guy explain to me that the platters looked like an airplane came in for a hard landing and scratched the whole surface deeply).
He leaves laptop in hand, tears freely flowing, and you look to your buddy and tell him, "Dude if I ever lose my porn like that just kill me". Then you remember that you have knowledge and it is protected with ZFS and scrubbing. Thank God.
Some years ago when my grandmother entered the final stages of her illness--and her life--her longtime physician issued a "Do Not Resuscitate" order. He informed us one afternoon that her end could come at any time. Because she was a religious person, we ensured that she received the appropriate religious rites. Then we settled down, quietly, to watch and wait with her. It was somewhat inspirational and comforting, as she began to "see" friends and family who were long gone and to speak with whoever she was visualizing. She drifted in and out of consciousness. Late in the evening she appeared to fall asleep, we left to get some dinner, and that's when the whole thing went out the window. Her heart stopped, and instead of just letting her go, the DNR order was disregarded, the resuscitation equipment was brought in, and the hospital staff set to "work" on her. It's brutal. It can be like beating up on someone. Fragile old ribs can be broken, the body is bruised, and there is a great deal of noise and pain.
They succeeded in restoring her heartbeat, and she lingered for another two days in pretty severe discomfort. The doctor was livid and handed out appropriate reprimands, but by then it was too late for my grandmother. She was robbed of what had been a peaceful end-of-life interval, and we were left with a boatload of guilt for taking a break and leaving her unguarded from the people who were supposed to be following her doctor's instructions and taking care of her.
Do what you can to safeguard your elderly relatives from this. It's brutal, violent, pointless, and turns a quiet death into a three-ring circus of pain for the victim.
"Here's what's happening. You're starting to drive like your Dad..." - Red Green
Sorry, there was a sentence error in the above. To make it more clear: Doctors will usually diagnose themselves much more optimistically than the unbiased diagnose they would give others.
Everybody has a cognitive bias, which makes even our logic prone to be overly optimistic judgements about ourselves or our loved ones. (unless we are depressed in which case the bias is reversed)l
Cut into your body, remove things you don't need, without killing you.
Sew you back up.
Set bones - with or without surgery
Kill infections
Figure out what is killing you
Cut into your body and move things around (i.e. plastic surgery,
Tell you which activities/things are bad for you - particularly if they first diagnosed you with a specific issue.
If you ask them to do much more than that, you get temporary fixes. Kidney transplants, pacemakers, etc. all have a relatively short life expectancy.
excitingthingstodo.blogspot.com
[quote]Patient dignity and welfare doesn't come into it - the hospital administrator needs a new Jaguar![/quote] That has not been my experience. At all. I've watched a number of people pass away from long-term illnesses. When it became obvious that they were not going to get better, each person was presented with a number of options, including discontinuing care. In each case, the person requested that the doctors continue aggressively treating their disease.
Let me guess. You are Mormon?
John McAfee 'It was like that time I hired that Bangkok prostitute; to do my taxes, while I fucked my accountant'
Well, I'm not entirely sure on that one. First, there are disputes over how to even perform CPR for maximum effectiveness, with some saying that chest compression alone produces better outcomes than a mix of chest and breathing. If the doctors aren't in agreement over what CPR should be done, and different methods are being rolled into a single line item, then the statistics for the outcome really don't mean anything useful. It tells you that *something* is ineffective, but it cannot tell you what that something is.
Second, all doctors either swear to the Hippocratic Oath or implicitly sign up to it by becoming doctors. Since the Oath is witnessed by an independent third party, it is arguably a legally-binding common law "gentleman's agreement"/"verbal contract". Technically, the Oath states that doctors should do no harm and minimizing suffering is technically doing just that. However, very few Western nations interpret things that way. If they did, assisted suicide under well-defined conditions* would be legal. It isn't because they don't. As such, doctors end up in a double bind. Do they do the clinical least harm or the legal least harm? Whichever one they do, they violate the other.
*I am not a fan of assisted suicide, but the only way to bring the ethics and law together is to have some cases where it is legal. IMHO, the Oath should move from common law to contract law and be the defining standard. It's a "floating" standard, since different levels of technology and understanding will alter what least harm is actually achievable, and it is a far more credible benchmark than the religious and political whims of the day.
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
Evidence isn't that strong, but yeah, there seems to be some positive effect, though not necessarily due to caffeine (seems to happen with decaf coffee also).
10 PRINT CHR$(205.5+RND(1)); : GOTO 10
Your point being? If I suffer excruciating pain, and tell my family to let me die, then I *am* making a choice how I want to die, am I not?
Or are you confusing this with a DNR? The point of the DNR is to let you die in case you cannot choose anymore, for example because you are essentially braindead. But again, you make a choice.
This sig does not contain any SCO code.
The entire western world bar the united states solved that problem decades ago (hint, doctors here aren't poor). Why is it that Americans think every problem is theirs and theirs alone? Is it that you think you are so advanced that no one could possibly have faced these problems before? Serious question. Those of us on the outside watching these debates go back and forth can't help but go WTF?!
Or being tortured by all your former cats (now Giant) while Satan watches his little minions eat your liver.
Just saying. You can't know.
John McAfee 'It was like that time I hired that Bangkok prostitute; to do my taxes, while I fucked my accountant'
You don't have to be Morman to understand how addiction works.
"[Regarding the 'cloud,'] ownership was what made America different than Russia." -- Woz
The patient only has to be legally alive. I would be astonished if hospitals didn't add the occasional day, week, month or decade to a patient's death certificate date in cases where hospitals thought they could milk the insurance company and/or government for a little bit longer.
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
I have been told by doctor friends that it is common practice to slowly increase the morphine drip on patients with end-stage illnesses to provide additional "comfort". The doctors understand that the patient's body will likely succumb to the affects of the drug and "slip off".
Of course, one of the doctors telling me this winked and said "I'VE never done it, mind you."
Really it's a convoluted mix of several things that account to a poor death experience in the States. Doctors are under orders to do everything they can and money is not a consideration. Insurance companies don't want hindsight 20/20 lawsuits alleging that more could have been done. There is a general "religious-y" feeling that people die when "their time has come". And the families almost never want to "let someone go".
In the end many people either suffer weeks of painful life-prolonging treatments or spend the last days in a drug-induced coma. I would guess that many west European doctors would be amazed, medically impressed, but ultimately dismayed at the lengths we go to keep 90 year old patients alive.
Ok, and how do you propose we fix it?
Couple of ideas:
1) Ban pharmaceutical company reps from hospitals.
2) Limit hospital administrator pay to the median salary of their employees.
3) Criminalize the practice of outrageous markup on medical procedures and equipment; The one time I had surgery, I was charged full retail price for every implement present in the OR at the time, as well as $25 for the fucking Sharpie they drew on me with... and they wouldn't even let me keep the tools (scalpels, forceps, etc.) I payed for!
Should the medical profession community be forced to absorb the insane cost of education only then be forced to accept a salary they themselves do not want?
If so, that would put them more in line with the real world in terms of compensation versus cost of education. Do you think they deserve a better post-college shake than the rest of us, simply by virtue of the fact they chose to spend more on said education?
An enigma, wrapped in a riddle, shrouded in bacon and cheese
Troll?
I'm a physician that works for a hospital.
I have the futility talk with patients and their families quite frequently. It kills a little bit of me when I hear a family say they want everything done. And a little more dies every time I run a "mega code", lasting over an hour trying to save someone who if by some miracle they survive, will have no quality of life and be dependent on machines for breathing and feeding and urinating (hemodialysis) for the rest of their life.
"Where there's life, there's hope" is a common saying in the community I work in. Every time I hear that, I cry a little inside.
I have never had a hospital administrator even hint at anything that would extend suffering. If anything, the administrators like us to call the local hospice services, to free up beds for individuals who will survive.
Help! I'm a slashdot refugee.
Hell man, I'm an atheist (nothing but organ donation / apple tree fertilizer / medical room decoration in my "after-life") and I wouldn't want to live like that.
---
ECHELON is a government program to find words like bomb, jihad, plutonium, assassinate, and anarchy.
The only study I've seen to suggest this was deeply flawed by its reliance on self reported alertness levels. There is nothing to suggest that people who are used to caffeine do not simply have a higher base level expectation of alertness. In fact the research boiled down to "people that haven't had coffee think they're as alert as people who have had coffee."
RUGBYRUGBYRUGBY
Even if that is true, there is no reason to think that addition is bad per se, as long as there are not negative health or social effects associated to it.
I think that's the main idea of John Scalzi's "Old Man's War".
Actually the tea is even worst, especially if it is not made properly, which is true in 99.999% of the cases.
My mother died last month. She was a physician who worked primarily with elderly patients in nursing homes so for her losing a patient was a regular occurrence. She had a bad bout of pneumonia and her lungs were not recovering, so I had to make the hard choice whether or not to put her on a ventilator in order to keep her alive. My justification was that the respirator would only be used for a short time in order to give her lungs a chance to heal and recover. When it became apparent that she was not recovering, I had to make the decision to remove it and allow her to die naturally (it took less than an hour).
My mom did not have an advanced directive specifying what kind of care she wished to receive if she were unable to choose for herself. This made my decisions very painful and difficult. I remembered the conversations I had with her about her caring for her own patients and how sometimes the families of her patients would request extreme measures at the end of life, and how this would contrast with borderline neglect during the patient's life.
My mom also was opposed to assisted suicide. That much I knew. She felt life was a gift that shouldn't be wasted or rejected.
In my mother's case, it was clear that if she were to survive she would need to be on the ventilator for an extended period of time, and enough time would pass that she would deteriorate physically due to being immobile in a hospital bed. Also, she was in the early stages of Parkinson's and it was almost a given that this violent shock to her system would result in an acceleration of its effects.
Knowing that if she did recover her quality of life would be greatly reduced, I made the tough choice to let her go. One advantage of this was that I was able to hold hand, stroke her hair, and sing to her as she died surrounded by family. She was 73. I encourage everyone regardless of age to set up an advance directive determining the level of care they wish to have. It wouldn't have prevented my situation, but it would have made it easier if I knew ahead of time what mom wanted.
What morons rated this '5 insightful'? Ken Murry is not bitter and angry, he is thoughtful and kind. PCM2 has done the typical thing of morons: he assumes his imagination = reality. Give us all a break and don't post if you don't even read the article.
My mom died from cancer when I was in highschool and my aunt was diagnosed with Stage IV cancer about a month ago. Though nobody has said it out loud, I think everyone in the family understands that my aunt is also going to die.
I still don't really know how to talk to someone who's going to die. It's...weird to talk about the future (which they won't be a part of), or to ask "how are you doing? (because they obviously aren't doing too well). We want to communicate care and support, but we also don't want to burden and tire out the patient by repeatedly calling to remind them that they're going to die. Is it better to confront the elephant in the room? Or to ignore it? It's disturbing to voice out loud the certainty of death, but it's also galling to bullshit someone by saying everything's going to be ok, when it's not.
What do you guys do in these situations? I'd especially like to hear the prefences of anyone who is dying or at one point believed that they were going to die.
My Uncle recently passed. He was 94. In the last weeks of his life, "they" did everything to keep him alive, when all he wanted to do was die. He even had a document (as I recall) stating he wanted to die, but they had to bring in a psychologist to determine if he capable of making that decision. He had no family, just a few nephews and nieces. I can't fathom why they would have done such a thing, unless it was to squeeze as much medicare as they could.
It makes my blood boil every time I think about it.
Absolutely, if we take your point of observation to be a fixed point. However, once you factor in MORE observations, concerning the movements of the moon, planets and stars, we must revise the assertion.
It's not only a problem of unrealistic expectations by patients.
There is also a conflict of interest between the doctor's duty in the best interests of his patients and in the best interests of the medical practice that employs him. A principled doctor can stay on the honest side to a large extent, but take transparent honesty too far and your career prospects are threatened.
It's not really all that different to how it is in other professions. However, other professions don't have the same direct effect on human life and suffering, so the problem stands out a bit more in this discipline.
It's especially bad in a country in which the medical industry is extremely lucrative which has the inevitable consequence that medical insurance is astronomically priced. That turns everything into a money game, and the result HAS to be bad medical practice: after all, a doctor cannot offer the same level of service to a person without money as to one who is rolling in it, because if he did, what would the rich person be paying for?
Money distorts everything, but the effect is particularly harmful in the health profession.
"The question of whether machines can think is no more interesting than [] whether submarines can swim" - Dijkstra
That is more or less along the lines of what I have seen. There is some evidence that it is beneficial in several ways, and very little indication that it may be harmful.
True, it's not like the discovery of a connection between adenosine receptors and caffeine is that new.
This is so wrong. The majority of those providing care to the terminally ill know it is pointless and don't want to do it, even for the money. Their hand is forced by legal requirements and family members.There are plenty of other things to be done that will make a difference, but they get pushed to the back because they aren't considered "life-saving".
Often the effort to extend the terminally ills life another day/week/month is written off and not paid back in full. The profit margin at that point of life is very slim. Even procedures that aren't lifesaving and are becoming more routine have slim margins. For example, there is no (ie, zip, zero, nadda) profit on total knee or hip replacements at the hospital where I work. We have to do them because of legal requirements, but insurance won't pay more than a certain amount.
Profit could be maximized much better if the vast quantities of manpower and resources dedicated to saving those already dead were instead allocated to those who will live to pay.
As a healthcare worker, it pisses me off to see people ranting about the costs/quality of the US healthcare system without knowing anything about it other than their own pocketbook.
It sounds like Survivors Syndrome was very cruel mistress to the kind doctor.
I don't know about doctors.
But dentists _all_ routinely torture their patients for extra money.
80% of wisdom tooth extractions are unnecessary and are done to milk a patents dental plan.
That's right: You suffer for a week. He or she makes an extra grand or two. Hell of a deal.
John McAfee 'It was like that time I hired that Bangkok prostitute; to do my taxes, while I fucked my accountant'
Given that damnation is supposedly eternal, the plus or minus few extra years isn't going to make much of a difference.
I can quit drinking coffee anytime I want! Not just now.
She is amazed how many people are "full code" (meaning the staff must do anything to save them), even when they are very old and frail. It is usually the family that wants this. They don't realize what this will mean in reality. It means that if their heart stops they must do chest compressions which will probably break the persons ribs when they are old and fragile.
It depends. If you're trying to compile multiple projects simultaneously in Xcode then, yeah, get the new machine. If they're just running Word, IE, etc, that 10 year old machine can still do the job. And why not use an otherwise perfectly serviceable machine? One of my cars - Toyota Rav 4 - is going on 10 years. I have no intentions of replacing it just because it's 10 years old.
A bit more than 30 years ago my mother was diagnosed "terminal" cancer. To the point where she was told to go home and die, less than 6 months to live. Instead she signed up for at the time totally experimental neutron radiation therapy (specifically her doctor lied to get her into the program, and when she got to the university running the experiment she was told "if we had known your condition we wouldn't have accepted you")...
Her life was shit for years because of that treatment.
So here we are, 30 years later, and she's still alive. The shit she went through is mostly forgotten, the health issues she lived with from the radiation therapy have mostly been replaced by more typical "60+ year old American" health issues. She has has now spent half her life as a cancer survivor, and while it hasn't been chocolate and unicorns she seems happy to be alive.
That sort of colors my view, I'll admit, but it seems to be a point that gets lost in a lot of this discussion.
1) Not all doctors take the Hippocratic oath. I am a doctor, and while I appreciate the sentiment behind the oath, I did not swear it myself.
2) There a many different forms of the "oath". Nobody today takes the oldest know form, which of course is likely not the "original" (it is unknown if Hippocrates actually was involved in the original oath anyway). Did you know that the original oath prevents a physician from performing urological sugery, abortions, or assisted suicides? And did you know the original oath required the oath-takers to give free medical care and support to their teachers for life?
3) Medical ethics has moved way, way beyond this simplistic and confusing Oath as the end-all-be-all. Re-adopting it would be like swapping out the laws of England with sharia law, or even the ten commandments.
Bringing up "the oath" is entirely irrelevant to the discussion and is a red herring. It would also be a big step backwards to include it in physician training in the future, except as a historical curiosity.
Why wait until you're faced with aggressive, difficult treatment? How do you want to live your remaining days now? Your life is already terminal enough to carefully evaluate that.
How about one of the author's nurses turning him over to the police for obeying a patient's desires to not be put back on life support? You think that doesn't support his notion that doctors suggest treatment plans with the specter of a police investigation in the back of their mind?
How about him keeping his cousin in his home after his cousin was found to be terminally ill? You think there isn't a difference in the cost of the bottle of pills they sent him home from the hospital with as opposed to forcing him to stay alive?
Have you seen what chemotherapy does to people?
Do you know the monetary and emotional cost of forcing a piece of meat to keep on breathing long after it's expired?
There's plenty of food for thought in this article, and you think geocentrism has something to do with it.
What the hell is wrong with you.
"First, there are disputes over how to even perform CPR for maximum effectiveness, with some saying that chest compression alone produces better outcomes than a mix of chest and breathing."
There is pretty close to ZERO dispute over how to perform CPR. Compression-only CPR is intended for untrained individuals who may be under stress; it's easier to just simply keep pumping than to keep track of "how many compressions have been done, oh, now it's time to take a breathe". The average person may be more reluctant to put their lips on a complete stranger; it's also more difficult to alternate between breathing and compressions if there's just one person available. Paramedics, EMTs, etc do both compressions and ventilation.
You don't have to be Morman to understand how addiction works.
No, but it does take someone who understands addiction to understand how addiction works. And it's pretty clear to anyone who who has ever regularly used caffeinated substances the parent poster isn't one of them.
http://humour.200ok.com.au/image_nicebigcup.html
bjd
My mother had a stroke this fall, and passed away as a result. She had an advanced directive in place, and my brother and I had medical power of attorney. Fortunately he and I agreed on what steps should be taken, etc.
The medical people we dealt with were absolutely wonderful. I live 600+ miles away, and prior to leaving I managed things over the phone. They took the time to explain to me exactly what was happening, what the prognosis was, etc. Nor was this an open-and-shut case at the start, but as things developed further it became apparent what the end would be. They always informed me, answered my questions, and respected my opinions.
By the time I got there, she was in the palliative care unit and they were keeping her out of pain, though by that time consciousness was long gone. They treated us well and were always concerned about how we were managing.
Four years ago she had a fall, hip replacement, and a tough time coming out of the anesthesia. The medical people were helpful and informative back then. She recovered, though went into assisted living instead of to her own home for her last years.
There are good medical professionals out there, and they're not all money-traps. There are also families out there who are not in the, "Do everything you can to keep Mommy alive!" mold. I have nothing but good to say about the terminal care she and we received at the hospital. Just before Christmas we received a few additional mailings about their grief counseling services, recognizing that things like this tend to hit hard in the holidays, especially the first after a loss.
Been there, done that.
The living have better things to do than to continue hating the dead.
This is the exact reason I carry a DDNR and a Med Alert style bracelet stating that.
If I'm to that point, most likely I'd do little more than put my family through hell during rehabilitation, both emotionally and financially for a possible good outcome.
My wife has a friend whose husband was injured in an accident prior to Thanksgiving, he is still in the hospital and is still in CCU, with little to changes for the better. A DDNR would have saved his wife the roller coaster of the dr's saying he is improving only to have him lapse into a worse state. Had he carried a DDNR she would be mourning his passing, but would also have the peace of mind of knowing the final outcome instead of 3 months of hell only to find he won't make it.
I am Bennett Haselton! I am Bennett Haselton!
I was told that applying oxygen along with chest compressions is better than compressions alone.
However...and this is important...911 operators who are trying to coax someone into giving CPR can usually get them to do the chest compressions, but all too often when the operator tells someone to breath into the dying person's mouth, the line goes dead, as does the person. When the EMTs arrive the person who was giving CPR will have faded back into the crowd. This was from an Austin EMT instructor.
Also, a nonskilled person might take too long switching from compressions to breaths and back, during which time overall blood pressure drops. It takes a while for pumping to boost blood pressure sufficiently to move it around to the brain, so the pauses to put more air in the blood can be worse than just moving around what little air is already there.
In other words, the science is pretty clear: oxygen with compressions is better than compressions alone. However, the sociology is in debate as to whether or not bystanders can be made to do things the better way, or if the less-good-but-better-than-nothing way is more likely to be implemented.
It doesn't hurt to be nice.
about how useless competition is in health care because you need too much specialized knowledge to make informed decisions, are too distraught to do so and don't use the service enough. This is interesting since it looks at it from the other end, e.g. someone with the knowledge to weigh their options for real.
Hi! I make Firefox Plug-ins. Check 'em out @ https://addons.mozilla.org/en-US/firefox/addon/youtube-mp3-podcaster/
Well, my sister died less than a week ago, and was fighting her cancer for about a year and a half. The conversations were pretty normal actually. I would ask how she was doing, not to bring up the impending death, but to see how she was feeling at that time. The chemo may be giving bad results, or not so bad. If she didnt want to talk about it then she wouldnt. We never really spoke about how dire the situation was for a long time, as she always had the perspective that it would pass like a bad flu. I wished that she had less treatment sometimes, as the days of recovery from medication took away more good days then she could have had with nothing, but she was insisting on remaining active and alive for as long as possible, and actually made a lot out of the days that she had. I made sure to do the fun things that we liked to do together, partially to distract her, and partially so I could have the memories now that she is gone. The important thing for me was to just continue to be alive with her. We got to have a lot of time that was just like always, but she made sure to fit in as much as she could. Dont ignore the situation, but dont focus on death ... focus on being alive.
Coffee and Tea are bad for you. I recommend a drop of dew from fern leaf.
Cut into your body, remove things you don't need, without killing you.
That depends on what they need to remove - not all tumors have well defined boundaries and they often have to followup with chemo or radiation therapy to make sure they got it all.
Figure out what is killing you
As long as you have a well recognized disease. My sister spent a year of unnecessary and ineffective treatment for a relatively rare condition that was much better controlled once she was on the right meds.
If you ask them to do much more than that, you get temporary fixes. Kidney transplants, pacemakers, etc. all have a relatively short life expectancy.
A kidney transplant lasts around 10 - 12 years on average. Even if it's not a permanent fix, it sure beats spending 4 hours on a dialysis machine 3 days a week. Over the lifetime of the transplant, it will have saved 6200 hours (260 24 hour days) of sitting on a dialysis machine.
A pacemaker lasts 7 years on average, and the original placement is a relatively minor surgery done under local anesthetic - a replacement is even easier since typically the leads don't need to be reimplanted. My father is on year 14 with a pacemaker, and has had one replacement. He is very happy with the performance of the unit and is thankful to have it.
I'd say that pacemakers are something that doctors do exceptionally well - it's a relatively low-risk surgery that is nearly routine in nature and gives an excellent prognosis. Don't confuse the life expectancy of the treatment with the life expectancy of the patient. A painkiller may last only hours, but when I have a headache, I still take an aspirin.
"Critical Care" by Richard Dooling nails this. $2-5K per day for ICU means that you do NOT let anyone code out if you can keep vital signs going in some fashion.
Imagine how bad overpopulation would be if we all lived to be 150.
I am Bennett Haselton! I am Bennett Haselton!
The usual interpretation of the unusual high mortality of doctors
Doctors have the same mortality rate as lawyers, beekeepers and hobos: 100% over a long enough span.
Not really. I know at least one person that's been on dialysis for most of his life.. and pacemakers are a decently working thing too.
In the end every fix we know is temporary - like that Onion article said, the death rate is still 100%
No, he's just conscious, and right.
I drink coffee maybe 5 times a year, if that. It just isn't my thing, but I know caffeine addiction from the absurd quantities of pop I used to consume. It's as strong an addiction as any other drug. One day, I tried quitting cold turkey - big mistake! I would get these killer headaches that no painkiller could beat, so instead I had to wean myself off, very gradually. I still go through a cycle in the afternoon, just a few hours after waking up, where I get very sleepy for maybe a half-hour - that's caffeine withdrawal! I'm not actually tired, it's a programmed nervous response.
Moreover, caffeine doesn't perk me up at all. I could chug a gallon of Jolt cola before bed and sleep like a log. I even tried using coffee once, to power through a 48-hour death march... didn't work! That tells me that I've been consuming so much excess caffeine since childhood, that my brain's receptors are just fried from overstimulation. A lot of people are like this, so it's just not some random conjecture to say that caffeine has negative effects.
-Billco, Fnarg.com
Medical doctors should not help people die. Make some other profession up. Keep the medical doctors out of it. Let them pledge to preserve life. Let them also pledge to not force life on someone.
Allow that other profession to be the people that setup the death drip or whatever they do to make that happen.
Personally If i was going that route I would want a cool Rube Goldberg device to do the deed.
Situations like these teach us just how trite and pointless most of our communication really is.
One relays recent events, the other responds with empathic emotions or, in cases of perplexity, relevant knowledge or advice. This formula compromises the vast majority of familiar conversation. And, obviously, its applicablity in a hospice circumstance is limited, at best.
Sometimes, we tell jokes. The mood must be right, though, which it usually isn't when dealing with a dying person.
Sometimes, we make declarations of love. There are only so many ways to say that, though, and simple repetition gets strange, fast.
We make plans out loud. Not very applicable, as the OP pointed out.
We also solicit opinions. It can help to make the other person feel valuable, so long as it doesn't make the other person feel like the only reason you came out was to seek selfish benefit from the other's wisdom while the other is still around.
Maybe there is some other class of communication that would make sense, and my geek-cursed social skills just prevent me from understanding it. The only other idea I have is to play board games.
Seeing as they brought in a psyschologist, I am guessing it was the law. They had to make sure he was sane by law and meanwhile couldn't let him die because that would probably get them in trouble also... so ya back to politicians.
I'd have to say that the many variants on heart surgery are pretty major exceptions to that. From bypass to valve replacement to a full artificial heart. They are all pretty reliable and can add many years of very productive life and for the most part a "full recovery". Artificial joints are pretty great and quite reliable as well. Hearts and joints both perform simple mechanical functions that we can emulate pretty well. Other organs are much more difficult.
The main thing is to try to have a level-headed talk with your doctor and ask what the prospects are.
But 10-12 years for a kidney? Tell that to a kid with kidney problems. Cripes, tell it to a 40 year old man.
Pacemakers is a better surgery, but still - 7 years is not enough. Short term fixes.
excitingthingstodo.blogspot.com
Your uncle needed someone with medical power of attorney to be there with him. It sounds like, had he chosen to arrange that with you, you could have helped him suffer less. I say this with the hope that anyone else reading this could arrange things now, before their elderly relatives aren't capable of signing such legal documents.
My wife had medical POA with her 94-year-old grandfather when he got sick and died in 2010. She literally had to sit by his bed to be there when a random doctor would come in and try to intubate or give him something the legal paperwork he'd signed years ago said he would refuse, and she had to tell the doctor NO and wave the POA and No Heroic Measures paperwork at him. She had to do the same thing when the social workers would come by to try to plan his treatment. each new care provider would make or take a photocopy of all the paperwork. (My wife had like 40 copies made.) This took a few weeks until eventually he was transferred to hospice. Even there one of the regular care nurses was furious when they stopped all treatment. In this case, though, the hospice nurse told the regular nurse to STFU and stay out of the way while my wife watched her grandfather die.
With a medical POA and No Heroic Measures paperwork, not only would the paper exist but there would be a family member there with the legal authority to enforce it.
It doesn't hurt to be nice.
you say to them "It's good to see you" and leave it at that. talk with them about what they want to talk about and eventually tell them that they don't need to stick around to help you, they can move on.
I know that you're obviously a troll or just so brain-washed that you believe this kind of crap, but....I'm going to make a case for it. While watching my mother die the slowest, most painful death around (Alzheimer's) my sister and I prayed over and over for even the option to end her suffering. Not an option in America. At the same time, I couldn't help but notice others in the nursing home - worse off - but whose families insisted on prolonging things for what I consider to be their own selfish motivations. Yes, I said selfish. While focused on trying to avoid their own impending loss of a loved one, they never took any consideration for the ongoing medical torture being perpetrated on the patient. Every time blood pressure spikes - Bam! A trip to the ER with all of the attendant poking, prodding, jabbing, muscling their bodies around.....Fucking medieval.
The argument is that, if you are suffering excruciating pain, then you are under mental duress, and those under mental duress can't make rational decisions for themselves.
You need to have that DNR paperwork along with a medical POA set up when you are still relatively healthy, relatively pain free, and relatively unmedicated, then have the person you assigned to manage your care argue your case for you.
It doesn't hurt to be nice.
In terminal diseases (end stage cancer etc..) CPR never works and if for what ever miracle it did work, you're not back to square one, you're back to the end stage disease that brought you there. So...if I'm there, let me go.
Disclaimer: I'm a palliative doc.
Certain cases of cancer, like pancreatic, unless found out very early, are rather pointless to treat.
However, what worries me is, wouldn't adhering to his model deprive medicine of data and subjects needed to improve present cures and develop new methods?
I mean... the operation the article mentions has a success rate 15% - triple compared to old type. Suppose that with enough time, someone manages to triple the success rate again, to 45% - by then it's looking reasonable as a method. But if experiments can't be done , we aren't really going to solve anything.
Perhaps the solution would be pruning the uneffective methods, and paying patients who decide to undergo experimental treatment - truly experimental i mean, not just repeating things that usually don't work well.
I think that both medical insurance and all medical service providers should be, by law, forced to be non-profits.
A successful API design takes a mixture of software design and pedagogy.
Me, on the other hand- I always want to be kept alive. I don't care how much pain I'm in, how humiliating it might be, how "unresponsive"; I only get the one life, and I intend to make it last. And while we're on the subject, if I ever turn up dead, look for my killer- I'm telling you now, it's not suicide.
I've been in pretty terrible pain before with a few different illnesses, and I'd still be happy being alive in that state rather than dead in no state. And on the subject of "unresponsiveness"- there have been a number of studies showing the brains of "vegetative" patients can respond to speech in exactly the same way as normal conscious people, which would make unplugging the machine little better than murder.
"it takes more and more coffee just to reach normal alertness"
that would explain why my 95 year old grandfather who has been drinking coffee for 84 years, now drinks seven thousand five hundred and twenty one gallons of coffee each morning.
He started with one cup, one fine morning in 1927. And from there it just took "more and more coffee just to reach normal alertness".
Without it, it's like he's preserved in carbonite.
Thank you for your helpful explanation of the dangers of coffee.
I got them done after I had pain, not before, even though they had been impacted for 2-3 years. They weren't an oral surgeon, and couldn't have done it just to milk an insurance plan as a result.
hahaha, spoken like a true Shacklee Vitamin shill. From the experiences of my relatives and friends who were either nutrition nuts, supplement nuts, or health food nuts, I can tell you what happens. They get weird diseases and/or die early. Ask Steve Jobs how that raw health food thing worked out. Really you should exercise like a fiend, that is more important that what you eat. my relatives who lived into their 80s to 100s worked hard or worked out.
I had it done, and I'd hardly call it torture. I didn't suffer for a week. Hell, I didn't even suffer right after waking up from the surgery either (I opted for general anesthesia). There was some discomfort, I couldn't exactly start munching on nuts or muesli right after, but with good painkillers I was essentially pain-free.
A successful API design takes a mixture of software design and pedagogy.
In the US, healthcare isn't about getting people better, it's about maximising profits.
I have investigated this but could not find substantial evidence that the U.S. was significantly different from most other countries. That isnt to say that in the U.S. it isnt about profit, its to say that health care spending is surprisingly predictable simply based on the wealth of the people regardless of the country.
Here is a graph of health spending vs GDP/Capita.
The United States is right on the line with most everyone else, and those not near the line each have remarkable economic and political situations (oil rich nations, countries in political turmoil, bankrupt economies, etc..)
"His name was James Damore."
If a machine is what's keeping you alive the decision was already made for you.
I am Bennett Haselton! I am Bennett Haselton!
I finally get to join the club! The elite and ever whiny "I read this on an obscure technology/politics blog two months ago and slashdot is just posting it now?" club.
But seriously, this made serious rounds pretty quickly in medical and sociological circles, and even I read it more than a month ago. I'm actually astonished such an active submitter as Pickens didn't get it through till now. It's pretty much talked to death everywhere else (pardon the unintentional pun), and it's not exactly an old conversation to begin with. Most doctors feel pretty similarly to Dr. Murray; they've been saying these things to each other for years as far as I know. They're not all brave enough to respect a patient's verbal requests over family and staff objections (although even here Murray says he had copious, accurate notes of his correspondence with the patient), but Murray's blog hardly describes anything new or emergent.
"What it buys is misery we would not inflict on a terrorist." No, I would inflict a lot more.
Conservative, mod down for violating
That's what I think everyone dreams of-- that their parent, or spouse, or, worse, their child, will defy the odds and come out somehow stronger, and better able to deal with death on his or her own terms.
Christopher Hitchens recently poured water over this sentiment.
However, in the essay, Charlie's survival odds were five percent, or fifteen percent with treatment, and he was able to understand that for him, several months to wrap up his life were better than a few years of futile struggle. Perhaps he understood that the "fifteen percent" rate was a cold equation, and it did not matter whether he was morally worthy, or lucky, or "fought hard." Unfortunately, this isn't "the fragile reality of Discworld, [where] the gods [] like to play games, [where] a million-to-one chance succeeds nine times out of ten."
Perhaps someone has already written a paper studying responses to cancer treatment among the innumerate and among those who understand statistics.
I enjoy "House," on television, and the conceit of the episodes is that every case is a puzzle, and it's a race against time to solve this puzzle, and if the doctor is brilliant enough, the patient will be saved and life will go on. That sound like a theme that appeals to a lot of people, and perhaps the illusion for the loved ones who have to deal with the impending death of a patient is that if even a faint glimmer of life is sustained, that gives the doctors time to figure it all out.
You have my condolences and sympathies. I have similarly wrestled with those issues and simultaneously had a strong desire verbally destroy bullshit, and the purveyors of the bullshit. Within the hospital there is no lack for this. To cope I read the literature on cancer, at first simply looking for a definition. What is cancer? To the best of our knowledge, after roughly a century of study, it is still a fairly abstract definition that nearly applies as much to weeds in your garden as the tumors of cancer in a body: a malignant and invasive proliferation (growth) that may metastasize (spread). I suppose we can thank the biologists for the lack of meaningful technical specifications as much as the fact that there are thousands of cancer variants, so conflicting evidence and mis-diagnosis is common. The whole situation is depressing. In the end I was not able to impact the situation technically but have retained the curiosity of picking experts' minds as I come across their paths.
What I have found in the mean time is that the placebo effect is too real to ignore. Suddenly the bullshit and the theatre have significance beyond our cultural ties to mysticism and ritual. Feeling good and positive about life is about as important as living it. Ignoring reality in pursuit of your dreams seems like the standard these days, so why not embrace it for a dying loved one? I am partly not being serious, but wondering aloud, why be realistic when reality sucks? Sure, take care of the obligations that you must, be responsible and all that, but that is not very much work. The rest should be spent enjoyably.
A $1000 dollars for a wisdom tooth extraction? I had one extracted in Ireland as a walk-in patient. No insurance mentioned, no PRSI slips shown.
60 Euro. And that included an X-Ray to say, "Yes, that tooth is pretty much irrecoverable".
And I probably could have gotten it performed cheaper outside the capital.
So the corollary to the adage that a person who represents themselves in court has a fool for a client would be, a doctor who self-diagnoses themselves has a corpse for a patient?
God invented whiskey so the Irish would not rule the world.
Actually you misunderstand what a DNR is. I carry one, I'm 39 have done so for about 5 years now. If I'm out having dinner and have a heart attack and need CPR medical personnel will do nothing for me. If I suddenly stop breathing but am conscious and able to reason medical personnel can not intubate me. It is basically saying if my body needs something other than itself to keep me alive or to revive me they are to do nothing for me.
I am Bennett Haselton! I am Bennett Haselton!
Few doctors in Sweden swear the Hypocrite oath(the original, strict Hippocratic oath forbids the doctor from engaging in surgery for example), and those who do swear an altered version(that allows for surgery, and also shutting down life support apparatus when it's clear that it will just prolong pain with 0 quality of life).
As a swedish paramedic, I have sworn no such oath, nor would I ever do it.
Also, as a trained paramedic, we always do compressions+breathing, the compressions-only thing is a quick mnemonic taught to people who aren't trained, but they can perhaps manage to save someone.
Ok, and how do you propose we fix it?
Nationalize it.
That is all.
How about one of the author's nurses turning him over to the police for obeying a patient's desires to not be put back on life support?
Actually, that isn't what he claimed. Even with just his side of the story, we know it wasn't that; a nurse fulfilled her mandatory reporting requirements because the paperwork wasn't there with him, as it normally would be. The system worked, the paperwork was checked and his wishes had been followed.
Actually it seems to be a picture of the system working, regardless of the doctor's view.
No doubt. *Real* tea is served supersaturated with sugar, over ice cubes.
As long as we're sharing personal anecdotes, I've never had a headache due to caffeine withdrawal. I've been told both "maybe you don't drink enough coffee" (like hell) and "maybe you'll have to stop for longer before you get them" (I have).
I do notice the fact that it has less of an effect after habitual use, but that applies to anything. Even chewing gum. Know why it tastes better, if you stick it on its wrapper and chew it later, than it tasted when you took it out the first time? That's why.
I agree with andyring, I dated a doctor who worked on the ICU for a while. Same thing, family will keep their son, father, husband, ... alive even if it brings extreme pain to the patient. The doctors already do the utmost to save someone, when they say they can't help any further you might want to listen.
It also hurts the caregivers and makes them burn out faster. I've seen the issues up close, how it affects health care workers and I also work with some people. Euthanasia, abortion, heaven and hell, benevolent god - I've changed my viewpoint on all of those.
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Well, I'm not entirely sure on that one. First, there are disputes over how to even perform CPR for maximum effectiveness, with some saying that chest compression alone produces better outcomes than a mix of chest and breathing. If the doctors aren't in agreement over what CPR should be done, and different methods are being rolled into a single line item, then the statistics for the outcome really don't mean anything useful. It tells you that *something* is ineffective, but it cannot tell you what that something is.
That's not actually quite correct. The current debate isn't about whether hands-only CPR is more effective than full CPR (It's not), the question is whether hands-only is more easily performed correctly than compressions/vents, and is, on average, going to be more effective as it gets performed in the field, add into that the fact that hands-only is easier and faster to teach, and maybe we'll have more of the population able to perform CPR, which means a decrease in time from arrest to start of CPR, which will always improve outcomes.
Second, all doctors either swear to the Hippocratic Oath or implicitly sign up to it by becoming doctors. Since the Oath is witnessed by an independent third party, it is arguably a legally-binding common law "gentleman's agreement"/"verbal contract". Technically, the Oath states that doctors should do no harm and minimizing suffering is technically doing just that. However, very few Western nations interpret things that way. If they did, assisted suicide under well-defined conditions* would be legal. It isn't because they don't. As such, doctors end up in a double bind. Do they do the clinical least harm or the legal least harm? Whichever one they do, they violate the other.
Well, here we get into bioethics, which is a tremendously involved field, but I'll just give the nickle tour of the applicable issue.
The big one is the notion of patient autonomy. The patient (or their appointed medical decision maker) gets to choose what happens, provided they are competent to do so. As a medical professional, it is my job to determine what course is most appropriate, explain it to the patient, and once they understand what's going on, what the pros, cons and risks of the treatment are, they give me consent and I do it, if they refuse consent, I find the next most appropriate thing...rinse and repeat. In cases where there are multiple courses which balance the pros/cons/risks, I present them all, and let the patient choose.
A couple of quick sidelines we need to explore here, in order to have a decent understanding of the beast.
First is consent, and the second is competency, and the two are very closely linked, so we're going to do them as one.
There are two forms of consent, implied and expressed, expressed is relatively easy, the patient says "Yes do that" or "No go away.", alternatively, actions can be interpreted as expressed consent, if I need to take someone's blood pressure, and when they see the cuff in my hand, they roll up their sleeve, that's expressed consent...this can, of course get a little murky, and is part of why I have to carry malpractice insurance, since if I do something a competent patient didn't want, even with the best of intentions and in the full faith that I had been given consent, technically, I've just committed battery.
Implied consent isn't nearly as clear cut as that. Implied consent is used when a patient for one reason or another is not capable of giving consent, it could be because they're unconcious (obviously not going to be telling me to go ahead), they're a child (You're not legally competent until you're 18, or a variety of rare loopholes), they're confused and disorientated (If you don't know where you are, you surely can't understand medical procedures) or they're in the midst of a psychiatric emergency (If you think I'm a giant talking turtle, you're not going to understand medical procedures.). In the care of implied c
I needed a sig so people would know who I am, but I was too drunk to make something witty, so you get this instead.
I drink about 4-8 cups a day of the black gold. Of course, I'm aware of my addiction. I keep the coffee black so as not to add unwanted calories with sugar or milk. About every two months I do a detox and quite cold turkey, the migraines are a killer. Then I switch to tea for a while. Inevitably I go back to coffee though, once detoxed, the attainable caffeine buzz is better than ever. Besides, I hear coffee prevents cancer, so its a double win.
"zero chance" is a lie, and if a nurse who works in the field describes anybody that way, she needs to review her training. There are no "zero chance" cases.
The profit motive is the worst part, but number two is technology.
Today we have technology to perform literally unlimited testing, procedures, experiments, etc. Rationing health care is a scary notion with terrible openings for abuse, but spending unlimited money is just not viable.
Cost effectiveness is one side of it. The article addresses another, which is the cost in dignity and the opportunity costs of trying everything when there is a small but non-zero chance of success.
Do you think they deserve a better post-college shake than the rest of us, simply by virtue of the fact they chose to spend more on said education?
Yes. They invested more time, effort, and money, so they deserve at least the opportunity to have a better return on that investment.
Moderate drunk! It's more fun that way!
The reason that it is impossible to "live every day like its your last" is because of money. If someone has enough assets to spend every day checking things off a bucket list without having to earn any more money, more power to them. But the majority of the world has to keep working to earn the money to buy the food & shelter to keep themselves alive for the undetermined number of days they've got left as long as they don't starve or die of exposure. This isn't news to anyone, including you, but it always gets brushed aside when people suggest living every day TO THE EXTREME! If we all had a timer that told us how much time we had left, we could plan out our lives much more easily.
Either the dental office was being heavily subsidized by the government, or it was being heavily subsidized by milking the insurance companies of patients who did have insurance. No way could they afford to see and treat you for €60.
What he said is based on several studies (not conducted by Mormons). Here's one, just for example: http://www.sciencedaily.com/releases/2010/06/100602211940.htm
The study, published online in the journal of Neuropsychopharmacology, reports that frequent coffee drinkers develop a tolerance to both the anxiety-producing effects and the stimulatory effects of caffeine. While frequent consumers may feel alerted by coffee, evidence suggests that this is actually merely the reversal of the fatiguing effects of acute caffeine withdrawal. And given the increased propensity to anxiety and raised blood pressure induced by caffeine consumption, there is no net benefit to be gained.
Caffeine is highly addictive, and you cannot simply quit without severe side effects if you drink coffee daily. My boss tried to quit once years ago, and had the worst headaches of his life.
You can quit, but you have to ease off of it, not simply stop unless you want to experience terrible pain.
I heard that lioness milk is the stuff, but vegans seem to disagree.
Agreed. Especially that dialysis is under-administered, because fucked up insurers simply won't cover more of it. People on dialysis feel sick most of the time. There was a study where they dialyzed the "heck" out of people, just to see if it'd help. And of course it did help, but IIRC the patients needed dialysis for 8 hours every day, and they felt just as good as any person with full kidney function. So dialysis is something I don't wish on anyone as a "permanent" solution. It should be a life-preserving stand-in before a transplant. I'd much rather take risks of a transplant than suffering on dialysis. Recall how you feel when you'd describe yourself "under the weather". Now imagine feeling that way every day of your life while on dialysis. That's how insufficient dialysis makes you feel: it keeps you alive, but the quality of life is quite poor.
A successful API design takes a mixture of software design and pedagogy.
I still don't really know how to talk to someone who's going to die.
Fact: You and everybody you know is going to die.
Knowing that, how do you want to be spoken to...?
No sig today...
Exactly, that is what the new information is; that what you describe is in fact the old belief, and that applying actual oxygen is useful, but blowing into the lungs isn't. And they were measuring skilled people, not unskilled. That's the new way; just focus on your compressions, regardless of how good you are.
Should the medical profession community be forced to absoborb the insane cost of education only then be forced to accept a salary they themselves do not want? Perhaps you feel they should be like monks or other holy men and not live for material wealth?
I absorbed similar cost and took years longer in my education in order to earn one third what a doctor makes. I did it because it's what I wanted to do. There's nothing about cost or training time that entitles you to a high salary. The salaries in medicine are high because the medical profession controls the number of doctors that are trained each year. That number is kept artificially low. If a public university wants to start a medical school, it's other medical schools that will lobby against it. It harms their ability to keep costs high while they reject most of the capable applicants.
If your doctor went into medicine to make money, do you really want that guy to be your doctor? I'd rather have one that wants to be a doctor and doesn't give a damn about the money.
Support SETI@home
My boss also experienced awful headaches when he tried to quit drinking coffee. The headaches lasted for days until he finally gave in and started drinking coffee again. It's a very common withdraw symptom.
The problem with coffee is that not only do you build a tolerance for it, but the withdraw symptoms match the symptoms you were originally trying to treat, namely alertness. See this (for example, I've seen other studies that come to the same conclusion): http://www.sciencedaily.com/releases/2010/06/100602211940.htm
If you consume caffeine regularly, you won't receive any net benefit at all. With gum, at least you're getting fresh breath for a while.
In the US, healthcare isn't about getting people better, it's about maximising profits. So, on that basis, it's perfectly okay to keep people alive and suffering terribly as long as there's still a few dollars to be squeezed out of them. Patient dignity and welfare doesn't come into it - the hospital administrator needs a new Jaguar!
In my opinion it's not hospital administrators that keep people alive indefinitely, it's patients and their families. I base this on what I've heard from my wife, who has been an oncology nurse for 37 years in a variety of hospitals. She's literally cared for hundreds of people as they were dying. Many were her patients for weeks and months and she got to them and their families quite well. There are just some people that even when told there's no hope still want everything done. Either they can't let go or they think they're the one who will experience a miracle. My wife has not seen a miracle in 37 years. If a person is not a DNR - Do Not Resuscitate - if they code it sets in motion an incredibly expensive process to revive and stabilize them. All so they can die in the ICU in a semi-lucid state a week later. She's had any number of people tell her they never would have pressed for all the care and the DNR status if they thought it would end like it did. They were told, but they couldn't accept it. On occasion she's had to deal with angry relatives who want to know why more couldn't have been done.
One thing she's noticed is that people who are the most reluctant to let go tend to be the most religious. Not always, but more likely. They have faith that God is going to deliver a miracle. They've prayed and they've heard it can happen. I've always wondered why they think God needs the intervention of all that medical technology to work a miracle. One time she was caring for a woman who was dying. Her husband and brother would show up daily to pray at the woman's bedside. One evening they asked if they should be asking for God to rescue specific organs. One of the reasons I couldn't do my wife's job is I would have started laughing at that point. My wife didn't. She thought about which organs were failing and suggested they pray for the kidneys. The husband and brother set to praying for the kidneys. Before leaving the room my wife noticed that the catheter tube was kinked. She unkinked the line and urine started flowing into the bag. The husband and brother heard the trickle of urine flowing into the bag, but they were unaware why it started flowing. They were sure God had answered their prayer. My wife didn't have the heart to tell them her role in the miracle. They prayed and prayed, but no other organs were rescued.
So, while I'm sure there are cases of mean cruel hospital bureaucrats keeping people on life support just for profit, in most cases I think think it's the patients and their families. Oh, and my wife, she's a saint.
As managed care gets more and more expensive, expect to see more and more articles like this, convincing people not to bother with wellness treatments and just die. It saves money. Soon we'll be back to the life expectancy of a Third-World country, in the lower 60's.
Then here's a better study for you: http://www.sciencedaily.com/releases/2010/06/100602211940.htm
Approximately half of the participants were non/low caffeine consumers and the other half were medium/high caffeine consumers. All were asked to rate their personal levels of anxiety, alertness and headache before and after being given either the caffeine or the placebo. They were also asked to carry out a series of computer tasks to test for their levels of memory, attentiveness and vigilance.
In that study, they used placebos so they didn't know whether they were consuming caffeine or not and had them perform objective tests. Conclusion: regular consumption of caffeine provided no net benefit.
I never had any problems with addition,
well, ive had *problems* sure, and sometimes they were difficult ones.
But eventually i overcame my demons and won my battles, without any outside help, mind you!
Now, multiplication, that's a whole other story!
10 years ago, at the age of only 43, my Ex-wife was diagnosed with an advanced Stage IV Melanoma. The normal size for the primary tumor to be classed as stage IV at that time was 8 mm to 12 mm, and hers was about 20mm on discovery. The assumption is that a Melanoma that large has to have metastasized unless absolutely proven otherwise. The location was on top of her scalp, making it very likely by the standard model to have drained tumor cells into her lymph nodes just because of that location. The original physician diagnosing her gave her 3 to 6 WEEKS to live and was incredibly blunt about it. She is, however still alive, thank God. (And no, I didn't pull a Gingrich, she divorced me about 4 years later, then we found out the relationship could be saved, put it back together, and just never bothered to do another ceremony. We have great fun making my staid, conservative daughter roll her eyes at us.).
I don't like to tell people who are terminal about this. She beat odds that were quoted in the standard books on cancer as 10 Billion to 1 or worse, repeatedly. I'm not by any means totally convinced that it was a miracle, but her surgeon swears something guided him, literally forcing him to cut a small extra flap extending for about 2 inches along a scalp vein before it would let him put the scalpel down.
An experimental treatment program at Duke University got mixed results on a bunch of other people, triggered the weirdest side effects anyone ever saw in her (She was speaking with a foreign accent a few days after some sessions, spoke some fragments in recognizable languages and some that may have been a really exotic tongue or just some noises (and all she speaks normally is English and 1 year of Spanish, but there were times her German was excellent, and one where I recognized some Italian, but then, my own Italian is not that good), she had occasional weeks with feeling fantastic, not sleeping at all, and working like a fresh, new meth addict, while running a 103 fever and losing 10-15 lbs. a week, then other weeks with no other physical symptoms except where she slept for 33 to 48 hours at a time, and the program may or may not have been a factor in her survival - it's been dropped as inconclusive). She had other symptoms that would fit schizophrenia, things such as putting the car keys in the refrigerator's butter dish 'so they wouldn't melt'. None of those periods lasted more than a week or so before it was something else.
I've got no explanation for why any conceivable God would do such a thing as a miracle just for her, or wouldn't for so many other people, or why a miracle would be so strange. Worshiping some form of God for doing this almost seems irrelevant.
I know I prayed. I mean waking up at 2 am next to her with sweat pouring off of me and telling God how sure I was that there were things she was still needed for. I don't remember doing a lot of praying about how I would make this or that bargain with God if he would only change things, but as I understand it, a lot of people do pass through a stage where they offer bargain after bargain if God or reality or whatever will just fix the bad thing. I also felt a lot of anger at times, as did she. Whether you feel it and whether you express any of it to the dieing person, please understand, you are not there to vent. If admitting to your own fear or anger helps the patient tell you about theirs, then you do it - if it seems to make them even a bit uncomfortable, you don't.
Right now, I'm wondering what to say to her all over. Her older brother was just killed by a criminal on Christmas eve, Shot right after he opened a safe. The murderer had been out of prison for about 24 hours. She's basically in the shock stage right now, but she's seizing on some things in the news and starting to ask some very angry questions about how the authorities let this guy loose. So now I'm wondering what to do, not just for now, but every time the holiday season rolls around.
Who is John Cabal?
There are some bad effects of caffeine, namely increased blood pressure and anxiety.
My wife and I have had "that talk" and neither of us want to be kept alive by machines.
You say that now, Lord Vader, but we'll see!
That is all.
The grandparent is obviously mistaken. What is correct is it takes more coffee to reach an above-normal alertness. So if his baseline is 2 cups of coffee in the morning, he would need to drink 3 cups of coffee to have more alertness than someone else who never drinks coffee. If he drinks less than 2 cups of coffee then he won't be as alert as the guy who never drinks coffee.
Really?
http://www.irishdentist.ie/news/news_detail.php?id=3969
Mind you this was a walk-in procedure, not an impacted tooth or anything. And it definitely wasn't subisidized by the Irish government (that's where you get a discount for paying PRSI). Which appears to have been cut.
Leaching indirectly off insurance companies? That'd be interesting given the VHI tend to refund costs of low priced stuff to the you directly afaik.
I know it's a difficult subject that many people are uncomfortable discussing, but please talk to your loved ones about their wishes regarding end of life care.
I recently lost my father. He was never one to discuss his feelings, but that wasn't much of a problem in life. I would have less terrible time if I understood his wishes clearly when it was time to decide to take him off life support.
They invested more time, effort, and money, so they deserve at least the opportunity to have a better return on that investment.
So... A good return on investment is an entitlement now in capitalist economies? Would you care to buy my house?
I think I understand your sentiment...
However I think what the poster meant by "live every day like it's your last" is different than you're imagining.
[I know it's different than what I intend by that phrase.]
In short, I think one needs to assess whet in life is important enough to keep doing.
Do you like your job? If not, then find a way to do something different.
[Ah, but you say. 'I need money, I can't quit.' And I'm sure that's true.
But then, what you like enough to keep doing is living the way you are now. Or keeping your kids living the way they are now etc. And that's fair enough.
But realize that, and relish in the satisfaction that you ARE doing what you want to keep doing. Don't let the lousy job get you too down. Sure it sucks, but you're doing what you care enough about to keep doing.
That's a *great* thing. [In that example] You're becoming and acting as your best self. What more honorable and wonderful thing could you do?
There are a million different variations and they're certainly not as black and white as the above example, but the principles still apply.
1) Decide what really matters to you.
2) Find a way to really engage on what matters.
3) Really enjoy and take pride in your involvement in what really mattered.
4) Try not to sweat the "small" stuff that had to fall away to engage in the "big stuff."
5) Live like every day is your last. Doing what really matters and enjoying that pursuit.
If you find you can't do that, perhaps you need to re-asses what really mattered in step #1.
HTH
-Greg
I think you mean for nearly-dead patients.
I know a few people who have had pacemakers for many, many, years, and one forty-something fellow who had a heart transplant over 20 years ago and is alive and well. They were all people who would have died at a young age otherwise.
The urge to keep someone alive is also heavily weighted for age. Responders will do everything reasonable to keep someone under 50 alive, someone over 80, not so much. The circumstances are highly subject to case by case judgment, which is usually correct.
Give a man a fish and you have fed him for today. Teach a man to fish, and he'll say "WHERE'S MY FISH, YOU IDIOT?"
And had friends die of cancer. I've had cancer for that matter. Believe me, you're doing nobody any favors by putting off the inevitable. In a sane world, you'd have access to all the hallucinogenics and morphine you wanted from the moment you were diagnosed as terminal. Unfortunately, crazies drive AND vote so we're forced into these excruciating situations in the name of "valuing human life" (or whatever the conservative politicians are pushing these days).
Please do not read this sig. Thank you.
I'll add to this.
If I drink coffee for more than 2-3 days a week, and then not the following day(s), I'll feel like crap and often have migraines.
For some reason, decaffeinated tea seems to be not as bad (though it also has caffeine, sometimes more than coffee). A little bit of (caffeinated) cola usually pushed them off enough for me to get past.
Not everyone seems to have this issue, but some people (myself included) definitely have issues with caffeine that are best avoiding it as much as possible.
You mean this one:
Taken absolutely literally, it only forbids one kind of abortion. I would interpret this, in light of "I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous" to mean avoiding any kind of abortion that is likely to be destructive to the patient, but that any kind that is likely to be helpful to be entirely legitimate. The requirement of being for the benefit of the patient is, IMHO, the ruling clause and all others are contextual interpretations of it.
Urological surgery, the Oath states, should be performed by a specialist. I don't see any technical problems with this -- I wouldn't want a GP to be performing it either. Surgery is best left to surgeons, as the Oath says. ("will leave this to be done by men who are practitioners of this work"). General Practitioners are not brain surgeons, heart surgeons, urologists, etc, and should indeed refer the patient to a specialist. (I don't consider surgeons to be doctors in the sense meant by the Oath. The Oath seems to make it clear that it is intended for village doctors making house-calls, or GPs in local practice, with similar but suitably-adjusted Oaths being required of those trained in highly specialized areas of medicine.)
Frankly, the Laws of England would be better served if attempts to revise or delete elements of Common Law were examined in light of the original intents of such law, and if both the Houses of Parliament and the practicing lawyers were familiar with the purpose of Alfred's Book of Dooms, the elimination of Sovereign Immunity in the Great Charter, and the reasoning behind the English Bill of Rights. Sure, nobody would want to revert to Saxon law, but the reasons for why it was what it was have changed surprisingly little. It was a careful balance of revenge, punishment and mercy, a balance a lot of modern laws don't have. We've progressed a lot in theory and can strike a much wiser balance today, but unless you start from the
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
My wife passed away from a sudden illness so I didn't have this opportunity (she died from a pulmonary embolism while alone at home and was only 24 so we weren't prepared for either one of us passing away). However, I can tell you some things I would have loved to have been able to ask her before she died:
How would she want the funeral arrangements taken care of? You don't need details, just basics like if she wants to be cremated or buried and if she would prefer a big or small ceremony, etc.
How would she want her things disposed of.
I know those questions can be painful, but somebody needs to find that information out before she dies. In my case I had no idea and had to make many difficult decisions during the worst time in my life.
And, above all, be as open as possible with your feelings. Tell her how much she is loved. Ask her about some old stories. Talk about good times and family.
Wait, you got your definition of insanity from a coroner???
Age is definitely a factor. If I was 75+ years old, I would hope not as much effort is spent trying to keep me alive as there would be if I was 30.
Cold turkey, whether cigarettes or caffiene is murderously stupid. Cutting down a bit at a time works better. Of course you're going to get a physiological reaction. These are great fun stimulants. Sadly, cigarettes are slow death, but the evidence for caffiene isn't compelling. Neither have binging effects, and so are better cut a bit at a time, cigarettes in certainty, and caffiene if it's causing problems.
---- Teach Peace. It's Cheaper Than War.
Oh, and free education (as per Christ's Hospital in the UK, and universities prior to the abolition of the grant system) produced superior numbers of graduates with superior skills to the education produced by the "free" market of loans and deprivation. At this point in time, with the skills demanded by modern trades, there should be no such thing as paid tuition up to BSc level in most fields and MSc/MPhil in the medicines. 100% of students should be in school to 18 and 80%+ should remain in schooling until they complete either a university, technical college or trade school course of a "higher education" standard. What they learn would depend obviously on what they need, but you need to know more today, not less. There will always be a pyramid of employees, with people at the bottom working the hardest for the least rewards, and nothing can change that. Mechanization and technological improvements should raise that pyramid, though, not trim it. A greater population needs a greater range of opportunities and a greater set of skills to make use of them. Less is never more.
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
Actually, it is my personal experience that some doctors at least don't believe in "death with dignity." My grandmother had a living will that explicitly stated she should not be resuscitated, but when she had a stroke that should have killed her, the doctor ignored the living will and took drastic action to save her life. She survived, but was mostly paralyzed and incoherent. When we confronted the doctor about his disobeying her wishes, he replied that his job was to save lives, not care for the dying. When we took him to court, we didn't have a case because most states don't recognize living wills.
My grandmother was a self-sufficient woman who spent her life amassing a legacy she wanted to leave to her family. It was anathema to her that the hospital would do everything in its power to keep her alive as long as possible in order to consume her life's work. She could have died with dignity on the night of her stroke; instead she spent months wasting away in a hospital bed suffering for over $1,000 a night. Luckily, we were able to get her into hospice care to prevent the hospital from taking other drastic actions to extend her misery.
I saw the exact same greedy behavior just today as a doctor tried to pressure my father-in-law into going on kidney dialysis. The old man told the specialist he was just trying to make money off his illness and demanded that another nephrologist be brought in for a second opinion. That specialist arrived today, said the dialysis recommendation was premature, and other opinions from medical professionals we've gotten since this morning all seem to suspect that the first doctor was just trying to get another permanent patient who he could make thousands off of each month through their dependency on his treatments.
I know many many wonderful doctors who are in the profession to genuinely help people, but there are also many who have the scruples of an MBA and are just in it for the dollar signs. That's why you always have to be on guard, always get second opinions, and always be aware of your rights as a patient.
i ~ Celebrating Science, Cyberspace, Speculation
http://www.webmd.com/heart-disease/news/20101005/chest-compression-only-cpr-saves-more-lives
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
I saw a couple of friends go through chemo for lung cancer in the 90's. One of them died of the treatment. Lungs filled up with fluid or something the first time he went in. The other one died a year or so after being diagnosed. Neither looked like a particularly enjoyable close to otherwise great lives. Personally I'd rather check out on my own terms when I've run this husk into the ground. I'm sure I can find a suitable method when the time comes.
I'm trying to teach myself to set people on fire with my mind... Is it hot in here?
There was an idea by a Republican congressman that was included in the original healthcare reform bill. The idea was based on what one hospital is already doing, which is to have doctors talk about end of life care with patients and their families so that their families could make informed decisions. Unfortunately, this was labeled 'death panels' and subsequently removed from the bill.
http://www.webmd.com/heart-disease/news/20101005/chest-compression-only-cpr-saves-more-lives
"There may be additional benefits to this method as well. The survival edge may occur because interrupting chest compressions --- even just for rescue breathing-- may further hamper blood flow, and it takes longer to get that blood flow back when it is time for more chest compressions, explains study researcher Bentley J. Bobrow, MD, of the Arizona Department of Health Services in Phoenix."
I'd call that a very reasonable dispute. If you have papers falsifying the hypothesis, please share the links. Otherwise, I think it is reasonable to maintain that there is a dispute over whether blood flow is more important than oxygen injection. You can achieve only both, to the satisfaction of the above hypothesis, if two people are involved (one involved in compressions, one doing the breathing on a periodic basis).
I'm not saying the doctor was right, wrong or purple, only that one of the researchers involved in the study disputes the interpretation that it is solely because of scare factor and that this makes it a significant hypothesis until disproven. It may have been disproven, and if so I'd like to see the evidence, but no amount of pointing to paramedics, St. John's Ambulance, etc, will convince me that a counter-claim by a knowledgeable person was not made and that it should not be taken seriously. Habits die hard and most paramedics were trained prior to 2010, so without actual hard medical evidence I cannot tell from modern practice whether practice is governed by the knowledge now or the knowledge of several decades ago.
Things change, things evolve, but not all practitioners change and evolve with them.
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
Join a Syrian or Iranian protest march. More dangerous, less boot camp.
09 F9 11 02 9D 74 E3 5B D8 41 56 C5 63 56 88 C0
Do doctors really need a full 4 years PRE MED?? Cut it to 2.5-3 years and then start med school also pay doctors in residency so they can at least stat paying back loans at the point also make student loans interest free.
Read it again. This time for comprehension.
Moderate drunk! It's more fun that way!
Having worked in a morgue, and spent some time with doctors, I find myself constantly surprised how little they can accomplish against a great multitude of diseases, how they can only treat (and not cure) some diseases, and how many of those treatments suck (seriously, many of them are borderline barbaric). On one hand, there are an almost infinite numbers of ways that a human being can die, on the other hand, I'm left scratching my head that some of these doctors don't have a more aggressive approach towards one or two of these diseases. You know what I mean, the "I want to get into the (non-psychiatric) medical textbooks because I made this disease my willing bitch" kind of approach; the "I have some free time Friday, and while I'm drinking or watching a movie, I'm going to check up on how my 'project' is coming along -> googling around to check out the latest research on how the one disease you have it in for is going that week". In the words of Dr. Frank N' Furter -> " I could show you my favorite obsession."
Perhaps more money is being made in the treatment than the cure? Perhaps it's a job program? Perhaps doctors are too overworked to focus on pursing the cure for a disease? Perhaps they've grown complacent? Perhaps the medical schools screen out people with that kind of character flaw?
I am John Hurt.
As someone who has lost a couple of kinfolks to diseases where medical futility came into play, including a sister at just 36, I can see why they would rather just let it go. I've seen first hand there is a difference between prolonging life and prolonging death and frankly I'd rather just be given some painkillers and spend my last days comfortable than end up sick as a dog from chemo and radiation that isn't gonna do anything but prolong the sickness. if you get 50/50 odds or better that's one thing, but a lot of those illnesses (think pancreatic cancer) you are only increasing your 5 year survival odds from 5% to 10% and are gonna feel like death the entire time. No thanks.
ACs don't waste your time replying, your posts are never seen by me.
Yeah try it buddy and see how that skullsplitter feels. i know that if i don't have my 3 cokes a day here comes the pain, it feels like a hammer slammed into my head right between the eyes. My GF quit for ages until she hooked up with me but the first weekend she stayed over and all I had was cokes and coffee got her hooked again. Now when we do our morning chat before she goes to work I have to give her time to go get her morning cup doctored because she just can't function without her coffee anymore than I can without my cokes. Caffeine is a bitch, just try quitting cold turkey and see!
ACs don't waste your time replying, your posts are never seen by me.
Now that the administration is certain they'll become the payor of choice for most people they are testing waters with the propaganda campaign which amounts to "less care is good for you." They actually think that slashdot is "their people." What a bunch of bs.
Any guest worker system is indistinguishable from indentured servitude.
In that study, they used placebos so they didn't know whether they were consuming caffeine or not and had them perform objective tests. Conclusion: regular consumption of caffeine provided no net benefit.
This has the stink of a fanatic about it. While many people (including me) probably are addicted to coffee, it would seem to be doing little harm. Then there's this:
http://www.google.com/hostednews/afp/article/ALeqM5hhCEHxaVBwtPW_MtxUSqEVil6Hjw?docId=CNG.5546416fb2b33bb880d4246e81a40a68.7c1
"Coffee has been shown to reduce the risk of skin cancer by helping kill off damaged cells that could otherwise turn into tumors, according to a US study published on Monday. The findings indicate that moderate caffeine drinking, or perhaps even applying coffee to the skin, could be useful in warding off non-melanoma cancer, the most commonly diagnosed of all skin cancers."
"Previous studies have shown coffee drinkers tend to have fewer incidences of breast, uterine, prostate and colon cancers, but the beneficial effects are not seen in people who drink decaffeinated coffee."
And WTF has this to do with the main posting?
there have been a number of studies showing the brains of "vegetative" patients can respond to speech in exactly the same way as normal conscious people
For me, it's definitely just a plain old habit, not an addiction. During the week at work, it's 6-8 cups per day. At home on the weekend I usually don't drink it. Not because I deliberately try to not drink it, it just doesn't occur to me to do so.
Monday through Friday my habit is to drink it, and Saturday Sunday my habit is to not. I never feel physically compelled to drink it regardless of the day of the week.
I'm a board-certified physician (among other things). There is no way that I would allow my colleagues to inflict the kind of death on me that they are forced to inflict on so many. Part of this is certainly that I know full well that we all exit this mortal coil toes-up, and there's no getting around it. Part of this is the personal reluctance to experience the diminished autonomy, indignity, pain,and hopelessness that comes with fanatically-treated terminal illness.
But a big part of it, I think, is just that I know that there are so, so many things that are worse than simply dying. Dying in agony, for one. Dying after having bankrupted my wife or my children. Dying after being reduced to a stinking thing in a bed long enough that only those who loved me most even want to be near me, and that only because they feel they must. Physicians see these things all the time, and we see the road that leads to them. We're not (that) stupid, and we would rather exit early on that road, not at its terminus.
As long as I have the capacity for joy I will strive to remain alive to experience that joy. When the capacity - or the joy - is gone for good, I have given quite strict instructions not only to my family but to some other clear-headed and insistent people who will do their best to ensure that I too will be gone without further "heroic" intervention.
The only problem that I have with the article is that it pretends that everyone should make the same decisions. Everyone has their own decisions to make, and without my knowledge and experience I might not make the same ones. I think as physicians we owe it to the people for whom we care to educate as well as we can and help them to understand why we might personally decide one way or another. But I will never tell them how they "ought" to decide - it's really their choice. Taking that choice away from a person leads too easily to very real outcomes that are much nastier than simply a life that ends later than it ought.
... and yet there are very few decapitation survivors.
But 10-12 years for a kidney? Tell that to a kid with kidney problems. Cripes, tell it to a 40 year old man.
That kid with a kidney problem and 40 year old man have already been told the expected lifetime of a transplanted kidney yet they still choose to go through a major surgery and take immunosuppresive drugs for the lifetime of the transplant in the hope that the kidney will save them from the next 10 years of dialysis. I'm sure they all hope that they will be the exception where the kidney lasts longer, but they are well aware of the risks and expected lifetime of the kidney yet they still choose to go through it - at times asking a loved one to go through a similar operation to donate the kidney.
Pacemakers is a better surgery, but still - 7 years is not enough. Short term fixes.
Granted, it would be better if doctors could repair the heart's natural pacemaker, but as a stand-in, the current artificial pacemaker seems like an excellent fix. I'm not even sure that a longer lifetime is desirable - I don't use my 15 year old cell phone (which was the size of a brick), so why would I want to depend on a 15 year old pacemaker to keep me alive? All it takes to double the lifetime of a pacemaker is put a bigger battery in it.
Newer pacemakers are far smaller than older ones, and they have better features like better in-chest programmability, better monitoring of the heart to decide when to give it a jolt (and how much of a jolt to give), etc. I think a minor surgery every 7 - 10 years is not a bad price to pay to get the latest technology for the device that you literally depend on for your life.
Is there room to improve? Sure, but to imply that doctors are not good at what they do because medical science hasn't come up with permanent fixes for every ailment is a little unfair.
If we could manage to come to grips with this, we could afford universal health care in the U.S. I have seen various figures that show that for most people, the majority of lifetime healthcare expenses are racked up in the last few days of life and that those treatments are largely futile or even actively harmful (in spite of best intentions).
I generally agree with your post, but that bit quoted above is just plain foolish and irrational. Let's get it together.
Fuck systemd. Fuck Redhat. Fuck Soylent, too. Wait, scratch the last one.
The worst part is the way they glossed over the fact that we already HAVE "death panels". They ignore them since they are fully privatized death panels inside the insurance companies.
Well I think there is a big difference between some specific version of the oath and the meaning behind it. (Do No Harm)
Personally I think that all Doctors should be legally bound to "Do No Harm".
Troll is not a replacement for I disagree.
Oh, and free education (as per Christ's Hospital in the UK, and universities prior to the abolition of the grant system) produced superior numbers of graduates with superior skills to the education produced by the "free" market of loans and deprivation.
I hadn't noticed this alleged effect myself. My view is that if someone can pay for their education, and pretty much everyone can, then they should.
Compress to the beat of "Staying Alive" by the BeeGees.
His ignorance covered the whole earth like a blanket, and there was hardly a hole in it anywhere. - Mark Twain
I'm very sorry to hear your situation. I certainly hope the best for your family. I don't really have any advice, but your story reminded me of something I heard on NPR a while back that might at least be of interest:
http://www.npr.org/2011/09/12/140336146/for-the-dying-a-chance-to-rewrite-life
The snow doesn't give a soft white damn whom it touches. -- ee cummings
Give cold-turkey an actual try sometime-- it's worth it. It's about two days of headaches (a couple of ibuprofen cover this nicely) followed by three or four days of slight drowsiness. Then you're good. And when you do get around to starting back up, it's SUPER AWESOME. I do this every few months-- usually when I find myself going for a third cup of anything caffeinated in a single day.
Eh, that's sounds pretty anecdotal, doesn't it? Coincidentally, I picked the following article as an example for my statistics class about a month ago: http://jama.ama-assn.org/content/304/13/1447.short
In short: Arizona set up a 5-year program to educate people in CCOPR (chest compression-only CPR). Comparing victims who got CPR from non-medical professional bystanders, to those who got CCOCPR, the latter had almost double the chance of surviving to discharge from a hospital (7.8% to 13.3%). However, when looking at multiple randomized trials for dispatcher-assisted CPR over the phone, there was no statistical difference between the techniques. (P-values 0.18, 0.09, and 0.16; p. 1452-3). The sociology factor is suggested, but it's at the bottom of the list:
"There are multiple reasons COCPR might have advantages over conventional CPR techniques. These include the rapid deterioration of forward blood flow that occurs during even brief disruptions of chest compressions,8,31 the long ramp-up time to return to adequate blood flow after resuming chest compressions, 8,31 the reduction of cardiac venous return with the use of positive pressure ventilation,32 the complexity of conventional CPR,21,33 the significant time required to perform the breaths,28,33,34 the critical importance of cerebral and coronary circulation during arrest,8,31,35,36 the reduced time required for emergency medical dispatchers to instruct a bystander over the telephone how to perform COCPR, 6 and the reluctance to perform mouth-to-mouth ventilation on strangers.25,26,28,37" [p. 1453]
We know where leadership by an anti-intellectual "strongman" who scapegoats minorities and likes boisterous rallies goes
I agree with jd. There are several major studies that have happened in recent years that all point to compressions only being most effective. The first step to achieving this was changing the ratio of compressions to breaths from 15:2 to 30:2. Soon it will be compressions only.
That's not actually quite correct. The current debate isn't about whether hands-only CPR is more effective than full CPR (It's not), the question is whether hands-only is more easily performed correctly than compressions/vents, and is, on average, going to be more effective as it gets performed in the field, add into that the fact that hands-only is easier and faster to teach, and maybe we'll have more of the population able to perform CPR, which means a decrease in time from arrest to start of CPR, which will always improve outcomes.
Actually the current debate is not about the effectiveness per se but about the outcome. Compression only CPR is showing better patient results for lay-people and professionals alike.
http://www.physorg.com/news/2010-10-chest-compression-only-cpr-survival-cardiac.html
http://www.theheart.org/article/1106815.do
And the quality of compressions in compression only CPR goes down over time.
http://www.ncbi.nlm.nih.gov/pubmed/17069958
Speaking as someone who goes through regular cycles of caffine addiction, I can attest to the OP.
In the winter months I abuse caffine, due to my working second shift, and having low exposure to natural light. (This causes all kinds of sleep related trouble for me, so I abuse coffee to keep from becoming narcoleptic :).)
During the summer, I lay off the stuff completely. I have gone through the addiction cycle numberous times, and can speak from personal experience that I too have noticed that coffee doesn't make me more alert, it just keeps me from sleeping, especially after the first few weeks of routine use. In truth, it makes me feel lethargic and bitter when I don't get it, which are classic signs of addiction. I find myself much better after quitting when my sleep cycles start to level out as the winter months pass. It's fantastic to wake up and be actually alert, rather than a drag-assed zombie until I prop up my nervous system on drugs.
Why should they? The business and indeed the country profits from the better education far more than the individual. They're ultimately the real customer, the student is merely an instrument of delivery. The customer should pay.
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
http://www.nlm.nih.gov/medlineplus/news/fullstory_118513.html
"American Exceptionalism". We're in the lead, so everyone else must be behind us.
Here are the current top two contenders to the U.S. Presidency attacking the sitting President because he "simply does not understand the concept of American exceptionalism": http://www.huffingtonpost.com/jerome-karabel/american-exceptionalism-obama-gingrich_b_1161800.html
I assume that this is a feature of imperialism on the cusp of decline.
We know where leadership by an anti-intellectual "strongman" who scapegoats minorities and likes boisterous rallies goes
Is it numeracy to opt for absolute termination of being, right then, simply because you only have a 5% chance of living past another 10 years? What is 5% weighed against infinity?
It is Pascal's wager, which is a form of innumeracy. To argue that even a slight increase in the odds of survival has infinite payout, has some serious implications for our lives. For example, the argument precludes stairs, cars, and taking showers standing up because those things increase our risk of dying. You can't eat solid foods (choking hazard), swim (drowning hazard), or walk (many hazards including falls, hypothermia and heat stroke, getting lost, etc).
So effectively, you have to live in some sort of bubble (the actual form of the protection dependent on what maximizes human life span). No expense can be spared or additional risk tolerated because any such expense is finite compared to the infinite cost of risk.
But in reality, our lives do not have infinite value even to ourselves. We think nothing of the modest risk from fatal car accidents or what could go wrong as we walk up stairs. We also willingly embrace risk with dangerous activities such as sky diving or fire fighting. Every day we make decisions which compromise our safety.
Assigning infinite value to something doesn't work, because it means that everything of finite value is subordinated completely. I doubt there is anyone out there who merely wishes to live just a little bit longer at the cost of everything they have known which isn't of infinite value.
As a physician, I agree with the article.
Does God treat us as servants or friends? Check my homepage.
Why should they?
I find your subsequent claims disingenuous. The student, not the business or country, is the real customer because they get the benefit and choose what education to consume or not. The business and country don't get to select what form the education takes.
The customer should pay.
And there's your answer once you ignore the bogus rationalizations.
Thanks for sharing that.
We know where leadership by an anti-intellectual "strongman" who scapegoats minorities and likes boisterous rallies goes
Only stages I and II are based on the size of the tumor. Stages III and IV are based solely on the spread to lymph nodes and other parts of the body.
http://www.cancer.gov/cancertopics/pdq/treatment/melanoma/Patient/page2
My son has some medical issues and needs close care, but I stay out of the way of his team, and most of them (possibly all of them) don't even know I'm in the health care field.
not a doc myself, but I purposely avoid planting ideas in the doc's head. I figure that being a doc yourself, you might be even more tempted by suggestions.
last time I went, I figured I had condition X, but I didn't say it. I simply described/showed the symptoms (it was indeed X; the condition went away with the appropriate prescription and some behavioral tweaks)
I listen to both RIAA and non-RIAA stuff if I like the music, tangential business/politics nonwithstanding.
to me, "god from a machine" seems to fit. miraculous divine intervention (by writers) to get around a plot issue.
I listen to both RIAA and non-RIAA stuff if I like the music, tangential business/politics nonwithstanding.
This will be one of the few times I'll defend my religious relatives but they are all like the above -- no extraordinary measures, have a cancer/smancer attitude, (my Uncle just died recently -- we watched the mole on his arm for years but he was happy with his 85+ years on this planet and did absolutely nothing about it), etc. And they all go out with memorial services.
I come here for the love
"I distrust those people who know so well what God wants them to do because I notice it always coincides with their own desires."
-Susan B. Anthony
I listen to both RIAA and non-RIAA stuff if I like the music, tangential business/politics nonwithstanding.
maybe it's the sanctity-of-life thing as a condition for entering heaven at all?
I listen to both RIAA and non-RIAA stuff if I like the music, tangential business/politics nonwithstanding.
I'm not sure why this article is even on Slashdot. Is there any evidence supporting this contention that physicians get less care, or is this just a doctor telling us how much better doctors are than everyone else and how we should strive to be like doctors. I've known two doctors who died of cancer in their forties and both went kicking and screaming, taking every last shot medicine would allow and some that had no shot in working and would at best provide days of painful life in a hospital bed. Two isn't a statistically significant sample, but it's more of a sample than Ken Murray gives us.
I think it's likely that Dr. Murray is just making things up in hopes that his patients will chose to die quicker than they currently do.
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Last week the nurses at a hospital near here went out on a one day strike. Their issue, they were being asked to contribute about $1200 a year to their health care costs the way everyone else working there does. Whenever a reporter asked, they would say it was about patient care and that they were striking for their patients. "Strikes are a last resort, but nurses will only strike if they want to make sure that patients have safe care every day." They had a one day strike a couple months ago and one of the replacement nurses accidentally (probably) killed a patient. Oops. The nurses strike typically two or three times a year until the hospitals cave to their demands.
The average nurse's salary without overtime at those facilities: $138,000. Maximum non-overtime nurse's salary: $291,000. The median family income in the area: $46,000. The nurses don't see a connection between their salaries and increased health care costs. The doctors, of course, are independent contractors that set their own charges. You can be sure that they wouldn't be happy if a nurse could make as much as a doctor, so I'd guess $300,000 is the low end of their range.
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It is Pascal's wager, which is a form of innumeracy. To argue that even a slight increase in the odds of survival has infinite payout, has some serious implications for our lives.
I don't see how that's really related to Pascal's wager, which is the idea that, assuming it is unknown whether or not God exists (but assuming the Christian God, or similar), it's a good idea to bet that He does... because if you're right you gain eternal rewards and if you're wrong you don't lose much. In Pascal's wager, the successful bet does in fact provide infinite payout. In the case of decisions made to extend life, the payout is guaranteed to be finite.
Note to ACs: I usually delete AC replies without reading them. If you want to talk to me, log in.
Insurance companies were required to be non-profits. I think we have Reagan to thank for the wonders of the for-profit free-market entering health care.
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Wisdom tooth extraction != tooth extraction.
John McAfee 'It was like that time I hired that Bangkok prostitute; to do my taxes, while I fucked my accountant'
I had to deal with caring for my dying parents, whom I loved greatly. Senile dementia is not a nice way to go, and if I'm diagnosed with it I shall suicide without hesitation.
The post was Funny, and my folks (pre-dementia) would have found it amusing too.
Life is for living while living is good, and laughter is part of good living.
"This post is an artistic work of fiction and falsehood. Only a fool would take anything posted here as fact."
Perhaps the parent has and he has learned that death comes to us all, and all that matters is how you lived life and treated others.
Lighten up a bit dude :)
Here in the USA, especially in the larger cities, a wisdom tool extraction isn't handled by a dentist, but by an oral surgeon. The fees are exponentially proportional to the number of syllables. You'll need anesthesia for the process, so there's an anesthesiologist.
When I needed by wisdom teeth out, the dentist said three were impacted and one was "bony impacted", and that it would cost about $700 per for an oral surgeon to remove them over the course of two or three visits and that I'd need pain killers for several days after each. I called my childhood dentist in a rural midwestern state and he said that didn't sound right. So I spent $500 on round trip airfare, went to my old dentist and he pulled them under Novocaine in less than an hour for $65 a piece. No general anesthesia. No stitches required. Pain was gone by morning and I got up early and went fishing.
But I won't come out and say oral surgery is a scam. My childhood dentist has long since required, and I'll need a root canal, and my dentist will send me to an oral surgeon for that because dentists don't do that anymore, apparently.
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Ah, you've read "Yes, Jolonah, There is a Hell". Pretty warped stuff. I like it.
In any given town the doctors were near the top in the town, with one of the nicer houses in town, one of the nicer cars, and took nicer vacations than most, but they never really made much more than 3x the average income in the town.
You're telling me that doctors in say Oakland where the median household income is $46,000 are making no more than $138,000 per year? Which is weird, because in Oakland the average nursing salary is $138,000 per year. I'm calling bullshit on that one. No general practitioner in the Oakland metropolitan area would work for $150,000, with the exception of a few that specialize in serving the impoverished.
I agree salaries aren't the entire problem. Salaries aren't the problem at all, they are a symptom. The problem is that lobbying organizations for doctors and nurses control the certification and education process, and they manipulate it to restrict the number of doctors and nurses in practice. The nursing lobby is especially adept at lobbying for minimum staffing regardless of hospital needs (increasing demand for nurses) while simultaneously making it harder to certify nurses or import them from out of state and lobbying for limits to what nursing aids can do (reducing supply). All in the name of "better patient care," of course. It's a recipe for rising salaries. Doctors limit their supply by making it impossible to open a medical school or increase enrollment. Know a promising young student? Well, he's not going to be a doctor, because there's no room for him here. Besides, he got an A- in Calculus his freshman year.
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So that's why it takes them soo long to pee!
Cwm, fjord-bank glyphs vext quiz
I have cancer. I have faced situations where my death was nearly a certainty. I have lost people both slowly and quickly.
That said, I disagree. I found it terribly amusing. Facing death requires humor in order to make it tolerable.
I've accidentally quit caffeine cold turkey several times (not a big coffee drinker, used it strictly as a stimulant).
I would forget to have my "daily dose" after finishing whatever task that required me to stay awake and alert longer.
I.e. At the beginning of a vacation.
Splitting headaches, muscle and joint pains and generally a zombie-like behavior would last for about two days before I'd get back on my feet.
Switching to green tea, first as a "cool down" stimulant then switching to it completely, I don't have those issues anymore.
Sure, there's still caffeine in the tea but there is far less of it and I never reach my caffeine limit. So, I don't get the "buzz" but I do get the alertness.
Plus, I don't have the issues with dehydration as a decent cup of tea is still mostly water.
And if I want to or have to quit the tea too, i.e. I forget to take it with me to a place where they don't serve it - at worst I'll get a bit drowsy.
Also, I'm told that it's rather healthy.
Granted, if you are used to taking your caffeine through coke instead of coffee it may be harder than simply"deciding to switch".
Particularly in the summer, when most bars/restaurants/coffee shops don't serve tea - but everyone serves Coke. And coffee.
Bonus difficulty points if you are getting most of your supply from a local vending or coffee machine at work.
My solution is to order mineral water instead of coke (unless they serve green tea), and bringing my own supply of tea to work in a thermos bottle.
Mit der Dummheit kämpfen Götter selbst vergebens
Caffeine is not highly addictive, it causes physical dependency. The two are not the same thing. You can be under the influence of one, the other, or both.
Some may become psychologically addicted to it, but not all. In my personal experience, the number is relatively small (even then it's debatable whether it's addiction rather than habit). Almost everyone who consumes it regularly will become physically dependent on it, however.
Multiplication is just addition in groups. You can overcome your problems with multiplication, I know you can!
You just made me spray my monitor with today's 5 gallon bucket of coffee, you insensitive clod!
Caffeine isn't fun. It's just bitter. Deliciously bitter.
Can you be Even More Awesome?!
You are right but also the fact that there is such a thing as a prescription. The laws that make certain drugs only available by prescription in effect makes doctors gatekeepers to getting well. I have allergies and maybe once or twice a year it gets out of control and I get a painful ear/sinus infection. I usually try to tough it out but with all of the normal adult responsibilities I sometimes need an antibiotic and course of steroids. This has been going on every year of my adult life. But by law I am not allowed to go to the store and get the $10 in drugs I need. Instead I need to go to a doctor and pay a $30 copay and whatever the insurance company is billed to get better.
An easy way to reduce healthcare costs is to eliminate prescription drugs. Also eliminate the FDA's ability to approve drugs. You own your body and should be able to take what you want. I would keep the FDA as an advisory board like UL. Drug companies can pay to have an FDA review the drug and put a seal of approval on it.
By eliminating the FDA's approval process drugs would get to market much faster and you can get rid of drug patents. All the drug company would be responsible for was insuring the content of the drugs they produce is what is on the label similar to a food label. They wouldn't be responsible for side effects and that risk would be borne by the user. This is similar to food also. There are people with allergies that need to avoid certain foods. As long as the manufacturer lists the ingredients it is up to the user to decide if it is safe for them.
I love Jesus, except for his foreign policy.
It's probably best to take cues from the person who's ill. Everyone is different, any people deal with the prospect of death in different ways.
I prefer being straightforward and looking at the humor in things. I know it is difficult for many around me to discuss my condition and current mental and physical state, but I've worked fairly hard to make people feel comfortable with talking about it. I'm not particularly bitter or depressed, so that helps.
But.. if he paid for the tools, he should get to keep the tools. Surgeon's tools make good electronics tools, you know. Especially those locking forceps thingies.
Can you be Even More Awesome?!
I actually once went cold turkey off of caffeine once. After surgery for a traumatic injury. After about a week on Percocets, I realized, hey! I haven't had any caffeine! I'd broken the habit! I didn't think I'd ever be able to get off of it.
Fast forward a few years, and I once again fell prey to its siren song. Going to sleep late, needing to get up early, seriously dragging, have some caffeine and voila! I'm on top of the world. A few more cycles of this and I'm back to being hooked. I fought it but after a while, I thought, "Why am I torturing myself?"
If I ever decide to get off of it again, I'll probably take several days off, clear my schedule, get a new bottle of ibuprofen and go for it.
In my experience, about a quarter of the doctors I've seen treated me like an assembly line object ("Get em in, get em out, next!"). The remainder seemed a bit more casual.
Remember - doctors are people too, just like you and me. With bills to pay, mouths to feed and house. And desires to satisfy. Just like every other human. To expect the best people to do a difficult job like doctoring without demanding high compensation is not consistent with reality.
Yes, one will find the occasional altruist or someone who really cares little for material trappings. But I submit they are very few and very far between and trying to build a system that works for everyone, patient and doctor, on a such an improbable individual, is doomed to fail.
"A policy based on illusion will crash on the shoals of reality."
Nonsense. As a smoker for 41 years, I tried almost every conceivable method of quitting: slow withdrawal, NRT, other drugs. Nothing worked. Then I read Allen Carr's book in which he recommends cold turkey as the most effective method of quitting, so I tried that. I had a few days of quite severe discomfort, followed by a week or two of intermittent cravings, but I was able to get through that, and I have now been smoke free for three years. It's a question of mental preparation.
As for coffee addiction, I don't have it. I drink 4 cups of Italian roast every working day because I like the taste and the ritual. On weekends or vacations I don't drink it at all, and have never experienced any discomfort. I suppose it's a matter of individual metabolic idiosyncracy.
Tempora mutantur, nos et mutamur in illis
You a 100% wrong. The people we are talking about here have Universal Healthcare. It's called Medicare. And it's run by the government and everything.
I see this as the problem. If the family was paying the bill you would see less extreme measures being taken.
I'm curious how you solve this problem in your country since it is universal healthcare too? I assume the government just tells people it isn't covered and they should shut up and die.
I love Jesus, except for his foreign policy.
I'm not buying it either. I drink 2-4 cups of coffee every work day. I don't have a single cup on the weekends. I'm just finishing up a 7 day vacation and in that time I have had precisely one cup. No headaches, no jitters, nothing.
NTITE
-You can cry, but you'll still die. There'll be no tears in the end.
In a perfect world, yes. However, this is a story about one doc he has turned into a hasty generalization. I'm an RN in a ICU and "medically futile" is a word I am all too familiar with. I've heard docs say they're going to have their DNR and signature tattooed on their chest, but I've more often seen doctors put themselves through the pain and anguish he speaks of. I even cared for a doctor's mom with a prognosis that left little to no hope of recovery, but we pressed on despite torturing her all because Mama's boy, MD wanted it done. These guys are human and sometimes emotion clouds rationality. And not all ICU stays are a painful experience. We have great drugs and a vigilant nurse will make sure you're as comfortable as possible. That may not always be painless, but hospital beds aren't magic. You don't get well just laying in one. It always requires work from the patient whether it be walking even when it hurts, using the damn incentive spirometer no one wants to be bothered with, or dealing with some temporary discomfort you should've known you'd have after having open heart surgery.
Chewbacon
The Bible is like Wikipedia: written by a bunch of people and verifiable by questionable sources.
The Usual method of death for us mere mortals is by heart attack or accidents involving cars. The doctors are people placed in direct physical contact with large amounts of contagion. They can choose their own profession of choice.
I do the exact same thing (minus the ibuprofen... usually). Then I typically save the "SUPER AWESOME" for when I actually need it.
I need to delete my facebook account. It's bad that I now want to click "like" on various comments here =(
In the end, it's all the same. We either die of discorporation or asphyxiation.
At the heart of the debate, most people think they can live forever. They think that death is unnatural, and if you can stave off the attack then everything will be OK. Let's say you have cancer. With treatment, you have a 10% chance of survival, but a much lower quality of life during treatment. Without treatment, there's a 0% chance of survival. If you assume you'll live forever if you survive (which most people seem to do), the choice is trivial, even if your life expectancy barely exceeds the time you'd have without treatment. The real answer should be very different for a 30 year old and a 90 year old.
This is why the system is geared towards resuscitations. It *sounds* logical - of course you want to resuscitate, right? His point is that unless a patient is young (80) and fit (not otherwise terminal), it might not be such a great idea.
The last days of life after being resuscitated are not likely to be enjoyable, for the patient or their family. They can "go peacefully", or with broken ribs, hooked up to life support (assuming they can't , as their family debates whether to finally switch them off. Even on the tiny off-chance that they do survive, they aren't going to live forever.
Doctors need to balance cost, quality of life, and length of life. It sounds inhumane to say that cost should be a factor, but it is, and people have to face that fact.
The you sir are what I call one of the "lucky bastards' whom caffeine doesn't affect. My youngest is like that, he can drink cokes all week and then not touch one for a month, no side effects. my oldest on the other hand when he misses his daily caffeine is seriously hurting with a MAJOR skullthumper. I've had him come in between classes at the college and go "Man i forgot my coke and spent all my money on gas, can i have a coke and a BC?".
For those that get the caffeine headaches? BC Powders ALWAYS have some. its a 50/50 mix of caffeine and aspirin and kills the caffeine headsplitter but quick. Now once a month I go and get the 50 pack from the Wally world and split them up among the family that way if anybody misses their caffeine or gets a skullthumper they're set.
ACs don't waste your time replying, your posts are never seen by me.
"Caffeine is highly addictive, and you cannot simply quit without severe side effects if you drink coffee daily."
People are obviously different. I drink a fair amount of coffee on a daily basis. But when I've gone cold turkey I've had absolutely no symptoms at all.
Drinking coffee for me becomes a habit, not an addiction. And it's a relatively easy habit to break because you have time between getting up to get another coffee and actually getting it to realize what you are doing. The first time I realized I should probably try to moderate my coffee intake a bit was when I realized I was boiling the kettle for the next mug of coffee before I'd finished drinking the previous one. So I stopped drinking coffee completely there and then and didn't have another coffee (or tea or any other caffeinated drink) for a couple of months and I had no symptoms at all other than sometimes catching myself walking to the kitchen to put the kettle on.
I used to bite my nails. That was an extremely hard habit to break. Not because I was addicted to biting them but because I wasn't even aware that I was chewing them. I still often chew the skin from around my nails (to the point where I can draw blood) and that is proving just as hard to stop.
Tim.
God said, "div D = rho, div B = 0, curl E = -@B/@t, curl H = J + @D/@t," and there was light.
When you have two EMTs, there is no interruption. One guy does the compressions, whereas another uses an squeezable apparatus (the name escapes me at the moment) to pump air in.
Then you remember that you have knowledge and it is protected with ZFS and scrubbing. Thank God.
Muahaha, priceless. Hooray for FreeBSD :-)
The argument is based on the assumption that there is a possibility of an outcome with infinite value. The actual labeling of this outcome as say, "Heaven" rather than say, "live longer" is irrelevant. Keep in mind that the original AC poster said "What is 5% weighed against infinity?" He really was assigning an infinite value to living longer.
Similar here - had to quit for a while due to illness and found that my life wasn't any different without it. To be fair, I'm on 2 half-cups of moka-pot brewed coffee each day, so many it's just not enough to cause a massive upheaval when I stop drinking it.
This airplane has been nicknamed "the Doctor Killer".
https://aviatorcollege.wordpress.com/2010/06/25/why-is-the-%E2%80%9Cdoctor-killer%E2%80%9D-airplane-so-dangerous/
Speaking in any way is a good start, I'm sometimes impressed on how many people will not talk about death at all!
Can't speak about coffee because I neither like the taste nor the smell, but I drink about two liters of tea every working day (green Oolong and Sencha mostly, but also often enough Darjeeling FTGFOP), but at home drink only tap water due to my laziness - and I can be at home for three weeks in a row when I am on vacation. No withdrawal symptoms whatsoever. I also routinely make a second or sometimes even a third stepping (where is almost no caffeine left).
Guess I am either lucky or things are different with tea, but either way it's okay with me - I certainly would hate to be addicted.
"It's such a fine line between stupid and clever" -- David St. Hubbins, Spinal Tap
There is a difference, say, with being (for example) in your mid 30s, in good health, and fully expecting to live between 40 and 60 years more - and being in your mid 30s, diagnosed with type 4 metastatic cancer and not expecting to be alive this time next year.
Oolite: Elite-like game. For Mac, Linux and Windows
So you're saying that Caffeine is a bit like my ex?
Using your self as anecdotal evidence is nice in the "testimony era" but is a sample of ---> one.
My "sample of one" was a pack of Camels (no filters) a day for forty-three years. But this isn't about me. This is about statistical success/failure/relapse with cigarettes and caffeinated beverages (most likely, coffee).
Your reply is very focused on you. I'm very focused on the rest of the world in terms of what seems to work, and not. You don't quit fit in the statistical center, but I'm glad it worked for you.
---- Teach Peace. It's Cheaper Than War.
Don't take the premise of this article too seriously. Lifespans have increased by about 20 years in the last 40 years. Heart-attack care, for example, is generally an emergency care operation and it's generally not fatal. There is plenty of other examples. Emergency treatment works and works successfully. If it didn't, people wouldn't live as long.
Any guest worker system is indistinguishable from indentured servitude.
He said nothing about this problem being ours alone. He simply identified the problem and a natural solution to it. Basic care can be provided with much less training than we demand of health care providers. That's all.
Any guest worker system is indistinguishable from indentured servitude.
Please define “harm” for us.
I thought Doctors never die...they just regenerate.
I normally have two-three mugs of near expresso strength coffee a day. Some years ago I went on a two week canoe trip. The guy running the food wasn't a coffee drinker and didn't bring any along. While I missed my sugar fix I had no symptoms of caffeine withdrawal.
At various other times I've been denied coffee for one reason or another. No problem.
I dislike instant coffee enough that when the choice is instant or none, I'll take none.
Like many statements about addiction, take this one with a grain of salt. It's over generalized.
Third Career: Tree Farmer Second Career: Computer Geek First Career: Teacher, Outdoor Instructor, Photographer.
High blood pressure is only bad as it potentially leads to heart attacks, strokes, etc, not on its own (you cannot even feel it usually). However coffee consumption appears to have a protective effect on the cardiovascular systems.
Let's not multiply entities beyond necessity here.
Actually, current theory is that one person doing chest compressions only is better than one person taking breaks from chest compressions to do rescue breathing and/or one person doing chest compressions and breathing wrong, so best to just teach chest compressions in basic first aid.
Compressions and breathing are still better if done correctly by two or more trained para-medicals (meaning anyone with adequate training & experience... industrial first aid people, nurses, care attendants, paramedics, doctors, etc)
My younger brother was diagnosed with terminal cancer. We became much closer during.
Don't treat them like they're glass. They know what the hell is going on and it's insulting to pussy-foot around the topic like they're five.
Also, don't go maudlin. With the limited time that the both of you have left together, enjoy being with them and discussing whatever. If they want to talk about it, they *want* to talk. Do so. Don't avoid it because it upsets you.
"It's disturbing to voice out loud the certainty of death, but it's also galling to bullshit someone by saying everything's going to be ok, when it's not."
Yes, it's galling to bullshit. Not because it's death, but because they're intelligent. But, they are certain as to the certainty. My brother found out by "You have about a five percent chance of living for another six months."
By the way - he lasted another five years. It would have been a horrible shame to have avoided talking to him about things for what I thought was six months and have that drag on to five years. Five years I got to know my brother better.
I miss him.
What we need is to make regenerative and repair nanotech/biotech research a priority by reducing the worlds bloated, wastefull military budgets adn wars. Aubrey de Grey of the SENS and Mprize research foundations said that 1-billion spent over a 10 year period on current research could eliminate aging in mice, the humans....we waste that much (worlds militaries) in about an hour.....if we spent a weeks worth of miltary $$$$ wastage in say, 1 to 2 years, we could have aging an caners etc eliminated... Some good sites: www.fightaging.org www.mprize.org www.sens.org Books: Ending aging by Aubrey de Grey 100plus by Sonya Arrison Reviewed at: http://mariakonovalenko.wordpress.com/2011/09/20/we-need-more-books-like-100-plus-by-sonia-arrison/
What utter tripe. As already mentioned, decapitation is the obvious one. There are many, many more. On current topic, cancer infiltrating the heart's nerves will do it.
Yeah, I was exactly the same and never had a headache and what people told me was, "well, after 3 or 4 days without you'd start getting them".
At least in my case, I didn't after 3 or 4 days without, either.
1. Just be there. That is often enough.
2. Don't ignore the elephant. Be open. Be candid.
Everyone dies. It's a matter of when. Our culture has a huge fear/denial of death.
Third Career: Tree Farmer Second Career: Computer Geek First Career: Teacher, Outdoor Instructor, Photographer.
http://blogs.law.harvard.edu/abinazir/2005/05/23/why-you-should-not-go-to-medical-school-a-gleefully-biased-rant/
Slashdot = Sarcasm
If I ever start drinking, I plan to drink myself straight into a homeless shelter. What's the point, otherwise?
As for cigarettes, I never saw the attraction. The calming effect is quite mild, and there's other commonly available substances that are much more effective if you're going to take part in an activity that is so clearly damaging.
Karma: Poor (Mostly affected by lame karma-joke sigs)
The argument is based on the assumption that there is a possibility of an outcome with infinite value.
Which is a perfectly valid assumption in the case of Pascal's wager, since that's exactly the expected payout under the Christian theology with which Pascal was familiar.
If there is a defect in Pascal's wager, it's in the assumption that an unknowable deity offers a known reward for known actions. Essentially, Pascal's wager takes as a given that if God exists, God is of a certain form. But if you can't know if God exists, how can you know what God is like?
The actual labeling of this outcome as say, "Heaven" rather than say, "live longer" is irrelevant.
No, it's not. Living longer has finite value, because it has a definite and unavoidable end. Heaven is purported to be endless, and therefore can offer infinite value. There's a big distinction there.
Keep in mind that the original AC poster said "What is 5% weighed against infinity?" He really was assigning an infinite value to living longer.
Erroneously assigning an infinite value to living longer.
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My Father died (very) recently, after a relatively short time of being unwell (2 months). As a family we knew his wishes if he were to be in an effectively unrecoverable state - that he would prefer to not be put through agony just to go through futile care. His surgical team did everything they could for him, but knowing his and his families wish seemed confident in talking to us at the point where they could continue to carry out surgical work, but they felt there was no possibility of his ever recovering. We made, i think, a rational decision.
It was not easy, knowing wishes and discussing them with siblings and then our Mother and my Fathers siblings (large, close family), knowing when the treatment became futile, watching him die that last day - it was pretty much the fucking hardest thing I think I will ever do. But it *was* the better thing ultimately.
So - if people forgo futile treatment to spend time with family and to make the most of the time that remains then I would like to figuratively shake their hand for showing such a vast amount of bravery and *character*.
The best is the enemy of the good
There are solutions that would actually work:
1. Increase the supply of doctors by licensing more medical schools. Right now there are too few seats for doctors in schools and this leads to an artificial shortage. By all means maintain standards for graduation, but get more people into the system.
2. Employ a triage system. Right now the medical profession basically involves doctors and everybody-else. There is no reason that the qualifications for somebody who screens kids for strep throat need to be the same as the guy treating some rare form of plague.
Both would get more people into the system and drive down wages/costs. The best would still make the money they make now, but they would only work on cases that required their expertise. Most people don't need House, and they shouldn't have to pay for it. What would the cost of car maintenance be like if you had to pass the maintenance supervisor qualifications for an A380 in order to do an oil change on a Ford Focus? I don't want the 20 minute lube guy doing an engine rebuild on my car, but I don't want to pay for top-level expertise to remove one bolt and add the right amount of replacement fluid.
> Imagine how bad overpopulation would be if we all lived to be 150.
We'll "all" *never* live to be 150. At best, a percentage of those who currently make it to 100 might make it to 150, and most of those who make it to 40 would probably make it to 80 or 90. Even if cancer gets decisively vanquished like polio, people are still going to have fatal car wrecks, fall from ladders & roofs, die from snakebites, get shot by street thugs, and have medical emergencies in awkward places.
If anything, given that most western countries now reproduce below the rate of replacement, extending the death date by a couple of decades would do little more than maintain the population status quo. Fewer kids, but more great-great-...-grandparents.
I drink 2-4 cups of coffee every work day. I don't have a single cup on the weekends. I'm just finishing up a 7 day vacation and in that time I have had precisely one cup. No headaches, no jitters, nothing.
I've never been addicted to caffeine. Never had a regular habit. However, I used to be like this -- I could hang out with people on vacation for a week drinking lots of coffee for many days in a row, then stop suddenly afterward, and nothing happened. Caffeine never prevented me from sleeping, never gave me jitters....
Then, over the course of a couple years, I became more sensitive, and now I have to be very careful. A few days of drinking coffee in a row, and I'll be treated to a headache when I stop. Coffee anytime beyond about 2pm might mess with my sleep.
Everybody's different. And people change over the course of their lives. I know a lot of older people who insist on decaf after dinner but say they used to be fine with caffeine in the evening.
Then you're good. And when you do get around to starting back up, it's SUPER AWESOME.
Agreed. I've never been addicted to caffeine, and thus I occasionally get the benefits when I want. As studies have shown, addicts actually live their non-caffeinated lives below their normal alertness level and only get up to their non-addiction baseline when taking caffeine. Non-addicts actually get a net benefit, but addicts don't: http://science.slashdot.org/story/10/06/02/219229/caffeine-addicts-get-no-additional-perk-only-a-return-to-baseline
Well, yes. (I think I noted myself that traditional CPR could only meet requirements if 2 people were performing it.) The dispute I alluded to was what a single individual (no matter what their background or training) should do, and the linked article would imply that when a single individual performs CPR that there's uncertainty as to whether continuous blood flow is the overriding concern or whether you should mix compression with breathing.
I don't think there's any dispute - at present - that if two people are performing CPR that you should have both (since that should improve the chances of success). I emphasize "at present" because if CPR has as low a success rate as is implied in the original article, then the method may have additional problems. Further studies might well alter the technique even for 2-person CPR. Personally, I think that the stats for CPR are conflated with all the different methods to the point where it's impossible to infer anything about the success rate of doing it properly -- whatever "properly" turns out to actually be.
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
You don't pay for Google, the advertisers do, because the advertisers are the real customers.
And, frankly, I find your elitist view of education to be Medieval at best. Well, no, Christ's Hospital is medieval and offered free education. So that doesn't work.
Corporate? No. Robert Owen demonstrated that mill workers were more profitable when they were given free education and free housing, and that is the basis of the corporate relationship with universities in Britain ever since.
Senile. That seems more appropriate. There is simply no evidence for your assertions, whereas the last 600 years (and the last 3 generations of my own family, myself included) contain ample evidence that mine are indeed correct.
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
Human beings are not "beloved computers," and they are not "porn collections." The comparison, if you want to be pedantic, is a category error.
I didn't think it was funny. Instead, I found it rather insulting. I should have realized that slashdot was full of immature solipsists before bothering to read the comments.
How does a fucking porn collection live and treat others?
I think the general public needs to know that pretty much every patient having chest compression that I've seen being brought into the ER have been dead. That's roughly 0/100. Now if it happens in front of you, a MD, now that's a different story - maybe 30-40% go on and live their lives.
Movies portray CPR, resuscitation, end of life, defibrlllation (the heart "jump start" paddles), etc, in a wholly unrealistic way, and I think it's wrong to continually mislead the public. They have no idea about breaking multiple ribs on the persons chest, electric burns from the defibrillator, brain damage from hypoxia, etc
There may be differences between the above mentioned methods of CPR, but I bet they are trivial, and even more so for the general public.
I'm an oncology surgeon still taking trauma call, and I've seen more than my fair share of death. There are many things we can do to prolong life, but until you, or a loved one gets to that point, then it's hard to say what you will do, and how much you will panic at losing a loved one.
..........FULL STOP.
How do you live and treat others being that serious all the time?
Peace Brother
Erm, how's about - as a society, we need doctors, just like we all benefit from everyone being educated generally. That implies (about as strongly as can be implied) that doctor's shouldn't have to pay anything to be trained. Then, they wouldn't 'have' to earn as much to pay off their student loans. Neither would teachers, accountants, engineers, journalists...
"You only get ONE LIFE." Richard Rahl, Faith of the Fallen - Terry Goodkind
You are ridiculous, no person has ever been cured of cancer by any mineral or vitamin supplement. You've bought into snake oil cure, backed by irrelevant studies. Let me clue you in, "redifferentiation" of cultures of cancer cells has been shown with many, many things, not a single one of which cures a human of cancer. Have fun watching your friends and relatives with cancer die or be maimed, after you give them false hope while stuffing them with Schacklee or Nature's Way products.
Then what's the difference when comparing to nicotine? It also forms a physical dependency and strong habits. Where would you draw the line between a 'habit' vs 'addictive'? Many smokers for years just called it a habit.
I've never bothered to try and define a line, because the only way to do that is to get inside the head of a given person. That doesn't change the fact there is one. Anyway, none of this is relevant to the point that addiction and physical dependency are not the same thing.
We put people in cages with other animals, treat them worse than we treat wild animals, then release them directly back into society, and wonder why things like your brother in law getting killed happen. Tell your wife to go visit Delancey Street in San Francisco if she wants to understand how we might treat criminals in a way that doesn't lead to tragedy.
Social Credit would solve everything...
I could have sworn you said three times the average income in town, not three times the average income in the gated development where they live. Sure, if you discount any area of Oakland that contains middle class or poor people, you'll get average incomes high enough to be 1/3rd of what doctors make. I see this problem in the Oakland hills, people who live there think that they are middle class because they are just like all the people that live around them. Many seem to have delusions that earning $250k per year and living in a $1.5M house is how everybody lives. Then again, people in much of the rest of the country making $45k and having a $300k mortgage on a house worth $100k think they are somehow part of the top 1% of earners.
Support SETI@home
Living longer has finite value
I'm not the person you have to convince.
Keep in mind that the original AC poster said "What is 5% weighed against infinity?" He really was assigning an infinite value to living longer.
Erroneously assigning an infinite value to living longer.
Tell him, not me.
And, frankly, I find your elitist view of education to be Medieval at best. Well, no, Christ's Hospital is medieval and offered free education. So that doesn't work.
Maybe you should stop having opinions until you can get this fixed? It doesn't seem to be working for you.
Robert Owen demonstrated that mill workers were more profitable when they were given free training
FTFY. The savvy manufacturer knows that a low turnover, highly skilled employee base is most profitable. But how to get that? You get it by having a highly trained and decently paid employee base that can't transfer those skills to another employer with similar pay.
So right away, education is out because it is readily transferable. Similarly, things like free housing don't contribute unless you can somehow provide that housing cheaper than the value of the benefit to the employee. Health benefits are often of the sort of benefit that an employer can get cheaper (with tax consequences taken into account) than the employee. Housing typically isn't.
Funnily enough, my appendix ruptured too. I've had exactly two major medical conditions in my life (and many small ones, obviously). That was one. The other I won't go into (because I don't feel like talking about my medical history on the internet), but it was considerably more painful and more protracted.
Yes, I would prefer be alive in a great deal of pain than have my short existence snuffed out. For one, it might get better!
Which is a terrifying thought. It would make "vegetative" patients little different from those suffering locked-in syndrome combined with paralysis. Imagine being a patient, fully aware of what's going on around you, listening to your doctors and family talking about you as if you're already dead, and discussing when to dispose of you. It's the sort of thing my personal nightmares are made of.
Living longer has finite value
I'm not the person you have to convince.
Keep in mind that the original AC poster said "What is 5% weighed against infinity?" He really was assigning an infinite value to living longer.
Erroneously assigning an infinite value to living longer.
Tell him, not me.
You're the one trying to convince me that his argument makes sense :-)
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You're the one trying to convince me that his argument makes sense :-)
No, I wasn't. I merely defended my description of it as a "Pascal's wager".
You're the one trying to convince me that his argument makes sense :-)
No, I wasn't. I merely defended my description of it as a "Pascal's wager".
So I see, after reviewing the thread.
I do take issue with your characterization of Pascal's wager as a form of innumeracy. I would agree that the assumption that life extension has infinite value is a fallacy of some sort, which might be characterized as innumeracy, if you squint.
Note to ACs: I usually delete AC replies without reading them. If you want to talk to me, log in.
I do take issue with your characterization of Pascal's wager as a form of innumeracy. I would agree that the assumption that life extension has infinite value is a fallacy of some sort, which might be characterized as innumeracy, if you squint.
The point is that when you ascribe infinite value to a particular thing, then there should be no consideration of anything of finite value. For example, if you consider going to heaven of infinite value, then the obvious strategy is to kill yourself in an approved manner (say martyrdom) so that you don't risk backsliding at a future date. I'd wager that some people have actually done this.
The innumeracy comes from not understanding this. So you get as in this thread, people who speak of life having infinite value, but who act as if life had finite value.
I do take issue with your characterization of Pascal's wager as a form of innumeracy. I would agree that the assumption that life extension has infinite value is a fallacy of some sort, which might be characterized as innumeracy, if you squint.
The point is that when you ascribe infinite value to a particular thing, then there should be no consideration of anything of finite value. For example, if you consider going to heaven of infinite value, then the obvious strategy is to kill yourself in an approved manner (say martyrdom) so that you don't risk backsliding at a future date.
Ah, but suicide is a sin, so that option's not available. Deliberately seeking out martyrdom is still suicide.
Blaise Pascal was not innumerate.
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Shannon Malloy survived her decapitation.
power tip: few > zero
Look at it this way, high blood pressure and arthritis runs in my family. Though I may pwn you with regards to caffeine, eventually it'll catch up to me.
I met a friend of a friend of a friend a couple of years ago who was a serious caffeine junkie. She drank coffee constantly, as well as keeping a stash of caffeinated candy in her purse and used the caffeinated soap.
By the way, what is BC powder?
NTITE
-You can cry, but you'll still die. There'll be no tears in the end.
Well, I didn't say, "TO THE EXTREME", nor did I even say "live every day like its your last".
However, what I'm left wondering is why on Earth you equate "live every day like its your last" (keep in mind, all I said was, carefully evaluate how you want to live your remaining days) as spending beyond your means or even spending beyond what you imagine to be an unattainable sum of money.
Why also would you need a timer to tell you how much time you have left? Yes, plans are great, but would you really be happy if you knew for certain and just sat and watched the plan unfold day after day? Maybe I just much prefer the chaotic unknowingness that is day to day life. Plans seldom account for the happenstance that is opportunity.
Deliberately seeking out martyrdom is still suicide.
I doubt you'd be surprised how many religions and religious people have that covered. For example, in Islam, martyrdom of dying in a fight against the unrighteous and wicked is the express route to Allah even though some infidels think it's suicide.
The Christian version of martyrdom usually involves the person confronting a foe or an evil non-violently, say confronting an anti-Christian tyrant by opening practicing Christian religious traditions (Buddhism and Sikhism have also sometimes used similar approaches). Death is not assured because it depends on the choice of others (and often the opponent blinks), but death often can be very reliable.
But we're talking about 17th-century French Catholicism, not the whole wide world of religious ideas and motives.
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But we're talking about 17th-century French Catholicism
There were several dangerous places to go proselytize. The person looking for a fast but righteous exit could go to the Ottoman Empire, the New World, Africa, or England and preach the word.
My mom isn't dealing with cancer. She's dealing with Parkinson's. It's tough watching her move around and talk as if she is becoming feeble bodied and feeble minded. Just the other day, I had to coach her to help her breath through her nose again. She had somehow lost that ability to the extent that her tongue was becoming dry and raw, and she had difficulty pronouncing words. It dawned on me only at that time, that maybe we don't know why her breathing is like that, and maybe it is correctable. Sure enough, her quality of life is much better now. She seems to be more alert on average. Today, was the first time in 2 weeks, that she didn't feel dizzy. She seems stronger.
On a more positive note, she actually is getting better. A couple of months ago, the doctor said that she is improving. A couple of weeks ago, she said that she is gaining weight again. It seems that her efforts, via diet and exercise, whether placebo or not, are actually helping her to get better.
So, to answer your question, I think that I need to be positive, and to show some hope, but at the same time, acknowledge that things could get worse. I also need to acknowledge that things aren't good right now. I think that there is always hope, even though it is a small chance. I expect people to try to live, as long as it only requires basic nutrition and exercise. You don't want your aunt to kick back and wait 2 years to die, right? On the other hand, I also want people to get off of any pills and treatments that don't live up to their claims. I want my mom to *live* life to the fullest, especially since she has worked so hard in the past.
I think that when their days are numbered, and when they lose abilities, they get a certain freedom. It's like being so sick that you're bed ridden. You lose the opportunity to work, but you gain the opportunity to rest. When you can't sleep, you can read, or think.
This happened to me in December. I spent 2 weeks at home, due to pneumonia or bronchitis, and missed work. I used that time to do the bare essentials, read and rest according to the doctor's orders. In fact, I am still dealing with it. I plan to see the doctor again, but I digress.
When conversing with her, I try to focus on being sympathetic and empathetic, when she comments on how difficult things are and when she asks for help. When helping her to do things, I try to help her find ways to be independent.
Our conversations are not very deep, because my conversations are not very deep unless I am discussing moral and social issues. She seems to be the opposite.
To be honest, she has come to grips with her death more than I have. Every time she has commented at activities possibly happening for the last time [e.g. "This might be the last Christmas gathering I attend, so I'll try to make it."], I have cringed and died a little inside.
I think that 1 of the many reasons that I struggle a lot with this, because I am not very good at doing most ordinary things, while I perceive her to be like a super hero.
testing out my trending skills
What do you guys do in these situations? I'd especially like to hear the prefences of anyone who is dying or at one point believed that they were going to die.
My wife is currently battling stage IV cancer, so I can answer this as best I can.
The hardest conversations for her to have with people who mean well (it's not like someone is going to bring up the really difficult topics like not being there for our kids, etc.) are the ones that keep probing her for some shred of good news. The cold fact is her chances of surviving this are low, and it's been a long while since we've heard any news that could reasonably be interpreted as "good". I understand where these people are coming from, and I know that they mean well, but it just doesn't work.
"How are you doing/feeling?" is fine. It's not like you're somehow reminding her that she feels like shit. She already knows. And I think you're right, that speaking about the distant future is best avoided, but I also wouldn't worry so much about slipping up and accidentally "reminding" her that she is going to die. Believe me, it's most of she's thinking about. Hopefully, she's reached some stage of acceptance.
Good topics are any current events, movies, books, TV shows, stuff in the news. Things that you know interest her. If that is even too hard for her, then she is probably depressed, anyway. Understandable, but hopefully her onc would treat that a bit, if possible.
You're right about respecting that she is probably too tired for long conversations. Texting a caregiver first to see if she's up for a phone call would be appreciated. Invitations to do stuff, if her health permits, could be nice. Letting her know that she's in your throughts/prayers, as appropriate, would be nice. I guess it all depends on how close of a relationship you have with your aunt.
Anyway, I wish you and your family the best of luck. Cancer sucks, and that's about all there is to say about that.
They don't grade fathers, but if your daughter's a stripper, you fucked up. --Chris Rock
I've always wondered why they think God needs the intervention of all that medical technology to work a miracle.
Well, I don't think anybody knows for certain how or if God works miracles on earth, or even if there is a God at all. But among many who believe, there exists a parable:
A elderly religious fellow lived alone in a small house. He was listening to the radio one day when an evacuation order came in for his area due to an impending flood. The man said to himself, "I've been a pious man for all my life. I have nothing to worry about. God will save me if anything bad happens."
An hour later, his neighbor rings the man's doorbell and says to the man, "This area is going to flood. We've been ordered to evacuate. Here, hop into my car. I'll take you to safety." The religious man considered this, and considered that the rains had already started, but replied, "I've been a pious man for all my life. I have nothing to worry about. God will save me if anything bad happens."
Several hours later, it was really raining hard and his street had flooded. A rescue worker went past his house in a boat and ordered him to board to be taken to safety. The religious man considered this, but again replied, "I've been a pious man for all my life. I have nothing to worry about. God will save me if anything bad happens." The worker could not convince the man to come with him, so he went off looking for others.
Several hours later, the flood waters and really risen. They had risen so high that the man had to climb onto his roof to avoid being swept away. Just then, a helicopter flew by, and the workers ordered him into the helicopter, but I'm sure you can guess where this is going. "I've been a pious man for all my life. I have nothing to worry about. God will save me if anything bad happens."
After another hour, the man and his house are swept away, and the man drowns and ascends to the heavens. Upon meeting God, he says, "God, I've been a pious man all of my life. I've done everything that you told me to do. How come you didn't save me?" God replies, "I sent you a radio broadcast. I sent you a car. I sent you a boat and even a helicopter. What more were you expecting?"
They don't grade fathers, but if your daughter's a stripper, you fucked up. --Chris Rock
But 10-12 years for a kidney? Tell that to a kid with kidney problems. Cripes, tell it to a 40 year old man.
Pacemakers is a better surgery, but still - 7 years is not enough. Short term fixes.
My wife is in her 30s and has stage IV cancer. 1.25 years ago, she showed up at the hospital within an inch of her life. The doctors got her patched up well enough to start chemo without her bleeding out of several of her internal organs simultaneously, and then started.
The first month or so was hell, but things improved significantly from there. She handled all her chemo, radiation, and surgery like a champ. She is able to lead a relatively normal life now, except for the fact that she isn't very likely to see 2013, and she sure gets tired easily.
Anyway, we'd be happy for another 10-12, even 7 years. And yes, even at her current comfort level (which admittedly is pretty high, considering). 10-12 years would be a blessing. I know it wouldn't get her anywhere near 90, but, well, we already know she ain't makin' it to 90.
They don't grade fathers, but if your daughter's a stripper, you fucked up. --Chris Rock
I was commenting more on what I perceive to be the general intent of the "live life to the fullest" kinds of statements than on your specific phrasing. The reason they irk me is because I hear them most often in marketing - "live every day like its your last, eat out and get that big piece of chocolate cake for dessert!" The constant drone of the marketers has co-opted these statements and made them mean spend beyond your means. I agree that the good things to keep in mind are making sure to spend time with family, etc. As for plans, what I mean is that I would like to know if I'm going to kick the bucket at 55 of a heart attack or cancer. That way I would know I only need to earn enough to support myself until 55. Otherwise I might still be working at 55 thinking I need to support myself until 95. I'd be able to spend even more time with family, etc. that way. Not that I don't spend time with them now, but more is better with no limit.
Was your mother's husband alive at the time? The difference is probably due to different hospital policies, but I wonder if it also has to do with whether or not the spouse is the one making the decisions.
I know when my grandfather's wife died in the early 1990s, he was allowed to make such a decision without being given shit by the doctors. However, it was a different hospital AND they were married, and being married carries all sorts of implied things including extra-strong medical POA.
If your mother's husband wasn't there enforcing her wishes, and she wasn't deemed sane enough to have made the choices herself, then I would assume it comes down to hospital policy.
It doesn't hurt to be nice.
What's the point?
What's the point in rollercoasters?
What's the point in spinning in circles as a kid?
What's the point in masturbating?
The point is some things are just fun to do, and just because alcohol is a poison and can have some pretty terrible effects it doesn't mean they MUST be destructive. I don't understand the appeal of cigarettes personally, but they wouldn't be around for this long if there wasn't SOME kind of 'upside' to them.
If you are of sane and rational thought I can not see how you cannot see 'the point' in either binge drinking to the point of destruction or nothing at all. What happened to the shades of grey?
We all cope with loss differently. I cope by using humor - I hope I have the wits about me to be funny to the end.
Also it was a joke, we are allowed to joke about really taboo subjects - it's what makes us human.