Slashdot Mirror
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?"
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.
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.
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!
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.
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.
Think about living in constant pain, mental confusion, maybe even in a coma which you a guaranteed to never come out of. And you know you're not ever going to get better--only worse. And all you're doing is adding more and more onto the medical bills that your family may end up being be stuck with. Would you really want one more day of pain, or one more day of not even knowing where you are, or one more day of simply breathing and nothing more? To what end? That's not "life."
SJW: Someone who has run out of real oppression, and has to fake it.
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.
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"
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.
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
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
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?!
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.
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.
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
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.
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.
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
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.
"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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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...
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
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.
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?
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.
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.
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)
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)
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.
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?
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.
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.
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)
So that's why it takes them soo long to pee!
Cwm, fjord-bank glyphs vext quiz
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.
Caffeine isn't fun. It's just bitter. Deliciously bitter.
Can you be Even More Awesome?!
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
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.
I need to delete my facebook account. It's bad that I now want to click "like" on various comments here =(
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.
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.
Speaking in any way is a good start, I'm sometimes impressed on how many people will not talk about death at all!
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.