It means I accepted life and death on my own terms. Thanks for this, Kelly. My guess is that once you start doing it the process becomes less ominous each time — not for patients, but for the professionals in charge. One compelling reason for the patient having the final word over, say, any document they may have signed, or someone else with POA is that without that provision many people would be reluctant to execute an advance directive, fearing that if they later changed their mind it would be too late.
Of course at some point they may need to be informed that what they want will not have the results they are seeking. And delivering that message also takes courage. These situations are beyond unfortunate, and highlight the importance of nurses and physicians knowing their state laws.
I work in an academic center in CA, and launched a workshop on advance directives this year in response to a need that was verified when over 70 staff members showed up at a class I gave with only two days notice via e-mail. The workshop has been very well attended, too. From our experience too many doctors use too many euphemisms. An impossible position. One patient, as 92 year old man, has been in our unit five times in the last year on the ventilator.
The patient has had multiple strokes and can no longer speak for himself. The MPOA, his son, avoids attempts at education by not coming to see his father in the unit. It is soul crushing for most of the staff who care for him. My father had a DNR, a very clear and detailed list of what he wanted and a cooperative understanding Dr. At his end, we four daughters had to fight to keep his nursing home nurse and covering Dr.
They thought he might be obstructed and wanted to do tests and maybe surgery. His desires were not even an IV. If we had not been quickly available and argued very forcibly he would have been sent. They had the paperwork all filled out and a transfer bed parked out side his room. All hospitalized patients need an educated advocate. Great comment. I have also worked in the ED in Australia. I wish the public was made aware of the extremely low success rates of CPR.
What a great article, even if some details were a bit fuzzy. Very compelling to read. I am a nurse working in Australia, and my colleagues and I frequently talk about what sort of measures we would want for ourselves, if we were to become very unwell. What would we want done if these patients were our parents? I was once told by my student mentor that sometimes, after a sudden event MI, CVA etc where the outcome is poor, the patient will be sustained on life support while the family can come to terms with the situation — and eventually make the decision to remove these measures.
To me, this is appropriate. What is inappropriate in my eyes is a family choosing to prolong the suffering of their loved one when they no longer have a quality of life. It can be so sad to be nursing a person who shows so clearly in their eyes that want to die, but are unable to. May I also say that it still shocks me to hear about the health care system in the US.
Here, if you find out you are sick and need immediate treatment, all medical costs are ALWAYS covered by our medicare system. And finally, a DNR or NFR in Australia tattoo or bracelet will be ignored in a life-threatening situation because it is not a legal document and the order may have been changed since the tattoo. Not that many people would opt for this anyway! Eventually, one if the metastasized tumors — usually caught in time — proliferated and he was too late.
In his final 2 months he chose hospice care and was given control over the amount of pain killer he wanted for dosage. I could see the wisdom of patients deciding their own pain schedule, but I also wondered if this was a nod and a wink to letting him choose the time of his own death. He chose not to overdose himself, even when one of the many tumors that sprung up in the final weeks pressed against his larynx and he could no longer speak.
He had a few more weeks of friends and family visiting and played a few more hands of online poker.
He slipped into a coma and left, I truly hope, in peace. But I still wonder if he ever considered using his self-dosing as a mechanism.
Sean, I hope you are healthy and when you die, you die in your sleep. I work in ER. Do you know why? Because in 20 years in ER I broke plenty of ribcages, seeing more penises on dead man and breast on women who would be ashamed of what we did to then in our effort to resuscitate.
None of them survived long enough. We all die. Just a few of us can do with dignity. Because unlike on TV, we do not shock systole. Read the paragraph a bit more carefully. This really hit home with me. My father, age 76, had an aneurysm to the brain while watching his favorite TV show in his recliner…perfect way to go.
They airlifted him to a local hospital, who put him on life support. That was on a Tuesday. On Thursday, we finally talked to his neurologist after many tests. He told us that my dad died on Tuesday, but his body was still here. We signed the papers to remove him from life support the next day, Friday, his 77th birthday.
I totally respect all of these doctors decisions. Sean B — There are no death panels. Yours is among the most misinformed and mean-spirited comments in this thread. Thank you for a nice piece, dr. All I can say is that this type of reading should be mandatory for peeps when they sign up for Medicare.
Also the dr. I am extremely conservative and hate everything about Obamacare, but the one thing he had right was the creation of death panels.
There is a great conservative case to be made for death panels. Unfortunately, I am alone. As a 70 year old MD with multiple sclerosis I am still ambulatory , I have made it clear to my three children that under no circumstances do I want CPR performed on me. I am adamant about never being admitted to an ICU. In the event of a terminal illness, I want hospice care, which not only cares for the patient but also the family.
I have seen this endless heroics have far too many time and it happens pretty much how he described it. A family member is suddenly faced with the loss of a loved one, they grieve, they panic, they grasp for hope……one more day, one more week, or a miracle.
Why families sit at their loved ones side, we do what they ask. There is a great video series basically goes through the life saving measures we provide at the end of life.
It actually shows real patients. The hope is only then will the families understand what we are trying to explain in regards to end of life care. I have never known a Doctor to want to provide unnecessary care unless they are doing so out of fear not greed. Oregon received a huge federal grant in order to attempt to solve the healthcare finance crisis. It will be years before all the kinks are worked out. I am happy to hear that you were able to receive the care your family needed without going bankrupt.
Now, if only the rest of the country would figure this out. This is an interesting article on how doctors make different choices for their own care than their patients often do. The one big thing it fails to mention is how much money plays a part in all of this. I find it hard to believe that patients and their families are convincing doctors and hospitals they need surgeries and treatments in a state confusion and desperation, as this article would have you think; in my experience it is the other way around.
And while maybe there is some truth that they are concerned about being sued by angry families, it would seem the larger reason, the umbrella cause of all this suffering, is to make money. Imagine now how the nurses who have to administer such care feel about it. In reality, the doctors get to walk away at the end of their 15min with the pt.
They can generally write their orders and leave. If MDs have high rates of depression and drinking then nurses have more…. I must take umbrage with your opening anecdote.
Too often, throw in the towel is told to early-stage patients who might benefit greatly from treatment. In fact, I was diagnosed with pancreatic cancer over three years ago at age I had chemo, radiation and the horrible surgery.
And—guess what—my quality of life is not poor. Far from it. I surely feel your pain, for both you and your son. I have a client who has ankylosing spondylitis. We have had 2 treatments so far — a cranial structural core distortion release and 2 series of pelvic balancing. For the first time in a long time, she was able to do things around the house laundry, cleaning and even mowing the lawn all in one day with minimal pain, rather than a little piece each day in excrutiating pain.
She also reported her pain level to be 5 to 6 on a scale of 1 to 10, rather than a 9 or 10, as it was the first time I saw her. Yesterday, after our session, she told me she did not experience any pain for a few hours that evening. If you will take some time to review their website, you might just find some relief for him. LOL, Eric…. I am married to a pharmacist that hates to take any medication!! Thanks for sharing.
They are too busy treating the person who the call was placed for to be looking around for paperwork. No one is blaming the doctors, per se. Doctors can only do what you or your health care surrogate allow. If the doctor is led to believe you want everything done, they will do it. As for the poor year-old woman who was intubated in the ER before her family arrived…as a former ER nurse I can tell you, in an acute situation we do NOT have time to ask about paperwork….
We treat first, ask questions later. The family handled the situation very well. I recently lost my husband to lung cancer and he thought long and hard about Chemo and radiation treatment and after going one round with both decided on a DNR and Hospice.
He live almost four more years in quality care without the sickness of Chemo and burning of radiation. He died at home peacefully and was able to travel during those 4 years and see much of his grandchildren which were the Joy of his life.
He chose to live without treatment with dignity and peace of mind. What a wonderful perspective this Doctor shares!!! It was a choice my husband made also and gave the quality of life he wanted and we shared that together. The Physicians Order for Life Sustaining Treatment forms clearly state the level of treatment they want, which matches what their Medical Directive and what all of their kids know about their wishes. It is in writing and properly documented. I will have the same in place soon.
I appreciate their foresight more than words can say! Kristin and Kevin: Interesting conversation. I have worked for several years in a ED. Maybe different in your states, cut and in Wisconsin!! Unfortunately, I believe this pool of money has run out. It was a well intentioned piece of legislature but not properly funded, especially for the type of patients it is meant to help.
These patients frequently have medical costs over a million dollars. Yes, I have a directive filed with my HMO, but is that enough? My mother, a 67 year old with end stage COPD among other dx was diagnosed with severe aortic stenosis. The cardiologist wanted to do a cardiac cath on her.
At first we were under the impression that he might be able to repair the valve with CC. She was mentally intact.
I explained that with her level of COPD she would either not make it off the table or live whatever time she had left on the ventilator.
She passed away on her couch, in her own home, caring for herself with some help from her children. I wish we were able to lay it out for family members in this manner.
I believe you that in the real world it does occur often. From what I was taught in medical school and what I tried to confirm online, the official rule is that the DNR over rules the health care surrogate.
They Can and do do it! In response to Robyn- a legally authorized DNR signed by you is not allowed to be overturned by your health care surrogate. Who is your health care surrogate? That person is someone you legally appoint or is determined by closest family member spouse, parent, child, etc.
Your family member may come to the ED and also say that they want everything done. However, when the appropriate paperwork your DNR comes, the doctor will follow those written documents over anything that your family or health care surrogate says. While I believe that it is true that many physicians will not go through extenuating circumstances to prolong their life through unnecessary treatment, I believe it is because they are educated.
I am tired of our society targeting this profession and not taking responsibility for their own actions. Ask questions!!! Do research!!! Educate yourself!!! This is very true. My mother was diagnosed with stage 4 colon cancer in She had surgery and did chemotherapy, resulting in 6 years remission. She had three subsequent recurrences, which involved surgeries, radiation one round , and two-and-a-half more rounds of chemo.
She died last month, peacefully, having long ago talked with my brother and me about her wishes and given us the legal authority to make certain they were honored. Caring for her was an honor and a privilege, and it was a gift to be able to help her manage her pain without having more inflicted. The thirteen years following her initial diagnosis also allowed her to see us with our own families, and her biggest delights were the grandchildren she would never have known and who would never have known her if she had made different decisions.
After excision of a mixed tumor of the parotid Salivary gland and 33 radiation treatments for a low grade carcinoma in the outer margin, I was diagnosed with pancreatic cancer. Oncologists and surgeons recommended that I proceed with the whipple surgery………. After reviewing the procedure on the internet and consulting with other dr.
I also used deionization, diet changes, sunshine and ingestion of many vitamins. After three months of many prayers, the abnormality in the head of the pancreas was no longer present…………. I trained in General Surgery and General Psychiatry — I specialize in medical psychiatry and treat chronic illness.
He lived a quality life for a year or so, but the cancer came back. I remember my grandfather who raised me since I was a child. At the age of 80 he was bed-ridden due to numerous illnesses he had. Because of his condition he had aspiration pneumonia and eventually got weaker. I treated him at home and even turned his room to a regular hospital room with the help of my brother and aunt who are nurses. Our neighbors would visit him and they will sometimes comment that it would be best for my grand dad to be put in a hospital where tubes and monitors will be in placed.
Then, I remembered what he told me when I graduated medicine that if his time comes I will let him go in peace.. So I continue treating him at home with no advance life support and when he died on his birthday I can see in his face that he is very happy. During his funeral I heard people talking that I made a bad decision as a doctor not bringing my grand dad to the hospital. It really made me sad. Then I realized, I still made the right decision because as a doctor you know what is worth fighting for and what is worth giving up.
When my time comes all I want is to be with all my love ones holding their hands and not in a hospital bed hooked to monitors and on ventilator….
Your family needs to know and understand your wishes. Despite a DNR, decisions are left up to the healthcare surrogate. May I share your story, BR? I have been fighting a losing battle with the anti-ACA folks….. I can barely afford it. I was turned down for cheaper coverage due to preexisting conditions past treatment for breast cancer for me and my son has an auto-immune disease called ankylosing spondylitis- a type of arthritis.
Cherie Magee This comment thread has become so long that hundreds of comments no longer appear. Notice the date of the post — I have left the link below a couple of times before, but here it is again — a couple of informative videos and further links underscoring the importance of advance directives for medical care. Everybody should have one, filled out, signed and legally executed, which includes the names and contact numbers of at least three agents for medical care decisions.
Your agents should know who they are, where to find your paperwork and have all agreed to the responsibility. In some states to avoid a conflict of interest, agents for medical care named in your Advance Directive for Medical Care cannot be the same as whoever may have Power of Attorney POA. Your advance directive should be reviewed and updated at least every three years.
Medicine and science changes. Agents may change their minds or beat you to the end of life. And you may simply have changed your mind about something. There is plenty to learn and do in advance of the need. And be aware that all that planning may not be necessary if you are still able to communicate for yourself. Your agents are only needed if for some reason you cannot communicate for example, if a medical procedure goes horribly wrong and you are comatose, or if you have brain trauma stroke or accident which leaves you incoherent.
Here is the link I mentioned. Do an internet search for the pills and potions that you are using and decide for yourself if side the noted side effects are okay with you. I had an aneurysm in the basilar region of my brain in the summer of , at 6 weeks I was ordered to a nursing home as I had no memory, I was a 99 lb male heading for deaths door.
My memory made a weak connection which saved me from a nursing home and being medicated until I die in the not so distant future. I was taking Dilantin only when discharged and read the side effects online, , better yet I was living them in person, they are horrible, more than horrible and were given me to dilated my blood vessels. A few days ago was my 9th anniversary from the stroke, I gave up all pills in after taking Dilantin for 4 months, 4 long agonizing months.
I have no paralysis, I have a good supply of energy, I can run a bit, work for hours and keep up with others who were born long after me. I eat healthy when I eat but the 3 meal a day public health department guideline is deadly and in serious error.
For over 35 years I developed a habit of eating my first meal of the day after work and drinking water only during the day. This is so true. I even had a doctor tell me to find another doctor but no one tells me what are life threatening and to refuse treatment and what is relatively minor and take treatment.
At the moment, I am taking a blood pressure pill and Spireva. I wish there was good advice available to know when to stop taking medication which is the only medical advice I have ever been given about my plan.
This is a timely piece for me to read. Five years ago on the 30th of July I lost my wonderful, loving husband Joe. He had a local trucking business and needed surgery for pain and numbness of his right arm. Thus he underwent a series of horrible accidents; 1st surgery was done after testing his nerves heinous for those watching , he had major surgery of his neck and was sent home.
He did the necessary rehabilitation and fell at home not while I was watching; he was sent back for a second surgery where it was said by him that his head fell off of his neck.
Nothing was ever right after that. Now I know in reading this post, nothing I ever did would have ever been enough. In thanks for the beginning of the grieving process. Almost 40 years ago I worked nights in a hospital as a certified nursing assistant.
I was 18 years old. One of the duties of the night CNA was to give the preparatory enemas to patients undergoing diagnostic testing that day. One night, I was working with an elderly woman with a diagnosis of advanced cancer, in pain and very weak, but lucid. She was scheduled for a barium enema, and I was to do the prep.
I reported the refusal to her nurse and she was spared the procedure. I will never forget her, that 5 am conversation, and, at such a young age, the sense of clarity about how senselessly the medical system can treat suffering people. So I guess it is true. So what exactly needs to be said in a written request to NOT perform certain treatments? She would be so miserable sitting in a hospital for weeks on end. So what is really necessary to insure no one goes to extremes in keeping either of us alive?
So true. I myself do not desire any extreme measures when my dying day comes. I just want to go peacefully. This is our true story about Obama Care, In my wife and I, both retired and in our early 60s, went to a local insurance agent to secure private health care.
We were both turned down for coverage. I was turned down because a minor, pre-cancerous lesion was removed from my face several years earlier and Barbara because she had had a hysterectomy 15 years earlier. After this first rejection we applied through a different agent. This time I was approved and my wife was turned down because she had a minor, laparoscopic procedure on her knee years earlier. In the summer of Barbara was diagnosed with stage 4 esophageal cancer.
After this devastating diagnosis and being well aware of the financial realities related catastrophic health emergencies my next stop was a bankruptcy attorney. I checked with a local insurance agent who told me we would not qualify. But later my other daughter called, telling us that it appeared Barbara would indeed, qualify for FMIP benefits and faxed the application to me.
We faxed our application to her and were informed within 2 days that we met the criteria for ObamaCare and that our coverage would begin the first day of the next month. They checked their records and already had the necessary information for my wife to begin her treatments. There is a lot of mis-information out there about ObamaCare and I just want people to know that because of the fast and efficient response from ObamaCare my wife and I were able to battle her devastating illness and not have to live with distraction and the fear of financial ruin.
Beautiful blog. My yr old grandmother was rushed to hospital in heart failure — by the time family arrived she was intubated even tho she had a Living Will — the hospital refused to extubate her and take her out of ICU. My mother called and said what do we do? And Voila — 5 minutes later she was extubated, and transferred out of ICU soon after. She lived a few more days with lots of visitors and humor and cookies, and died peacefully the day of discharge.
When my uncle was in a vegetative state after a devastating MI, with no hope of recovery, the doctor in charge refused to withdraw life support, even with an Advanced Directive. My aunt called and said what do we do? I said go to the nursing station and request a Palliative Medicine consult, and when they arrive, request a transfer of services.
He passed away peacefully a few days later. This is a timely piece for me to read as I am currently working with a woman whose father is dying of esophageal cancer. He has undergone multiple rounds of chemo that have no chance of curing his disease. Multiple blood transfusions. He is incredibly sick and miserable. Cannot talk. Cannot eat. Cannot do much of anything. He endured all of this treatment because his family panicked at his diagnosis of Stage 4b disease and could not bear to let him go.
He is living the most marginal of marginal lives. And watching all this unfold, I thought, how can I avoid having this happen to me? I am going to make sure I have documents and legal papers explaining exactly how I want to die prepared and ready to go.
No one lives forever and yet so many people are dragged through unspeakable pain and suffering as they approach the final door. I would rather walk through of my own volition, whistling and waving to my loved ones, if I can. That was very sudden.
God bless and comfort you and your brothers. I took care of my mother-in-law, mother and father at home with home hospice care. No science projects, just morphine for pain as needed and valium for anxiety. Father and mother-in-law lasted 2 weeks….
Not easy to do, but it is the best way for the patient. Terminal is exactly that and modern medicine can only delay the inevitable and at what cost emotionally, physically, and psychologically? Let me die at home and let me do whatever I want for as long as I am able.
Actually, heaven does come as a free gift. Salvation is absolutely free. You cannot earn your way into heaven. No good deed can get you there. The Bible is very clear about that. I Do think it is a very wonderful thing to care for an aging or sick parent just as they took care of you when you were little. It strikes me that we let our pets die more humanely and gracefully than our human family members.
Wish that death was more simple and natural, not a science project in prolonging the inevitable. Thanks for your thoughtful comments, from a young er person who has never really seen death, they are quite meaningful and insightful.
Study and documentation of the efficacy of non aggressive ancient cures would arm the MD with gentler alternatives and documentation to shield them from professional harassment and the notorious law suits. The desire to fight disease is as old as man. Many ancient herbs and cures are neglected because they are not patentable.
Drugs once off patent that are found to help other off patent diseases are not pursued due to lack of profit. For example, turmeric was found in actual lab tests to kill cancer cells but there is no incentive to pursue the study.
By the bye, India where tumeric is part of the diet has a significantly lowere cancer rate. How can we kick off this type of study? I worked on getting a man on the moon at great expense and with lots of technical fallout. Perhaps something similar is needed for medicine!
Nathan, you make a good point. Many people are not in a position to shift gears and stop everything, even if they get the ultimate of all bad news, a diagnosis of a terminal condition. Your letter underscores the importance of responsible financial planning which has more to do with peace of mind than the acquisition of wealth.
The ultimate safety belt, of course, is a good term life insurance policy, which most people consider something that they cannot afford as long as they are still struggling to make ends meet from one payday to the next. In that hamster wheel life insurance premiums seem like a waste — like spending money on lottery tickets or entertainment. I know. But the fact is that life insurance is as important as any other — fire, auto, health, etc.
And the good news is that it is also surprisingly inexpensive for young people. And the younger you are the better bargain it is. But you need to be a good consumer and buy term insurance only.
Tem insurance will not be easy to find, but a stubborn consumer can get it from just about any company. You just need to be persistent. If you are in your thirties and in fairly good health you should be able to be insured for half a million dollars for well under a hundred dollars a month.
And for a lower rate you can still leave behind a pretty good amount. If you have children this should not be a hard decision. As any salesman will tell you, that money is not for insurance as much as it is for peace of mind. The bad news is that you are far more likely to be disabled and live than to die, so disability insurance costs a lot more.
Sorry to add that down note, but it also needs to be said. What choices do doctors make for themselves and their families? They tend to utilize the system and opt for treatment much LESS than they prescribe for their patients. That is the key point the author is making. I want to thank you for sharing such an article. For years I have battled with my own personal beliefs on the subject or death and dying against what I have been trained to believe on a professional level.
I have worked all my professional nursing life in the field of Cardiothoracic Surgery and I encounter death on a regular basis. But they often do, brought back from the brink by some short-term medical intervention that buys them an extra few days of misery.
My grandfather passed away from terminal lung cancer when I was thirteen. He was in hospital for over a month with a chest drain insitu but nothing was improving. He was 78 yrs old and smoked heavily for most of his adult life. When his managing team found out his cancer was terminal, they spoke to my aunt and advised her to bring him home to live out his final days in familiar surroundings, amongst familiar faces.
As a quick follow-up, what all of the extra care is really providing people is hope. There are many other life situations out there, of course, such as those with young kids at home and those who do not make anywhere near as much or have been able to save as much as physicians.
What about those who have no choice but to keep working through terminal illness? I think articles like this need to be qualified — it reads as though everyone out there ought to be thinking the same way. My Mother passed on July 6, just a few days ago. She fought the good fight, she was an insulin-dependent diabetic for over 50 years, though she never weighed over pounds, even when pregnant.
She had the broken hip, and bounced back. She smoked for 50 years. A few weeks ago, she went into renal failure, and lung cancer was confirmed. She made it very clear that at 75 years old, she would not consider surgery, chemo, or radiation.
Dialysis was not very effective. All 5 of her sons were there as she signed the hospice papers, she went home the next day, and passed peacefully 4 days later. All 5 sons spent time with her on Saturday. She was lucid and coherent. That evening, she experienced shallow and labored breathing, and then it was done. Doctors may be better prepared for it. I don't know what will happen when it affects me, although I would say that right now, with experience, I'm less afraid.
Here we were, finally face-to-face, and yet nothing about it seemed recognizable. When you get an IV placed, for example, you can actually taste the salt when they start infusing it. They tell me that this happens to everybody, but even after eleven years in medicine, I had never known. Is there, then, any way to be prepared for death from the standpoint of health? The bottom line is that, generally speaking, they do not do so especially well. Their choice, therefore, is to forget it until it is near and visible, preferring to think about what he will cook for dinner.
The here and now will be the one corresponding to that moment. Anatole Broyard. Anatole Broyard was a literary critic diagnosed with advanced prostate cancer in It stinks of revelation. What seems clear is that we die worse than we should. The image with which healing at the end of life has sometimes been compared is that of a train that advances with the inertia of healing and from which it is very difficult to jump.
Although there are people who disagree, there is no right not to know. It is sometimes a question of lack of time, but also of training.
Doctors have not been taught, and it is not only a very important medical act, but possibly also the most difficult. And without prejudice on both sides. In this relationship at the end of life, other types of conflicts also appear, such as that of the possible induction of death when the time comes and the case arises. There is a fine line, a very important one for some, between non-intermittent palliative sedation and active euthanasia.
The former consists in putting the patient to sleep with the added possibility of interrupting his nutrition and hydration, which leads to death within a short time. In the latter case, a lethal dose of some substance is administered, which is the direct cause of death. Gomez prefers to focus on the absolute need to improve palliative care and end-of-life care. Every day a hundred people die in Spain waiting for the dependency help to which they are entitled.
Although he is against euthanasia, he has been asked to give his opinion on the latest media case , that of the now-accused man who helped his wife, who had multiple sclerosis, to die. The epilogue to Kalanithi's book was written by his wife shortly after his death in I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family.
She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs.
Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.
In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife.
Doctors did everything possible to resuscitate him and put him on life support in the ICU. Then I turned off the life support machines and sat with him. He died two hours later. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks.
They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. Several years ago, my older cousin Torch born at home by the light of a flashlight—or torch had a seizure that turned out to be the result of lung cancer that had gone to his brain.
I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months.
Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me. We went to Disneyland, his first time.
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