Doctors die. It's not like the rest of us, but it should be (2016)(archive.cancerworld.net)
archive.cancerworld.net
Doctors die. It's not like the rest of us, but it should be (2016)
https://archive.cancerworld.net/featured/how-doctors-die/
43 comments
Keep fighting the good fight, Internet friend. I look forward to reading your remission comment one day.
> Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack... He explained to me that he never, under any circumstances, wanted to be placed on life support machines again.
> Even with all his wishes documented, Jack hadn’t died as he’d hoped. 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. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it.
It's interesting that our laws punish homicide with maximum criminal penalties, but the opposite (keeping someone alive against their wishes) seems to be assault and battery at worst, with much much lighter punishment.
> Even with all his wishes documented, Jack hadn’t died as he’d hoped. 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. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it.
It's interesting that our laws punish homicide with maximum criminal penalties, but the opposite (keeping someone alive against their wishes) seems to be assault and battery at worst, with much much lighter punishment.
There is a huge unspoken blind spot for a terminal hospice patient. The medicine cabinet just opens up. My dad asked the doctor exactly how much of what he shouldn't take if he didn't want a quick easy death, and the doctor just told him. He didn't end up using it but it was a comfort to him.
The amount of morphine available to the patients on hospice that I have known has made it very clear what the actual intent of those scripts is.
Granted, my sample size of 6 isn't great, and 3 were in terrible pain so it made sense for them, but they had ALL the opiates. . . One had liquid injectable morphine in case he couldn't swallow. He had no issues with swallowing and wasn't in pain.
I wanted to ask the doctor if the intent was to allow a calm end, but chickened out.
Granted, my sample size of 6 isn't great, and 3 were in terrible pain so it made sense for them, but they had ALL the opiates. . . One had liquid injectable morphine in case he couldn't swallow. He had no issues with swallowing and wasn't in pain.
I wanted to ask the doctor if the intent was to allow a calm end, but chickened out.
Amazing how frequently people die after they’re turned over right when the family is all together.
Amazing and appreciated.
Amazing and appreciated.
Open secret.
Cowardice of the system, society, that doesn’t allow practitioners to discuss this.
Leads to scary grey areas, actually.
Cowardice of the system, society, that doesn’t allow practitioners to discuss this.
Leads to scary grey areas, actually.
This reminds me of an interview with neurosurgeon and author Henry Marsh who had prostate cancer.
He described how he's arranged to end his own life should he get alzheimer's or dementia as he didn't want to waste away. But he explained that he has access to knowledge and things ordinary people don't.
He described how he's arranged to end his own life should he get alzheimer's or dementia as he didn't want to waste away. But he explained that he has access to knowledge and things ordinary people don't.
I looked into this recently and it seems like it is basically impossible to pre-arrange assisted suicide for alzheimer's or dementia. Even in countries which allow death with dignity.
I find it very strange because it’s so common and I’m sure many people would prefer DWD in those circumstances.
To me, it doesn’t seem strange at all because I’m thinking about how complicated the system would have to be to carry out such a directive.
Does the US have the concept of DNR (Do Not Resuscitate)?
Yes.
If one lives in the US and feels strongly about it, they should file an Out-of-Hospital DNR and POLST with every local hospital. Also consider wearing or carrying official bracelets/necklaces (varies state to state).
I'm neither a lawyer nor a doctor. :)
If one lives in the US and feels strongly about it, they should file an Out-of-Hospital DNR and POLST with every local hospital. Also consider wearing or carrying official bracelets/necklaces (varies state to state).
I'm neither a lawyer nor a doctor. :)
There was a "culture war" (the rightwing government intervening due to religious reasons) in the 2000's involving a "DNR"-esque case https://en.wikipedia.org/wiki/Terri_Schiavo_case
Yes
I truly believe the conspiracy theory that hospitals are very eager to harvest our organs, and they will absolutely pull the plug to do that, maybe not even waiting until we are dead. So I think it's absolutely plausible they would ignore a DNR
Your statement is confusing. Please explain.
DNR means let me die and do not intervene in that process. Which is what hospitals would want if they were secretly killing people to harvest organs, right?
DNR means let me die and do not intervene in that process. Which is what hospitals would want if they were secretly killing people to harvest organs, right?
These ideas seem to be at odds with one another. I'm reasonably sure you can't harvest organs from a resuscitated person in a vegetative state, coma, severely brain damaged, whatever.
Like many older people I know, my notarized DNR, provided by and on file with my insurance company, local hospital, primary doctor, and medical power of attorney, includes standard language permitting organ harvesting.
The step that a lot of people miss is letting their family know their wishes as well in very clear and strong language. Don't forget to do that.
Are you saying that doctors want people to not be resuscitated so that they can harvest their organs to give them to people who need organ transplants?
People who die without resuscitation are far less likely to have harvestable organs than those that do due to lack of oxygenated blood.
People who die without resuscitation are far less likely to have harvestable organs than those that do due to lack of oxygenated blood.
Aren’t that contradicting actions
I'm a physician, an old one. We're lucky to live as long as we do, but life will end. The article emphasizes the value of dying peacefully. Sure, that's how we want it to be, but we have to make it known to assure it goes that way.
Don't know what happens elsewhere, but every time I see a doctor someone asks if I have a signed, notarized directive. Yes, I've done that, but so should everybody else concerned about the issue.
I have asked aged patients the same question. More than not the answer is "no". Why haven't you? Various versions of "on my list of things to do". We can't really predict future events, in our own interests best to be prepared. Some will take the hint, more than not, people procrastinate.
At least I've done what I can do, but we can't save people from themselves. Maybe people in healthcare are more aware of what's at stake, but everyone has the option to make it as clear as possible their wish (no, their demand) to die in peace.
Don't know what happens elsewhere, but every time I see a doctor someone asks if I have a signed, notarized directive. Yes, I've done that, but so should everybody else concerned about the issue.
I have asked aged patients the same question. More than not the answer is "no". Why haven't you? Various versions of "on my list of things to do". We can't really predict future events, in our own interests best to be prepared. Some will take the hint, more than not, people procrastinate.
At least I've done what I can do, but we can't save people from themselves. Maybe people in healthcare are more aware of what's at stake, but everyone has the option to make it as clear as possible their wish (no, their demand) to die in peace.
> Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a ‘tension pneumothorax’), walked out of the hospital.
This point has been made by many medically trained people over decades. It's a very energetic intensive process, it cracks ribs. If it's not done promptly the brain has been starved of oxygen.
While I understand people not wanting to drag politics into everything I invite you to think about this and the situation of the senior senator for Kentucky.
This point has been made by many medically trained people over decades. It's a very energetic intensive process, it cracks ribs. If it's not done promptly the brain has been starved of oxygen.
While I understand people not wanting to drag politics into everything I invite you to think about this and the situation of the senior senator for Kentucky.
I have a friend who had a spontaneous pneumothorax. He even wrote a song about it after he recovered.
I myself punctured and collapsed both lungs. My thinking is: if there's a reasonable chance I'll survive, go for it. If there's not, stop trying to prolong the inevitable. That said, when I had the accident they told my wife to get there as fast as she could because I was likely not going to make it, and that was thirty years ago. So: if they're confident I'm going to die, don't try to prolong it :-)
I myself punctured and collapsed both lungs. My thinking is: if there's a reasonable chance I'll survive, go for it. If there's not, stop trying to prolong the inevitable. That said, when I had the accident they told my wife to get there as fast as she could because I was likely not going to make it, and that was thirty years ago. So: if they're confident I'm going to die, don't try to prolong it :-)
> It's a very energetic intensive process, it cracks ribs.
I feel like lately this is becoming more common knowledge - but still something most people don't realize.
Part of it is probably the fact that it's impossible to depict "real" CPR in popular culture (movies, TV shows, etc) unless the production goes to extreme lengths to use a fake dummy. Even on The Pitt (which seems to make a point of being hyper realistic) I've seen them do "fake" CPR with shallow compressions.
I feel like lately this is becoming more common knowledge - but still something most people don't realize.
Part of it is probably the fact that it's impossible to depict "real" CPR in popular culture (movies, TV shows, etc) unless the production goes to extreme lengths to use a fake dummy. Even on The Pitt (which seems to make a point of being hyper realistic) I've seen them do "fake" CPR with shallow compressions.
so on Lost when Jack is really upset about Charlie, and he beats the shit out of his lifeless body, ... and it worked, did he do real or fake CPR? These comments make it sound very real.
Yeah, akin to the Gell-mann Amnesia Effect, we notice a few things where we're experts but then forget everything else is likely just as bogus. Apparently one reason "Queen's Gambit" was a big deal was that most pop culture chess isn't just not very good chess (as you might innocently assume), it's literally nonsense. Like, pieces on the wrong squares, illegal moves, even simple continuity errors where pieces move between camera shots. So QG begins scoring points for chess fans when it remembers stuff like the White Queen starts on a White square...
Do you know what is happening with McConnell? Because the news is everywhere from he's fine to he's dead.
Totally misleading. Early CPR (+AED if available) absolutely saves lives. Article is from 2011 by a family med doctor.
Overly aggressive resuscitation attempts are definitely a problem but context matters
Overly aggressive resuscitation attempts are definitely a problem but context matters
> Early CPR (+AED if available) absolutely saves lives. Article is from 2011 by a family med doctor.
You have to provide a denominator to make this statement. 30-day survival for out-of-hospital CPR is 10%, and discharge from the hospital (let alone functional status) is even lower.
CPR is thus a great example of the OP's thesis that doctors refuse certain things based on their poor efficacy.
https://www.redcross.org/take-a-class/resources/articles/cpr...
You have to provide a denominator to make this statement. 30-day survival for out-of-hospital CPR is 10%, and discharge from the hospital (let alone functional status) is even lower.
CPR is thus a great example of the OP's thesis that doctors refuse certain things based on their poor efficacy.
https://www.redcross.org/take-a-class/resources/articles/cpr...
Did you read what you linked? It's not a study of the effects of cpr, it's a list of facts about cardiac arrest that occurs outside a hospital. It explicitly says cpr is life saving:
>Survival chances decrease by 10% for every minute that immediate CPR and use of an AED is delayed.
>Survival chances decrease by 10% for every minute that immediate CPR and use of an AED is delayed.
100%. CPR initiated within 2 minutes of cardiac arrest increases survival rate by 81%. The fact that CPR is rarely initiated so quickly (and thus survival rates are extremely low), says nothing about the efficacy of CPR. In the best cases where CPR is initiated < 2 mins, and AED shock within < 5mins survival rate can be as high as 50%.
https://newsroom.heart.org/news/bystander-cpr-up-to-10-minut...
https://newsroom.heart.org/news/bystander-cpr-up-to-10-minut...
"Early" is load-bearing. Even brief delays, just mere minutes, significantly decrease survival or positive outcomes.
https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.010...
It's important to get people to realize the benefits of early CPR and more people should be trained on how to do it, or else it won't be prompt and the outcomes will be worse. That's what the Red Cross and AHA promulgate to the public, in so many words.
https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.010...
It's important to get people to realize the benefits of early CPR and more people should be trained on how to do it, or else it won't be prompt and the outcomes will be worse. That's what the Red Cross and AHA promulgate to the public, in so many words.
I've never heard the term "load-bearing" used outside of the civil engineering world until the more recent versions of Claude suddenly decided everything was "load-bearing".
Did you internalize Claude terminology, use Claude to write/translate your post, or lead Claude into temptation by being the OG?
Asking out of genuine curiosity and not at all trying to throw shade.
Did you internalize Claude terminology, use Claude to write/translate your post, or lead Claude into temptation by being the OG?
Asking out of genuine curiosity and not at all trying to throw shade.
"Load bearing beliefs" is a thing in the podcast/YouTube world at a minimum. Perhaps you're not as online as some other folks (probably a good thing!).
I have heard it in the way that Claude uses it going way back. Since I have to use Anthropic models for work, and they use that term prodigiously, it's been added to the list of "perfectly fine phrases that have been ruined" to me. It's really frustrating too because I don't know what other phrase I would use.
No. I do use the term.
How has CPR (or CPR data) changed since 2011? What type of medicine do you practice?
My only point was that this article shouldn’t be considered authoritative, wanted to put it in perspective for someone surfing hn and just reading the comments
The person closest to me was saved by CPR after cardiac arrest (and cooling at the hospital), with no neurological deficits
The person closest to me was saved by CPR after cardiac arrest (and cooling at the hospital), with no neurological deficits
If CPR is done right ~10% will walk out of the hospital. But that's a big if! Must be near a trained bystander. AED is much better on shockable rhythms, ~70%. Unfortunately most out-of-hospital cardiac events occur in homes which rarely have access to a device.
In 2021, a drone-delivered AED was used to successfully shock a 71-year-old man back into a stable rhythm in Sweden. The drone delivered the AED in just over three minutes from a 911 call.
Studying years of emergency drone data back up the anecdotes. The AED gets there 10-15 min ahead of medics and boosts survival 70%.
In 2021, a drone-delivered AED was used to successfully shock a 71-year-old man back into a stable rhythm in Sweden. The drone delivered the AED in just over three minutes from a 911 call.
Studying years of emergency drone data back up the anecdotes. The AED gets there 10-15 min ahead of medics and boosts survival 70%.
MY ex-wife who was a CNA had made it a point to me that she had a DNR. How or where, she never told me. Probably for the best.
Can confirm. Top of the article could be about my dad. Same flavor of cancer and everything.
This is not abstract for me. I have not one, but two forms of cancer.
Both were considered incurable when I was diagnosed.
Both have treatments now that, IN SOME PEOPLE, lead to remission.
I still don't know which group I am, but I'd be dead from either one by now, if I hadn't elected to treat.
New treatments, for SOME cancers are literally coming out monthly.
So the fact that you can't be cured today, does mean there won't be a better treatment by next year, if you can hang on.
I should find out soon on my more aggressive one. Either way, I plan on continuing to try.