How Doctors Die
I linked to this in a previous incarnation, when it was on Zocalo, but I found the ending of the piece moving and worth posting, so here it is again.
Dr. Ken Murray, a retired clinical assistant professor of family medicine at the University of Southern California, writes in the WSJ that doctors die differently -- that many of them respond to a terminal diagnosis by opting for "a graceful death"; that is, a death without extraordinary measures taken. The attributes of this sort of death include:
...Being comfortable and in control, having a sense of closure, making the most of relationships and having family involved in care. Hospitals today provide few of these qualities.Written directives can give patients far more control over how their lives end. But while most of us accept that taxes are inescapable, death is a much harder pill to swallow, which keeps the vast majority of Americans from making proper arrangements.
It doesn't have to be that way. Several years ago, at age 60, my older cousin Torch (born at home by the light of a flashlight, or torch) had a seizure. It turned out to be the result of lung cancer that had gone to his brain. We learned that with aggressive treatment, including three to five hospital visits a week for chemotherapy, he would live perhaps four months.
Torch was no doctor, but he knew that he wanted a life of quality, not just quantity. Ultimately, he decided against any treatment and simply took pills for brain swelling. He moved in with me.
We spent the next eight months having fun together like we hadn't had in decades. We went to Disneyland, his first time, and we hung out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He had no serious pain, and he remained high-spirited.
One day, he didn't wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.
As for me, my doctor has my choices on record. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like so many of my fellow doctors.
And like me. I have a little shrunken signed, witnessed photocopy of a note expressing my demand to not be turned into a human turnip. Do you have one? Or some directive expressing your wishes about your medical care?
My take is a bit different. I have a highly developed sense of self preservation, and I've made it VERY clear that if I have even one brain cell left, I don't want to be unplugged.
That said, once I'm brain dead? Go right ahead. I'll never know.
Daghain at February 27, 2012 11:00 PM
The last time I was in the hospital I was encouraged to sign the paperwork waiving heroic measures. I have such mixed feelings about this. Judgement must be used!
My husband is one that is not always cognizant of pain and tends to prefer heroic measures so he is not on the paperwork to make decisions for me - instead a friend has been given the job. I don't want to live with a poor quality of life.
On the other hand, how can I say that I want no heroic measures? If a couple of minutes of care could save my life and I could still be productive, treat away! I talked to my nurse about this and he was very negative. In the moment it is difficult to ascertain the outcome. Once heroics have started they cannot just be stopped because the quality of life has diminished,
I object to this. The quality of life makes a huge difference, perhaps this hits home for me because I wouldn't be here without heroics. 37 years ago, when I was 12 years old, while I was having a tooth extracted things went wrong, my sinuses collapsed, then my lungs collapsed, and then my heart stopped beating. I was revived and suffered no ill effects. I left the hospital the same day.
That is totally different from someone that is suffering a terminal illness. The paperwork however puts everything in black and white. I'm all for a little gray.
Jen at February 28, 2012 4:14 AM
I read an article recently in a medical magazine that quoted a study that found lung cancer patients who chose palliative care lived an average of 3 months LONGER than those who didn't.
At my age, though? I'm fighting with everything I've got if I get ill.
momof4 at February 28, 2012 10:17 AM
After the Terry Schiavo schlamozzle, my wife and I did advanced health care directives.
Here is the bulk of it:
Jeff Guinn at February 28, 2012 4:22 PM
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