醫生得了絕症為什麼會放棄治療？
作者：Ken Murray 醫學博士
內容摘要：當醫者面對自身死亡——醫者執筆，深度剖析臨終醫療利弊。
多年前，一位德高望重的骨科醫師，同時也是我的導師——查理，被發現胃部有個腫塊。經手術探查證實是胰腺癌。該手術的主刀醫生是國內同行中的佼佼者，並且，他正巧發明瞭一種針對此類胰腺癌的手術流程，可以將患者生存率提高整整三倍——從5%提高至15%（盡管生活質量依然較低下）。查理卻絲毫不為所動。他第二天就出院回家，停了自己的診所，並自此再也沒邁進醫院一步。他將所有時間和精力都放在家庭生活上，非常快樂。幾個月後，他在家中去世。他沒有接受過任何的化療、放療或是手術。他的保險商也為此省了一大筆錢。
人們通常很少會想到這樣一個事實，那就是——醫生也是人，也會迎來死亡。但醫生的「死法」，似乎和普通人不同。不同之處在於：和盡可能接受各種治療相反，醫生們幾乎不愛選擇被治療。在整個醫務工作生涯中，醫生們面對了太多生離死別。他們和死神的殊死搏鬥太過頻繁，以至於當死亡即將來臨時，他們反而出奇地平靜和從容。因為他們知道病情將會如何演變、有哪些治療方案可供選擇，以及，他們通常擁有接受任何治療的機會及能力。但他們選擇——不。
「不」的意思，並不是說醫生們放棄生命。他們想活。但對現代醫學的深刻瞭解，使得他們很清楚醫學的局限性。同樣，職業使然，他們也很明白人們最怕的，就是在痛苦和孤獨中死去。他們會和家人探討這個問題，以確定當那一天真正來到時，他們不會被施予搶救措施——也就是說，他們希望人生在終結時，不要伴隨著心肺復甦術(CPR)和隨之而來的肋骨斷裂的結果（註：正確的心肺復甦術可能會致肋骨斷裂）。
幾乎所有的醫務人員在工作中都目睹過「無效治療」。所謂的無效治療，指的是在奄奄一息的病人身上採用一切最先進的技術，來延續其生命。病人將被切開，插上導管，連接到機器上，並被持續灌葯。這些情景每天都在ICU（重症監護病房）上演，治療費可達到10,000美元/天。這種折磨，是我們連在懲罰恐怖分子時都不會採取的手段。我噎記不清有多少醫生同事跟我說過：「答應我，如果有天我也變成這樣，請你殺了我。」
每個人的話都如出一轍，每個人在說的時候都是認真的。甚至有些同道專門在脖子上掛著「不要搶救」的銅牌，來避免這樣的結局。我甚至還見過有人把這句話紋在了身上。
將明知會帶來痛苦的醫療措施用在病人身上，這本身就是一種折磨。
作為醫生，我們被訓練得「從不在醫療實踐中表露私人情感」，但私下裡，醫生們會各自交流發泄：「他們怎麼能對自己的親人做出那種事？」我猜，這大概是醫生和別的職業相比，有更高的酗酒率及抑鬱傾向的原因之一。這個原因使我提前10年結束了自己的醫務生涯。
為什麼會變成這樣？為什麼醫生們在病人身上傾注了如此多的心血和治療，卻不願意將其施予自身？答案很復雜，或者也可以說很簡單，用三個詞足以概括，那就是：病人、醫生、體制。
先來看看病人所扮演的角色。假設甲失去意識後被送進了急診室：通常情況下，在面對這類突發事件時，甲的家屬們會面對一大堆突如其來的選擇，變得無所適從。當醫生詢問「是否同意採取一切可行的搶救措施」時，家屬們往往會下意識說：「是。」
於是噩夢開始了。有時家屬所謂的「一切措施」的意思只是採取「一切合理的措施」，但問題在於，他們有時可能並不瞭解什麼是「合理」；或者當沉浸在巨大的迷茫和悲痛中時，家屬們往往想不到去仔細詢問，甚至連醫生的話也只能心不在焉地聽著。在這種時候，醫生們會盡力做「所有能做的事」，無論它「合理」與否。
上文提到的場景隨處可見。醫生們不可能要求每位病人家屬都能冷靜下來，專心致志配合臨床工作。很多人可能會以為CPR是種可靠的生命支持方法，但事實上，它可謂成效甚微。我曾收治過幾百名先被施行了CPR術而後送到急診室來的病人。他們當中只有一位健康的、沒有任何心臟疾病的男性是最後走著出院的（他患的是壓力性氣胸）。如果一位病人曾患有嚴重的疾病、或是年事已高、或有不治之症的話，那他即使接受CPR以後復原的幾率也很小，但所要忍受的痛苦將是巨大的。知識的不足、錯誤的期待是導致糟糕決定產生的主要原因。
很顯然，病人只是原因之一。醫生們也是。問題在於，即使醫生本人並不想進行「無效治療」，他也必須得找到一種能無愧於病人和家屬的方法。假設一下：急診室裡站滿了面露悲痛，甚或歇斯底里的家屬們——他們並不懂醫學。在這種時候，想要建立相互的信任和信心是非常微妙且難以把握的。如果醫生建議不採取積極的治療，那家屬們很有可能會認為他是出於省事、省時間、省錢等原因才提出的這個建議。
有些醫生能說會道，有些醫生堅定不屈，但無論如何，他們面對的壓力都一樣大。當需要處理涉及「臨終治療選擇」一類的事宜時，我會盡早把自己認為合理的方案一一列出（任何情況下均是如此）。一旦病人或家屬提出不合理要求，我會用通俗易懂的語言將該要求可能會帶來的不良後果一一解釋清楚。假如聽明白以後他們仍堅持這麼做，那我會選擇將病人轉去別的醫生或醫院繼續治療。
是不是該更強勢一些呢？有時候，即使病人已轉去別處，我依舊不能停止責備自己。我曾收治過一位律師病人，出生於顯赫的政治世家。她患有嚴重的糖尿病，並且循環功能很差，更糟的是，她的腳逐漸變得疼痛難忍。作為業內人士，我權衡了利弊後，盡一切可能阻止她去做手術。但是，她最後還是找了位我不認識的外院專家，後者並不很瞭解她的全部狀況，因此，他們決定在她血塊日益積聚的雙腿上做支架手術。這次手術沒能恢復她的循環功能，同時由於糖尿病，她的創口無法癒合。很快，她的雙腿開始壞疽，最終截肢了。兩周後，在那個為她進行了手術及之後所有治療的著名醫學中心裡，她去世了。
從這類故事裡想挑出醫生或病患的錯並不是件難事。但在很多時候，醫患雙方都只不過是這個推廣「過度醫療」的龐大系統中的受害者而已。在一些不幸的例子中，一些醫生用「有治療，就有進賬」的思路去做一切他們能做的事，為了錢而不擇手段。而在更多的例子中，醫生們只是單純出於害怕被訴訟，而不得不進行各項治療，以避免官司纏身的下場。
然而，即使做出了正確的決定，這個系統仍然能夠使人身陷囹圄。
我有個病人名叫傑克，78歲，疾病纏身，曾做過大大小小共15次手術。他曾和我說過，以後無論如何也不會再接受仰賴機器的生命支持治療。然而，在某個週六，傑克突發嚴重中風並很快失去了意識。他被火速送往急診室，妻子當時不在身邊。那裡的醫生用盡全力將他搶救過來，並將他插了管，轉入ICU監護室。這簡直是傑克的噩夢。當我匆匆趕到醫院並接手了傑克的治療後，我拿出傑克的病歷本和他的私人意願，經過和他的妻子以及醫院相關部門的談話後，拔掉了他的生命支援，隨即坐在他的身邊。兩小時後，他安然地走了。
盡管傑克的意願有正式檔為據，他也沒能完全按自己的願望死去。這個系統還是進行了幹預。事後我發現，當時的一名在場護士曾將我拔管的行為以「涉嫌謀殺」上報給監管機構。當然，這件事最後不了了之，因為過程的每一步都有理可循。傑克生前留下的大量檔案清晰地證實了這一點。然而，面對法律機構的質疑是每一位醫生都不想面對的事。我本完全可以忽視傑克的私人意願，將他留在ICU裡苟延殘喘，以挺過那最後的幾周時間。我甚至可以通過這麼做來多賺點診療費，讓保險公司多付近50萬美元的賬單。難怪那麼多的醫生都在進行過度治療。
不過，醫生們仍舊不對自己過度治療。因為這種治療的結局他們見得太多。幾乎所有人都能呆在家裡寧靜地離去，伴隨的疼痛也可以被更好地緩解。臨終關懷和過度醫療相比，更注重為病人提供舒適和尊嚴感，讓他們能安然度過最後的日子。值得一提的是，研究發現，生活在臨終護理所的終末期病人比患有同樣疾病但積極尋求治療的病人活得更久。當我前陣子在廣播裡聽到著名記者Tom·Wicker「在親人的陪伴中，安詳地去世了」的消息時，不禁愣了一下。
——值得慶幸的是，現在這樣的消息噎越來越多了。
很多年前，我的表哥大炬（因出生在家裡，由火炬照明而得名）發了一場病，事後查出是肺癌，並已擴散至腦。我帶著他去見了各種專家門診，最後明白了：像他這種情況，如果採用積極治療的話，需要每週3-5次去醫院化療，而即使這樣他也最多隻能活4個月。最終，大炬決定拒絕任何治療，僅僅服用防止腦水腫的葯物，回家休養。他搬進了我家。我們在之後的8個月裡共度了一段快樂時光，做了許多小時候愛做的事。我們去了迪士尼公園，這是他的第一次。我們有時也宅在家。大炬熱愛體育，他最中意的事就是邊看體育賽事，邊吃我做的飯。在那段時光裡，他甚至長胖了幾斤，每天想吃什麼就吃什麼，完全不用忍受醫院那糟糕的飲食。他沒有經受劇烈的疼痛，情緒一直很飽滿快活。直到有天沒再醒來。他昏睡了三天，最後安靜地走了。這八個月來他在醫療上所有的花銷，僅僅為20元的葯費。
大炬不是醫生，但他清楚地知道自己想要的是生活的質量，而非生命的長度。
我們中的絕大部分人，不也正是這樣想的嗎？假如死亡也有一種藝術形式，那它應該是：有尊嚴地死去。至於我，噎清楚地向我的醫生說明瞭我的意願。放棄搶救，這並不是件容易的事——對於絕大多數醫生來說都不。當死亡最終來臨的時候，我可以不被奮力搶救，而將安詳地睡去，就像我的導師查理，我的哥哥大炬一樣；就像我的那些做了同樣選擇的同事們一樣。
How Doctors Die
It’s Not Like the Rest of Us, But It Should Be
by Ken Murray
Ken Murray, MD, is Clinical Assistant Professor of Family Medicine at USC.
Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.
It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, 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. 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. But they go gently.
Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).
Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. 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.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.
To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent. “How can anyone do that to their family members?” they’ll ask. I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.
How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.
To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not.
The above scenario is a common one. 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. 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. 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. Poor knowledge and misguided expectations lead to a lot of bad decisions.
But of course it’s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.
Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman’s terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.
Should I have been more forceful at times? 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. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. 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.
It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.
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 78-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. This was Jack’s worst nightmare. When I arrived at the hospital and took over Jack’s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.
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. 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. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of overtreatment.
But doctors still don’t over-treat themselves. 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. I was struck to hear on the radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.
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 spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. 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.
Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. 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 my fellow doctors.
Comments
Rachel Chong says:
March 16, 2012 at 12:44 pm
Dr Murray,
I am curious if the cancer or illness you allude to, which you personally will not seek treatment for, only refers to terminal stages of the disease? The decision of whether or not to pursue chemotherapy is often a very difficult decision for patients and their family where there is a chance of recovery (or recurrence, as the case may be) no matter how small. I fear that depicting it as a choice of ‘quantity’ vs. ‘quality’ may be over-simplifying what is in fact, a very complex matter. Also, it is quite possible that someone afflicted with metastatic cancer suffers a great deal of pain and mental disorientation for a prolonged period (instead of gently ‘slipping away’) towards the end, whether or not they have opted to receive medication for their disease.
Thank you for a very candid and insightful article, I look forward to your response.
Ileana says:
March 21, 2012 at 6:12 pm
I find your article not only eloquent, but moving. I wish more MDs would have this kind of candidness and open-mindedness. I don’t find this to often be the case.
The closest I have ever been to a terminal illness was being by the side of my best friend who was enduring treatment for an advanced type of breast cancer. Since she had no family here, and her husband was a bit “out to lunch,” I was basically her main caretaker as far as chemo, radiation; etc.
I felt that she was “forced” by her oncologist to follow through with the entire treatment. I don’t think I would ever be able to go through all that. I think that patients have rights and I wish that as much as we talk about the rights of the unborn, we would have a dialogue in this country about the choices patients should be able to make even if they decide to follow a course of treatment and then choose something different.
Joyce Griffith says:
March 23, 2012 at 8:01 pm
An uncle of mine (husband of an aunt) went through torture such as is described. He was in his 80s, but they were “sure” he would survive double bypass heart surgery. He did, but only for a few days.
Please, doctors, share the word. You are trusted. You are believed.
I’m not looking forward to screaming in pain with my last breath, but I know there are ways to relieve pain and maintain a degree of comfort even for the dying. That should be our first choice. All of us.
Thank you so much.
mb says:
March 24, 2012 at 11:28 am
I found it “interesting” that while I was provided with some forms for a Living Will/Advance Directives/etc. at my hospital the last time I was there & asked for them, nobody was willing to witness sameor otherwise help me fill it out or file it anywhere. Perhaps it was just some bureaucratic/legalistic rigamarole, perhaps they didn’t want to “help” as a cost/time&motion/saving measure as has been hinted (or maybe even revenue producing device/rule). Seems we have a long way to go here.
Ann says:
March 26, 2012 at 5:42 am
Thank you for this article. I have Stage IV cancer and have been updating my advanced directive. My family has not understood why I am going to refuse certain treatments and why I have put NO CODE. My husband read this article and now understands my feelings.
dr.m.d.venkatesan says:
March 27, 2012 at 10:13 am
true quality of life is very important which should go along with the quantity. The last days of my mother was so painful that she was bed ridden for more than one and half due to untreatable neuro complications. The worst part that her cognizance, speech and memory were intact which made her sufferings worse. She was literally pleading for an abrupt end but i postponed the same extending her agony for the very reason that i did not want her to part coz ”she was my mom “Sometimes relationship overcomes reality.
Ken Murray, MD says:
March 28, 2012 at 8:37 am
Rachel, you correctly say that these things are generally complex, when we are talking about active treatment of illnesses. I think that for physicians, our experiences help us to understand the complexities. For the average person, expert guidance is critical. I think that cancer is actually less of a problem than some of the degenerative illnesses that wear a person down, in conjunction with age. The most common problems are where a person’s body is simply worn out. All we are doing is buying time, and often that is at a terrible cost to the person.
I strongly support active treatment of problems that have some reasonable chance of restoring a person to a quality life.
Eric Brewer says:
April 2, 2012 at 12:20 am
It is precisely this thoughtful approach to death that gives rise to the idea of “death panels.” The politics of death are such that people are encouraged to be as fearful of dying as they are of so many other things they don’t understand. But, rather than encourage understanding and compassion, we have politicians talk about “euthanizing the masses” and the “evil” of assisted suicide. We even have a GOP candidate for president who lies about Holland’s end of life care programs just so he can make points with a few of his unthinking followers. So many Americans are too lazy to think for themselves and let others shape their morals while stripping their innate compassion. Dying is unavoidable. Why do we try so hard to avoid talking about it? Why do we try so hard to make it a fearful experience? Why do we try so hard to find drugs to extend life without regard to the quality of that life?
Andrea says:
April 3, 2012 at 12:37 pm
Thank you so much for this insightful article. I was given the honour of ensuring my mother’s personal health care wishes were carried out. She was a nurse. I know that even in her life, she was watching me from above during those last weeks of her life as she lay there dependent on me to be her mouth. She had an advanced directive which spelled everything out. No tubes, no heroic measures. Although she was too unstable to move to a palliative care hospital, and I could not care for her at home, not only did I fight to ensure her every wish was carried out, but also that she be declared palliative so she could be pain free. It was not an easy fight, but a necessary one. During a lucid moment she thanked me. She passed peacefully, she was content. I am not a doctor or a nurse, but I did learn that if you, in the profession, know not to fight such a battle, why would I? I now volunteer in palliative care. Thank you Dr. for your words.
Mithil says:
April 3, 2012 at 3:52 pm
Thanks for this great article. The biggest challenge is start talking about “death”. It’s not ppl are fear about but uncertainty surrounding it. Also ineffective training among physician and their discomfort in discussing end of life. Nobody is 100% sure what going to happen but still majority of physician know what gona happen but still they don’t tell family about that. Cultural as well their own belief play a major role. Currently more than 60% of ppl in USA died in hospital. Dignity of a person, the most imp things for lots of ppl are lost during end of life.
DonnaMarie says:
April 4, 2012 at 8:49 am
Thank you for this article. I think it is important to differentiate between no resuscitation and compassionate resuscitation. My mother had been diagnosed with non small cell lung cancer. We questioned the diagnosis for a number of reasons. She had removed her DNR because she was experiencing some improvements and had hope for recovery. In a very sudden turn of events, on a day that oxycontin had been forgotten by her caregivers, she began gasping for breath and the nurses and hospitalists had to be FORCED to intubate her.
They said that because she had lung cancer, she should let go. They wanted her to die, helplessly turning blue, gasping for breath. I witnessed this, standing by her side. In the 48 hours that she was intubated, she was conscious. She was able accept and to come to terms with her impending death, receive several religious sacraments of the sick, said good bye to her family and removed the intubation. She was able to die in dignity, with some sedation. She was comfortable and surrounded by family. Kind and compassionate dying, as opposed to an ugly desperate event. There can be a difference.
Ron says:
April 4, 2012 at 5:11 pm
Terrific article, very thought-provoking. You have done a great service by sharing your experience. Thank you so much.
Barry says:
April 8, 2012 at 9:42 am
This article is great. Other professions often will not apply to themselves what they sell to their clients. My Mother and Father both died with medical issues, however, they passed on peacefully without the application of today’s medical solutions. My eldest son died in severe agony as a result of a doctor’s decision to operate in an effort to prolong his life. Which do I choose? You be the judge.
Mark G Bell, MD says:
April 24, 2012 at 8:02 pm
I consider this the best synopsis I have ever read on this subject of end of life care, and wish it were a mandatory read for every adult in America. Please take the time to go through it. Bear in mind that in America, in deference to almost any other western industrialized nation, we spend the vast majority of our healthcare dollars in end of life treatments that are for the most part ineffective in significantly sustaining life and which often lead to increased suffering.
I have seen statistics from reliable sources showing that we spend 90% of Medicare dollars on 10% of Medicare recipients, and that 90% of that is spent in the last three months of life. Oh what wonderful things we could offer at a much lower total price if this trend could be reversed. While America is often cited as spending many times per capita more than these otherwise comparable countries, the graphs documenting the expenditures don’t become divergent until after age 52, and don’t become widely different until after retirement age. Most other civilizations at that point switch to supportive care for their elderly, rather than cutting edge technologies like we do.
Decisions on these issues are going to have to be addressed by the American public soon, or we will bankrupt ourselves with medical expense without having any healthier population to show for it. Bear in mind these decisions need to be voluntary on the part of families and individuals after careful detailed counseling, never something imposed by governmental regulations, or so called “death panels.” As the old country song says, we say we “all want to go to heaven, but nobody wants to go right now.” We need to know when to let nature take its course. Withholding or terminating hopeless life support is not “playing God” – using it is!
Mark
Beth Zwecher says:
April 26, 2012 at 1:58 am
Thank you for your courage. Beth here from middlescapes. I am currently assisting my mom, a 90 year old WWII veteran, in her dream to die at home where she feels comfortable and safe. It isn’t always easy but it sure feels right. It is wonderful to know there is so much support for sensible acts of kindness regarding the inevitable end of life.
Corey Feldman says:
May 1, 2012 at 11:03 am
Maybe we need doctors to lie in way, that 5% to 15% happened because of the patients were willing to fight against the odds. The more people that fight, the more people now can be a blessing to future generations, maybe even their own decedents with the same genetic predisposition.
Dan Rubesh says:
May 1, 2012 at 2:51 pm
Sadly, years ago I watched my father and younger brother ‘rot’ in convalescent care.. I knew then that I did not want to go that way.. A few years back when the Terri Schiavo debacle was going on in Florida, I went and got ‘Do Not Resuscitate’ tattooed in red letters on my chest above my heart. About 2 months ago I had an arterial blockage and had to go in hospital for a stent. I was surprised and pleased about the way most all of the hospital staff I encountered accepted my tattoo and choice, from the Cardiologist on down.. After a brief ‘are you sure’ conversation with the Cardiologist he ordered a DNR bracelet to wear along with my hospital ID bracelet.. I told them all, ‘If you even think you’re going to resuscitate a vegetable, let me go!”
Dan Rubesh says:
May 1, 2012 at 2:53 pm
My commendation to Dr Ken Murray for his excellent article which was reprinted in the current issue of Utne Reader..
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