We went to Disneyland, his first time, and we hung out at home. He moved in with me, and we spent the next eight months having fun together like we hadn’t had in decades. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. We learned that with aggressive treatment, he would live perhaps four months. Several years ago, my older cousin Torch (born at home by the light of a flashlight-or torch) had a seizure caused by lung cancer that had migrated to his brain. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. 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. Almost anyone can find a way to die in peace at home, where pain can be managed better than ever. It’s no wonder many doctors err on the side of overtreatment.Įxcept, that is, when they are the ones being treated. I would even have made a little more money, and Medicare would have ended up with a $500,000 bill. I could far more easily have left Jack on life support against his wishes, prolonging his suffering a few more weeks. But the prospect of a police investigation is terrifying for any physician. Nothing came of it, of course Jack’s wishes had been spelled out explicitly. One of the nurses, I later learned, reported my unplugging of Jack to the authorities as a possible homicide. Then I turned off the life support machines and sat with him. 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. In Jack’s worst nightmare, doctors put him on life support. Then, one Saturday, he suffered a massive stroke and was taken to an emergency room unconscious, without his wife. He told me he never wanted to be placed on life support machines again. One of my patients was a 78-year-old man who had been ill for years and had undergone more than a dozen major surgeries. More commonly, they are fearful of litigation and do whatever they’re asked to avoid it. How has it come to this-that doctors administer so much care they wouldn’t want for themselves? In some rare, unfortunate cases, unethical doctors use the fee-for-service model to do everything they can to make money. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me that if you find me like this, you’ll kill me.” Some medical personnel wear medallions stamped NO CODE to tell physicians not to perform CPR on them. They want to be sure, when the time comes, that no heroic measures will be taken. But they know the limits of modern medicine. They know exactly what is going to happen, they understand the choices, and they generally have access to any sort of medical care they could want. What’s unusual is not how much treatment they get compared with most Americans, but how little. It’s not a frequent topic of discussion, but doctors die too-though not like the rest of us. He got no chemotherapy, radiation or surgical treatment. He spent the time with family, and several months later he died at home. He went home the next day, closed his practice and never set foot in a hospital again. He was diagnosed with pancreatic cancer by one of the best surgeons in the country, who had developed a procedure that could triple a patient’s five-year survival rate-from 5% to 15%-albeit with poor quality of life. Years ago a highly respected orthopedist (and my mentor, incidentally) found a lump in his stomach. Ken Murray, a retired clinical assistant professor of family medicine at the University of Southern California, explains why physicians, who routinely see “bad deaths,” typically refuse heroic measures for themselves Danielle Ofri, a clinician at Bellevue Hospital and editor-in-chief of Bellevue Literary Review, tells a story that exposes the messy truth of resuscitation and Charles Bardes, associate dean of Weill Cornell Medical College, considers what it means to let go. Yet that very technology, say these three physicians, can stand in the way of a peaceful, dignified death, because of the physical suffering it can cause and the glimmer of false hope it provides patients, doctors and their families. So wrote the physician-poet John Stone in “Spiritual,” a lamentation that technology hadn’t yet advanced sufficiently to save his father in 1954. They put him in / an oxygen tent / They made the diagnosis / just for show / They hoped the best for him. He died before / coronary care / Before the defibrillator / Before lidocaine / Monitors / Before intensive care / nurses.
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