"How Doctors Die"

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Great article, hopefully as more of these discussions become mainstream it will help people make end of life decisions. Thanks for posting.
 
Thanks for posting this great article.
 
Thanks for article great this posting.
 
searun said:
Great article. Totally agree with the author. Thanks for sharing it!
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Article really doesn't give any information. It's one doctor's perspective using a few examples of personal experience. Not exactly useful.
 
Belleza156 said:
Article really doesn't give any information. It's one doctor's perspective using a few examples of personal experience. Not exactly useful.
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Do you realize how much money is spent by Medicare maintaining life for a few months for terminally ill people with virtually no prospects for recovery. Hospice care for the terminally ill makes sense morally and financially and is in the best interests of most patients. The author provides valuable insights into the options that people have to maintain some control over how they die. This should become a model for our culture and society.

So I disagree. The article is very useful. My grandmother went through this process several months and died comfortably in hospice care. I was there to witness her death and to say goodbye. This is the kind of death I will choose for myself if possible.
 
Everyone who practices any kind of hospital medicine knows that this article is spot on. We watch futile care get delivered every day. I also agree with the author's blame on all three groups, patients and families, doctors and lawyers. I think the disproportionate share of blame rests with the lawyers. Doctors do communicate about this poorly but a lot of that is because we are, and rightfully so, afraid that we will be second guessed retrospectively by a lawyer and made to pay. The path of least resistance is to just do it all.
 
This is not how all doctors die and will not be how I go. This article makes some good points, but is very one sided. The problem comes from the fact that the author has not really had the experience that the patient's families go through. His experience (fortunately for him) with his family ended well.

While I agree that certain treatments are more harmful than good, there are still treatments that should be done. Do you think its good to die from dehydration and malnutrition? No. That is called torture. Hospice is only there to turn you in your bed every once in a while. They do not provide intravenous therapy. Do you really want to watch your loved one lay at home in bed in excruciating pain, dehydrated, and laying in their own feces?

I am sorry to be so graphic, but I have been a family member of a patient who chose to stay at home. We respected and honored his wishes. But it was a nightmare for us. We changed his diaper and washed the urine off his bed. Everytime we moved him, he cried out in pain.
Hospice was not of much use as they only were there to help with a quarter of care.

I don't regret all of the care we gave him, but I certainly will not put my family through the same before I die. Instead, I will do like my great-grandmother and die in a hospital. She had no machines or any special treatments. All she had was an iv ,nasal cannula delivered oxygen, and people who were trained how to properly make sure she was comfortable in her last days.

I do believe hospice is good in a few cases, but only for when the patient is going to go quick and painless.
 
^I get what you're saying about how he hasn't had the experience himself. One thing that can be said, is--this guy hasn't had to deal with a terminal illness himself. We all "know" we're going to die (even though we all live like we're not going to, but that's another topic), but the difference between knowing we're going to die and dying is night and day. I think if a treatment had, say, a 20% chance of working I'd take that chance. I don't know.

However, as far as hospice goes--that sounds like your family member was cared for poorly. That is the opposite idea of hospice, and not at all representative of hospice as a whole.

And what's the difference between dying in a hospital without being hooked up to machines (only an oxygen cannula, you say), and dying at home without machines? You're contradicting yourself here.
 
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It is hard to explain why hospice is not all it is cracked up to be unless you have seen the care that they give to someone you care for. Hospice is a great idea and can be a good option, but for limited circumstances. Their services are inadequate to truly handle end-of-life patient care.

Let me put it another way. Hospice may sweep your floor and change one diaper for the day, but thats about it. Hospice workers can not give IV's or prescribe any meds. They mainly function as a sponge bath and diaper changing service and even then they are not around when things really get messy.


The difference between dying in a hospital and at home is the strain that it puts on your family. Dying at home means that your family will do things for you that you wish they would never have to do. I don't think many people would want their son or daughter to have to change their diaper and clean them off. You also would not want your family to have to turn you in bed and see you wince and cry in pain. I would rather have someone I don't know do those things to me than make my child do it.

Unless you are wealthy and can afford home IV's and round the clock care, the hospital is the way to go.
 
Racer77 said:
This is not how all doctors die and will not be how I go. This article makes some good points, but is very one sided. The problem comes from the fact that the author has not really had the experience that the patient's families go through. His experience (fortunately for him) with his family ended well.

While I agree that certain treatments are more harmful than good, there are still treatments that should be done. Do you think its good to die from dehydration and malnutrition? No. That is called torture. Hospice is only there to turn you in your bed every once in a while. They do not provide intravenous therapy. Do you really want to watch your loved one lay at home in bed in excruciating pain, dehydrated, and laying in their own feces?

I am sorry to be so graphic, but I have been a family member of a patient who chose to stay at home. We respected and honored his wishes. But it was a nightmare for us. We changed his diaper and washed the urine off his bed. Everytime we moved him, he cried out in pain.
Hospice was not of much use as they only were there to help with a quarter of care.

I don't regret all of the care we gave him, but I certainly will not put my family through the same before I die. Instead, I will do like my great-grandmother and die in a hospital. She had no machines or any special treatments. All she had was an iv ,nasal cannula delivered oxygen, and people who were trained how to properly make sure she was comfortable in her last days.

I do believe hospice is good in a few cases, but only for when the patient is going to go quick and painless.
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Racer77 said:
It is hard to explain why hospice is not all it is cracked up to be unless you have seen the care that they give to someone you care for. Hospice is a great idea and can be a good option, but for limited circumstances. Their services are inadequate to truly handle end-of-life patient care.

Let me put it another way. Hospice may sweep your floor and change one diaper for the day, but thats about it. Hospice workers can not give IV's or prescribe any meds. They mainly function as a sponge bath and diaper changing service and even then they are not around when things really get messy.


The difference between dying in a hospital and at home is the strain that it puts on your family. Dying at home means that your family will do things for you that you wish they would never have to do. I don't think many people would want their son or daughter to have to change their diaper and clean them off. You also would not want your family to have to turn you in bed and see you wince and cry in pain. I would rather have someone I don't know do those things to me than make my child do it.

Unless you are wealthy and can afford home IV's and round the clock care, the hospital is the way to go.
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I am not sure why your experience with hospice was so poor but it is not representative of hospice as a whole. There is a broad range of hospice services from inpatient to home with IVs. Many of your generalizations are inaccurate.
 
My grandmother died in the hospital with hospice care provided by the hospital. It was a very peaceful process and the hospice workers and the hospital staff provided for all of her care and managed her pain very effectively. The family's only responsibility was simply to be present and express their love for my grandmother as she slipped away over the course of a week. When the hospice decision was made by the family, the hospice staff covered her with a special quilt that had been knitted for hospice patients. We treasure that quilt.

She was allowed to die with dignity in the presence of her family. She could have been kept alive for another month or two, paralyzed from a stroke with no possibility of recovery. Her life ended in a fashion that was consistent with the wishes that she had expressed in writing with her Advance Health Care Directive.

So be it.
 
Racer77 said:
While I agree that certain treatments are more harmful than good, there are still treatments that should be done. Do you think its good to die from dehydration and malnutrition? No. That is called torture. Hospice is only there to turn you in your bed every once in a while. They do not provide intravenous therapy. Do you really want to watch your loved one lay at home in bed in excruciating pain, dehydrated, and laying in their own feces?

I don't regret all of the care we gave him, but I certainly will not put my family through the same before I die. Instead, I will do like my great-grandmother and die in a hospital. She had no machines or any special treatments. All she had was an iv ,nasal cannula delivered oxygen, and people who were trained how to properly make sure she was comfortable in her last days.

I do believe hospice is good in a few cases, but only for when the patient is going to go quick and painless.
Click to expand...
This is a poorly informed post. My grandma just died in a hospice last week, with a steady infusion of Dilaudid going into her subq. Her symptoms and delirium were carefully managed, and the hospice itself is a beautiful, calm facility that hardly resembles a medical building.
 
TheProwler said:
This is a poorly informed post. My grandma just died in a hospice last week, with a steady infusion of Dilaudid going into her subq. Her symptoms and delirium were carefully managed, and the hospice itself is a beautiful, calm facility that hardly resembles a medical building.
Click to expand...

I agree, I had a grandparent and an uncle die at home under hospice care. It was very peaceful and as pain free as it could have been. This is what both desired and both were diagnosed with "terminal" disease. For my n = 2 experiences, Hospice is a great service. I am sorry your experience wasn't so great but I don't think you're experience is representative as a whole.

I believe Americans place too much value on length of life instead of the quality of that life, and the article highlights that.
 
Racer77 said:
Hospice is only there to turn you in your bed every once in a while. They do not provide intravenous therapy. Do you really want to watch your loved one lay at home in bed in excruciating pain, dehydrated, and laying in their own feces?

I don't regret all of the care we gave him, but I certainly will not put my family through the same before I die. Instead, I will do like my great-grandmother and die in a hospital.
Click to expand...

The top quote is incorrect for most hospice services. They do indeed provide IV infusions, depending on the patient needs. I am sorry if this didn't occur in your specific situation but it is not the norm. They don't starve people against their will nor do the deny pain medications, as it seems your post indicates... In fact, a big part of hospice care is providing pain medication as palliative therapy.

Also, hospice care can be given in a hospital or at hospice facilities, as other posters have affirmed.

I suggest you volunteer as a medical student as your local hospice. I think you'll get a better idea of how it works. It is a great service that is underutilized in our society.
 
Racer77 said:
Hospice may sweep your floor and change one diaper for the day, but thats about it. Hospice workers can not give IV's or prescribe any meds. They mainly function as a sponge bath and diaper changing service and even then they are not around when things really get messy.
Click to expand...

The hospice that I've been involved with has nurses that do manage pain meds. They don't provide things like chemo, for obvious reasons, but they do prescribe pain meds. That's one of the whole points of hospice care.
 
Racer77 said:
It is hard to explain why hospice is not all it is cracked up to be unless you have seen the care that they give to someone you care for. Hospice is a great idea and can be a good option, but for limited circumstances. Their services are inadequate to truly handle end-of-life patient care.

Let me put it another way. Hospice may sweep your floor and change one diaper for the day, but thats about it. Hospice workers can not give IV's or prescribe any meds. They mainly function as a sponge bath and diaper changing service and even then they are not around when things really get messy.


The difference between dying in a hospital and at home is the strain that it puts on your family. Dying at home means that your family will do things for you that you wish they would never have to do. I don't think many people would want their son or daughter to have to change their diaper and clean them off. You also would not want your family to have to turn you in bed and see you wince and cry in pain. I would rather have someone I don't know do those things to me than make my child do it.

Unless you are wealthy and can afford home IV's and round the clock care, the hospital is the way to go.
Click to expand...
Your perception of hospice could not be further from the truth.
 
kongzu said:
I am sorry to be so graphic, but I have been a family member of a patient who chose to stay at home. We respected and honored his wishes. But it was a nightmare for us. We changed his diaper and washed the urine off his bed. Everytime we moved him, he cried out in pain.
Hospice was not of much use as they only were there to help with a quarter of care.

g.php
Click to expand...

Not all hospice was created equal. A good hospice program would have made his passing much easier and I am sorry you and your family member did not get to experience that. Please dont let your bad experience with hospice discourage you from promoting hospice to appropriate patients in your future. It is truly an amazing resource.
 
Racer77 said:
This is not how all doctors die and will not be how I go. This article makes some good points, but is very one sided. The problem comes from the fact that the author has not really had the experience that the patient's families go through. His experience (fortunately for him) with his family ended well.

While I agree that certain treatments are more harmful than good, there are still treatments that should be done. Do you think its good to die from dehydration and malnutrition? No. That is called torture. Hospice is only there to turn you in your bed every once in a while. They do not provide intravenous therapy. Do you really want to watch your loved one lay at home in bed in excruciating pain, dehydrated, and laying in their own feces?

I am sorry to be so graphic, but I have been a family member of a patient who chose to stay at home. We respected and honored his wishes. But it was a nightmare for us. We changed his diaper and washed the urine off his bed. Everytime we moved him, he cried out in pain.
Hospice was not of much use as they only were there to help with a quarter of care.

I don't regret all of the care we gave him, but I certainly will not put my family through the same before I die. Instead, I will do like my great-grandmother and die in a hospital. She had no machines or any special treatments. All she had was an iv ,nasal cannula delivered oxygen, and people who were trained how to properly make sure she was comfortable in her last days.

I do believe hospice is good in a few cases, but only for when the patient is going to go quick and painless.
Click to expand...

Death from dehydration/starvation is essentially the most natural and painless way to die. It is how old animals die and people who die this way (from decreased thirst/appetite, not withholding food obviously) are far more at peace than those who do not in my experience.
 
chessknt87 said:
Death from dehydration/starvation is essentially the most natural and painless way to die. It is how old animals die and people who die this way (from decreased thirst/appetite, not withholding food obviously) are far more at peace than those who do not in my experience.
Click to expand...


Gosh, are you so sure about this? The other guy almost had me convinced that the best way to die was over 10 days in a noisy and foreign ICU without friends or family, with a nasogastric tube constantly sucking out bloody and bilious material, an endotracheal tube that gives me HCAP and with me constantly fighting the vent, with oversedation due to fighting of said vent, with an arterial line, central line, and no less than 5 peripheral IVs (each with numerous failed attempts), with all the antibiotics and pressors you can name, 4+ peripheral edema and grapefruit-sized scrotum due to third spacing all of the net +15 liters of fluids given to me, with a foley catheter and rectal tube up my butt, and chest tubes bilaterally draining God knows what, hemodialysis when my kidneys fail, to have every imaging technique available performed and invasive evaluation of incidental anomalies found on said imaging, with the consumption of half of the hospital's bank supply of PRBCs and FFP for all those above mentioned necessary procedures as well as to replace all that blood drawn for the dozens of lab tests and cultures ordered daily, and lastly but most importantly I was convinced that the best way to end it all was with a massive code where two dozen medical personnel ravage my body with chest compressions then crack it open and do an open heart massage to maximize my time living. That's whats most important to me, I thought.
 
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