Friday, March 15, 2013

How Doctors Die

Via Cousin Colby

 Doctors Die, DNR

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.

5 comments:

  1. We go gently in large part BECAUSE we've seen just what it takes to keep the almost-corpse hanging around just a little bit longer...and few of us want to experience that awfulness.

    There's an old paper in the nursing literature about "The Horrible Daughter From California"--the daughter who fought with Mama twenty years ago and hasn't been back since...but when Mama's FINALLY about to die (after all the misery she's been in the past few years), the Daughter comes screaming back into town. "Oh, Doctor, do everything you can for Mama...she just can't die", Daughter says. The Doctor, knowing Daughter's lawyer is just a phone call away, then bows to the Daughter's wishes and keeps Mama's carcass from cooling just a bit longer.

    In my experience, the only thing that stops this is the Other Sibling--the one who drove Mama back and forth to all those appointments, and sat with her while she slipped away--has yet another fight with The Daughter, and says things that make Daughter go away for another 20 years. Usually, this is the best for all concerned, but....

    Modern medicine can do fantastic things, but we all die. The Daughter's own psychological issues (she can't face the fact that she's done NOTHING to reconcile with her mother, and now it's too late) can't change that fact.

    Doctors know this, and know how awful (and generally futile) all those heroic 'end of life' things are. Many of us do support "death panels" that use objective data, conservatively applied, to let people go quietly. Sadly, there are far, far too many Daughters out there for any other practical solution to ever be effective.

    Not what you want to hear? Hate it for you. After speaking Truth to more than my share of Daughters, a few ugly words on a blog post don't faze me.

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  2. I couldn't agree more, having seen an ageing mother and father out. When I last went under anaesthesia, I told the cardiologist, write DNR on my chest, I've done everything. Today I received from England a brand-new condition copy of the immortal Nessmuk's book, Woodcraft and Camping" for a gift for my eleven year old grandson. The last chapter is "Final Advice" and it includes these lines:

    "We had our day of youth and May;
    We may have grown a trifle sober;
    But life may reach a wintry way,
    And we are only in October.

    PREPARE TO TURN IN"

    I'm well past October and next week I will have survived my 80th winter. I hope I'm more than a trifle sober, but if I am, it is owed to the men who wrote, "Our very lives, as ex-problem drinkers, depend upon our constant thought of others and how we may help meet their needs." AA p. 20.

    In 33 years since the last glass of Burgundy in May, 1980, I have followed that maxim and I have had a life that I would trade with no man. If the Great Mystery wills it, I will raise a glass of something un-ethanolic in May, 2013, at Tarboro, NC to toast three of my heroes, Robert E. Lee, Thomas "Stonewall Jackson", and Brock Townsend. Hope to see you all there and hope I don't "Turn In" before it comes to pass.

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    1. You're too kind, but you'll find the unpleasant truth when you meet me!:)

      “Bury me when I die beneath a wine barrel in a tavern. With luck the cask will leak.”
      --Death poem of Moriya Sen'an 1838.

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  3. I have no problem with that. I'll help pay for the wine barrel. Kentucky Bourbon whiskey can only be made in used French wine vats, or at least that was true in the seventies when I was buying a lot of conveyors in Louisville and drinking complimentary bottles of Old Weller 107. I figure on getting a new liver when I cross over and I'll join you under there. Heh.

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    1. I figure on getting a new liver when I cross over and I'll join you under there. Heh.

      I'm praying that mine has become impervious to alcohol from the generations of males in my family who have been imbibing excessively.:)

      Years later when he was on an extended drinking spree, my grandmother took over management of Panacea Springs Hotel outside of Littleton, NC. Once the doctor came and told my grandmother that my grandfather would have to be put in the hospital, but she didn't understand why. The doctor told her that my grandfather didn't even know where he was, and needed to dry out for a while!

      Evidently, my father and my uncle took after him, as they would drive from town to town in NC taking bets between the two of them as to who could drink the most beers during each trip!
      http://www.namsouth.com/viewtopic.php?t=837&highlight=koonce

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