This photo of Peter Capaldi, the new Dr. Who, is completely misleading for this story, but is less depressing than the other options..
Doctors die differently from other seriously ill people, as told in this story.
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.
A recent story in Philly.com summarizes more recent research on this issue:
The Johns Hopkins Precursors Study was conducted based on the medical histories and decisions of a voluntary group of older physicians who graduated from the Johns Hopkins School of Medicine classes of 1948 through 1964. According to the study, 65% of the surveyed doctors had written an advance directive, whereas only about 20% of the public does so. Approximately 90% of the physicians responded that they would not want CPR if they were in a chronic coma, whereas only about 25% of the public gives the same answer. So why do doctors die differently? Every day, doctors see the effect of what they call “futile care.” They see patients languishing in the ICU, attached to ventilators, tube feeds, and other devices keeping them alive. On the other hand, many patients only see what is on TV. A 1996 study found that CPR showed on television was successful 75% of the time and that 65% of the patients went home. On the other hand, a 2010 study of more than 95,000 cases of CPR in Japan found that only 8% of patients survived for more than one month and of those, only about 3% led normal lives post-code. Approximately 3% were in a vegetative state, and about 2% were alive with a “poor” outcome. And a 2010 study looked at terminal patients who did not want CPR but got it anyway. Of the 69 patients studied, eight regained a pulse, but, within 48 hours, all were dead. Physicians may also make different recommendations for their patients than they would follow themselves. Physicians often feel that failing to save a patient shows weakness and professional inadequacy. This sentiment does not necessarily carry over to saving themselves.
Can you imagine the stink that would be made if we treated dying animals, in this respect, the way we do most humans?
I don’t argue, as one politician famously did, that the old and sick have a “duty to die.” I do argue that they should have a choice. And, if it’s not coercive, part of what is saved by sparing themselves pain should, perhaps, be available to their estates. I’m sure that hospitals could find other people to treat even if their wards were cleared out of those who would rather be dead.
Makes sense. We should spend our resources more on healthy living and less on painful dying.
Matt – Who should make those decisions?
the patient and doctor
Knowing what is or isn’t possible, what’s reasonable and what the likely outcomes are, given the facts of any medical case, PRIOR to facing the decision is critical to making an informed decision. When you are trying to hang on, is not the time to be making those choices, you’re too emotionally involved in the fight to be fully informed and rational.
As I face these decisions of what I want, as I continue to fight throat cancer, I have mixed feelings. I want every chance I can get! I also don’t want to be laying in an ICU ward for weeks on end in a vegetative state either. It’s not so simple sometimes and placing the burden on others isn’t right either.
I urge all of you to think about it ahead of time and review the documents needed to write up advanced directives, at least make it one less thing your relatives have to worry about when things are turning to crap all around. I think even the doctors appreciate knowing what you want to be done, it saves them from at least a little of the gut wrenching conversations in the hallways.
Not like anyone around here has too many problems expressing their opinions on things…BUT, how many of you have told loved ones or filled out DNR paperwork?
First, I hadn’t known about your cancer, Carl, and you have my sympathies and best wishes for recovery or at least respite.
Your advice, of course, is completely on target. This is a case where “trust your doctor” makes sense — if they’re overwhelmingly doing this, why aren’t others?
Nobody wants to face the facts, Greg.
Nobody wants to think about their own endgame, but we need to face it head on and at least think about it a little bit…
But… doctors a wrong a great deal of the time. Always get a second opinion.
I have Advanced Directive. My family knows my wishes. I think dying is something people are uncomfortable talking about, even though we all do it.
Living will. This written, legal document spells out the types of medical treatments and life-sustaining measures you want and don’t want, such as mechanical breathing (respiration and ventilation), tube feeding or resuscitation. In some states, living wills may be called health care declarations or health care directives.
Medical or health care power of attorney (POA). The medical POA is a legal document that designates an individual — referred to as your health care agent or proxy — to make medical decisions for you in the event that you’re unable to do so. However, it is different from a power of attorney authorizing someone to make financial transactions for you.
Do not resuscitate (DNR) order. This is a request to not have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Advance directives do not have to include a DNR order, and you don’t have to have an advance directive to have a DNR order. Your doctor can put a DNR order in your medical chart.
I have an Advance Directive. I filled one out when I entered the hospital the first time. Its simple…no code, and anyone who ignores my wishes gets their ass kicked when I wake up. I spend about 10 hours a week in the cancer ward. I would say its the family members who refuse to give up the fight, even when the patient wants to stop. I can understand their point…its hard to let go of someone you love….hasn’t Mandela been on life support for weeks?
I firmly believe euthanasia should be available to those patients who want it. I think Oregon and maybe one other state allow it but you have to be a resident for six months before participating. I don’t mean starving someone to death like that woman a few years ago either. I mean getting an injection just like our pets when its better to let them go instead of watching them suffer. What was her name? Oh, yes…Terri Schiavo. The Congress got involved and my friends…the Religious Right to Lifers decided it wasn’t right to let her die. I bet they would think differently if they were the one paying the bill.
Doctors are not allowed to euthanize patients but there comes a time when the pain is so great…the amount morphine needed to kill the pain, kills the patient…but don’t tell anyone… its a secret.