Why doctors die differently

[Helen]

Quote:

Originally Posted by EvrClrx311 there is substantial evidence that through gene therapy aging can be stopped and even reversed (many think this will be a reality by 2050)...they are already extending the lives of some insects and small animals to be magnitudes longer than average. What you don't read about are the implications this will have on society and our bodies.

This will also help to keep the political debates lively. I can imagine the moral debates, for example, should people with 'life without parole' sentences be allowed the gene therapy to extend their life.

EvrClrx, I too am happy to hear that your daughter is OK.

-helen

[easysurfer]

I think from a patient/family point of view, part of the problem is they are exposed to stories of miraculous recoveries. People who were given no chance by their doctors to survive, but somehow do. So the patient/family then ask "Why not us?"

For every patient/family that experiences that miraculous recovery (bless their hearts), there are many many who are left with hoping for that miracle.

[Khan]

Quote:

Originally Posted by easysurfer I think from a patient/family point of view, part of the problem is they are exposed to stories of miraculous recoveries. People who were given no chance by their doctors to survive, but somehow do. So the patient/family then ask "Why not us?" For every patient/family that experiences that miraculous recovery (bless their hearts), there are many many who are left with hoping for that miracle.

Miraculous recovery?
You mean reversing all the 60+ years of deterioration so I am ~28 again?
Or just being old and in pain but Still Alive™ ?

[easysurfer]

Quote:

Originally Posted by Khan Miraculous recovery? You mean reversing all the 60+ years of deterioration so I am ~28 again? Or just being old and in pain but Still Alive™ ?

By miraculous recovery, I'm mean those who were at death's door, given very low or no odds of pulling through, yet do.

For example, ones who may have survived an auto wreck where it was very touch and go for a while.

[Nords]

Quote:

Originally Posted by easysurfer I think from a patient/family point of view, part of the problem is they are exposed to stories of miraculous recoveries. People who were given no chance by their doctors to survive, but somehow do. So the patient/family then ask "Why not us?" For every patient/family that experiences that miraculous recovery (bless their hearts), there are many many who are left with hoping for that miracle.

That's like having the crowd cheer you on from the sidelines: "Just one more round of chemotherapy-- this time it'll be different, and this time we really mean it-- you can do it! Now get in there and win one for the Gipper!!"

[easysurfer]

Quote:

Originally Posted by Nords That's like having the crowd cheer you on from the sidelines: "Just one more round of chemotherapy-- this time it'll be different, and this time we really mean it-- you can do it! Now get in there and win one for the Gipper!!"

I think the main thing is that ideally the patient, family and doctors are on the same page. Sometimes that isn't always the case which leads to very difficult decisions.

[Nords]

Quote:

Originally Posted by easysurfer I think the main thing is that ideally the patient, family and doctors are on the same page. Sometimes that isn't always the case which leads to very difficult decisions.

I think that the doctors are typically leading the cheering crowd (made up of the family), and eventually they wear the patient down into trying "just one more time". I wouldn't accuse the medics of crossing the line into "misleading", but I'd certainly say that the focus leads to "false hope".

I can understand a patient developing the will to live through a birthday or a holiday or even just one more sunrise. But at some point the quality of the sunrise is affected by all the medical equipment between you and the window.

Meanwhile when the doctor is the patient, they have no trouble flipping off the crowd and heading for the locker room.

I'm a little cynical on this perspective. My father's finished five of six chemo sessions for multiple myeloma, and he came through with such flying colors and great results that the oncologist may stop there. Meanwhile my brother, who's been sitting with Dad through these visits to the chemo and the doctor(s), has noticed that Dad's health has now perked up to the point where he's realizing what it's like to live with Alzheimer's. Waking up nearly every morning with no idea where you are. Not being able to remember any of the names of the staff or the patients. Reading the newspaper or watching TV from habit, not with retention. Going out for Sunday lunch and having nearly verbatim the same conversation every week. Tomorrow it starts all over again. Groundhog Day with every sunrise seeing the script for the "first" time. And Dad's symptoms are considered "good" as far as Alzheimer's goes.

Dad's not exactly capable of what anyone would consider to be "informed consent". An eager medical professional could get him to agree to just about anything, at least until the chemo starts to hurt. What if the myeloma symptoms return in a few months? What if the oncologist comes back with a new wonder drug or a different protocol? My brother and I are considered capable of "informed consent", for whatever that's worth, and at some point this whole process has to cross the line from "getting healthy" to "heroic measures". Dad's medical directive is very clear about heroic measures, and I have a stack of his hand-written correspondence to back up that attitude.

At some point my brother and I have to decide whether it's really a good idea for Dad to be the world's healthiest Alzheimer's patient, or whether it's better to start loading up on the palliative measures. However multiple myeloma does not sound like an easy way to die. At this point it's hard to claim that there's any "quality of life" in either lifestyle. How does one balance the relative quanta of pain between the two approaches?

Keep in mind that my brother and I happen to agree on this. Even if I had my doubts, my brother is the guy charged with the responsibility of making the decisions. It's my job to back him up and help us get figure it out, not obstruct the discussion or the decision. But we're just not sure how to have the conversation with the care facility or the oncologist. This is why I end up reading so many books on the situation and nudging my brother to get to know the care facility's hospice staff.

Last week was Dad's one-year anniversary in the care facility. 54 weeks ago he came within 30 minutes of dying on the operating room table from a perforated ulcer. From what I've been able to reconstruct of his files, he had cognitive-impairment symptoms as early as mid-2008. He lived independently for nearly three years until his cognition sharply declined and he could no longer live the way he preferred. I think that ever since he went to the ER with that ulcer, he's been living on borrowed time. Not that he can tell.

I don't have any answers to this conundrum. I'm hoping to have a clue before we have to make a decision. Maybe events will help cue us into it. My worst fear is that Dad falls and breaks a hip, forcing a quick discussion/decision about the next step. Or maybe at this point, that's Dad's best hope.

[easysurfer]

Quote:

Originally Posted by Nords ... At some point my brother and I have to decide whether it's really a good idea for Dad to be the world's healthiest Alzheimer's patient, or whether it's better to start loading up on the palliative measures. However multiple myeloma does not sound like an easy way to die. At this point it's hard to claim that there's any "quality of life" in either lifestyle. How does one balance the relative quanta of pain between the two approaches?...

I experienced this with my friend's situation recently and with mother years ago. As difficult it is to ask, I think one has to ask "Are we continuing the treatment for over loved one's sake or for our own?" I remember with my friend, I was talking to her daughter (her daughter had the health care directive). It was so painful to see my friend have to go through what she had to endure, yet at the same time, her daughther and myself agree, we had to try. Finally, my friend's condition had diminished so much that her daughter and family decided, no more suffering. Yet, even then, it was so heartbreaking to let go.

[Khan]

Odds are (given family history) I'm going to have a stroke at some point.
When the 18 year old cat had a stroke at ~1AM I took him to the vet to be put down at 8AM.
They kept Mother alive for ~6 weeks and her brother for ~8 months.
Just wish there was some way to assure the first stroke was the last one.

[REWahoo]

Quote:

Originally Posted by Khan Odds are (given family history) I'm going to have a stroke at some point. When the 18 year old cat had a stroke at ~1AM I took him to the vet to be put down at 8AM. They kept Mother alive for ~6 weeks and her brother for ~8 months. Just wish there was some way to assure the first stroke was the last one.

Maybe you can cut a deal with the vet...

[Khan]

Quote:

Originally Posted by REWahoo Maybe you can cut a deal with the vet...

I have considered that.
Can I do so without getting him in trouble?
Ideally I could go to the local medical college (where I have donated my carcass) and ask for an appointment.

[Texas Proud]

Quote:

Originally Posted by Khan I have considered that. Can I do so without getting him in trouble? Ideally I could go to the local medical college (where I have donated my carcass) and ask for an appointment.

Just tell them you are making an early delivery.....

[emitch]

Kind of another direction on this topic, but shouldn't doctors (or anyone) who prefer not to have life extending medical treatment have much lower health insurance premiums . . .? Since a large portion of our rapidly escalating medical costs are for end of life procedures, I wonder if there's a way in advance to let the insurance company off the hook for certain treatment, and let the patient elect to pay or not when the time comes. Probably very difficult to calculate a new premium rate, I suspect . . ..

[Brat]

I am copying this because a link may expire (I hope I am not violating any forum/copyright rule), from today's news:

PORTLAND, Oregon (AP) — A physician who campaigned for an Oregon state law that allows patients with terminal conditions to end their lives died Sunday after using lethal chemicals obtained under the initiative he championed. He was 83.

Peter Goodwin died Sunday at his home surrounded by his family, said a spokesman for Compassion & Choices. an organization he helped launch. The group advocates laws that help terminal patients die, and supports patients and families facing the end of life.

Goodwin was diagnosed in 2006 with a rare brain disorder, corticobasal ganglionic degeneration, that progressively robbed him of his movement. Years earlier, campaigning for an Oregon assisted suicide law, he talked publicly about what he would do if he received a terminal diagnosis.

"I don't want to go out with a whimper. I want to say goodbye to my kids and my wife with dignity. And I would end it," he said years before his diagnosis, according to a profile published last month in The Oregonian.
In an interview with the newspaper shortly before his death, he reflected on his life.

"We just haven't come to terms with the fact that we're going to die, all of us, and to make concessions to that is really giving up hope," he said.
Rather, in his view, when at death's door, "the situation needs thought, it doesn't need hope. It needs planning, it doesn't need hope. Hope is too ephemeral at that time."

Oregon was the first state to allow terminally ill patients to take their own lives with the help of lethal medications supplied by a doctor. Voters approved the Death With Dignity Act in 1994 and 1997. In 2010, 65 people used it to precipitate their death, the largest number since the law was enacted.

The states of Washington and Montana have adopted similar legislation.
Goodwin campaigned for years to enact the law, and he has called it his greatest legacy. He said it spurred medicine to focus attention on the needs of the dying, with more palliative care and hospice.

"I was honored to call Peter Goodwin a compatriot and a friend," said Barbara Coombs Lee, president of Compassion & Choices. "Our hearts are broken at his loss. The state of Oregon, medicine, and the world have lost a great leader. Most of all, our sympathies are with his family whom he dearly loved."

Goodwin, born and educated in South Africa, was a family physician at Oregon Health and Science University since 1985.

Life is unfair, Goodwin told The Oregonian. But he offered a prescription.
"Be fulfilled," he said. "In other words, be happy with yourself. Recognize achievements and be proud of them then go on to further achievements. Know what you want to do and do it. Be happy. Know good friends. Be in love."

[Texas Proud]

I think the Oregon law is good... I have also heard that some people have found comfort in knowing they can utilize it, have chosen to do so, but do not.... because they can do things on their timeline and they were not ready...

To me, just knowing that it is available is something that I would like to have... the only problem is if you have a long term issue and get depressed in the middle of treatment... I think it is only for terminal illness though... but could be wrong....

[chris2008]

The first goal scorer of the german league opted for assisted suicide when he developed cancer at 73:
http://www.dawn.com/2012/03/13/score...ide-group.html

[Lancelot]

Quote:

Originally Posted by easysurfer I think from a patient/family point of view, part of the problem is they are exposed to stories of miraculous recoveries. People who were given no chance by their doctors to survive, but somehow do. So the patient/family then ask "Why not us?" For every patient/family that experiences that miraculous recovery (bless their hearts), there are many many who are left with hoping for that miracle.

Or perhaps guilt- the family hasn't visited Grandma for long periods but when she has a medical emergency they want everything possible done for her...

[easysurfer]

Quote:

Originally Posted by Lancelot Or perhaps guilt- the family hasn't visited Grandma for long periods but when she has a medical emergency they want everything possible done for her...

Good point. Guilt could be a reason. I hadn't thought about that. I was thinking more of what patients/families see are what they've seen on TV. Old shows (if one goes back that long) like Marcus Welby, MD. Or more recently ER. Or even talk shows like Oprah. We've cases where patients were on the brink of death, yet pull through. So we think, why isn't the doctors/medical staff rushing in, paying all this attention to that one patient like we've seen on TV. Even in real life we've heard of cases like James Brady, Gabby Giffords, Christopher Reeve who were in such bad condition but yet survived.

For me, I'm torn. On one hand, believe who knows, medical wonders may be around the corner, on the other am cynical too.

Also, maybe it's just a matter of coming to gripes that medicine and treatment can only do so much when one's time has come.

There is just so many dynamics going on at such a critical time.

[Brat]

Oregonians want to control the way they live, and die. They don't delegate gracefully.

And yes those meds are only available to residents whose conditions is such that they have 6 or less months to live, are of sound mind and able to administer them themselves. The process requires more than one physician and a psy visit.

The elderly can also complete a request with their physician that is a DNR which is available to emergency responders and hospitals, no 'we didn't find the form' excuses. This law was created when a wealthy widow's personal representatives were out of the country and she was put on ventilators against her health care directive instructions. Her estate paid for setting up that system.

[haha]

Quote:

Originally Posted by Brat This law was created when a wealthy widow's personal representatives were out of the country and she was put on ventilators against her health care directive instructions. Her estate paid for setting up that system.

Good to think about when the 99% are out to put the 1% up against the wall. Most of the genuinely good things in my environment were put there thanks to the educated generosity of very wealthy people.

Ha