"How Doctors Die" -- One Physician's Dignified Approach

Interesting perspective. How would you go?

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. ...

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.

http://www.dailygood.org/view.php?sid=136

 

NPR had a similar segment recently. Pretty interesting.

 

Is this what you were referencing?
http://www.radiolab.org/story/262588-bitter-end/

 

It wasn't that one.

The story I heard was more about dealing with terminal illnesses, and how doctors are more likely to accept the diagnosis.

I looked for it, but haven't found it yet.

Interestingly, the article Riptide posted isn't new.

Here's a link to it from 2011: http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die/ideas/nexus/

And one from 2012: http://www.utne.com/mind-and-body/death-with-dignity-zm0z12mjzros.aspx

 

I've had more experience with death than many, and this article is wonderful.

As I've recounted before, I survived CPR and walked away -- never knew how rare that was until reading this.

But I've also seen death prolonged and death quickly come. It's amazing how little information or guidance our health care system provides us when it comes to helping others deal with end-of-life. I've had to ask a close friend, dying of lung cancer, to sign his DNR papers -- because the environment his hospital placed him in left him in the position of having to deal with these kinds of issues surrounded by strangers.

But most recently -- less than a month ago -- I've experienced my mother go from upright-and-coherent to dead in 3 days...and during that period, she made it clear to the doctors she wanted no, what I've learned from the article is called,"futile care." And her doctors -- who had never met her, or us -- understood, and as a result she was allowed to pass in peace, on her terms, with her dignity.

Had they "pulled out all the stops" she would, most likely, still be alive today. But in body only. I shudder to think what goes on in that same hospital every day, because others were not in a position to make informed choices.

 

Overdose of nitrous oxide or helium, or a gunshot to the head while standing on a high bridge or rooftop.

Or ...

 

Dr. Sherwin B. Nuland, a surgeon and author who drew on more than 35 years in medicine and a childhood buffeted by illness in writing “How We Die,” an award-winning book that sought to dispel the notion of death with dignity and fueled a national conversation about end-of-life decisions, died on Monday at his home in Hamden, Conn. He was 83.

The cause was prostate cancer, his daughter Amelia Nuland said.

To Dr. Nuland, death was messy and frequently humiliating, and he believed that seeking the good death was pointless and an exercise in self-deception. He maintained that only an uncommon few, through a lucky confluence of circumstances, reached life’s end before the destructiveness of dying eroded their humanity.

“I have not seen much dignity in the process by which we die,” he wrote. “The quest to achieve true dignity fails when our bodies fail.”

In “How We Die, ” published in 1994, Dr. Nuland described in frank detail the processes by which life succumbs to violence, disease or old age. Arriving amid an intense moral and legal debate over physician-assisted suicide — perhaps the ultimate manifestation of the concept of a dignified death — the book tapped into a deep national desire to understand the nature of dying, which, as Dr. Nuland observed, increasingly took place behind the walls of the modern hospital. It won a National Book Award.

Dr. Nuland wrote that his intention was to demythologize death, making it more familiar and therefore less frightening, so that the dying might approach decisions regarding their care with greater knowledge and more reasonable expectations. The issue has only intensified since the book was published, and has been discussed and debated in the medical world, on campuses, in the news media and among politicians and government officials engaged in health care policy.

“The final disease that nature inflicts on us will determine the atmosphere in which we take our leave of life,” he wrote, “but our own choices should be allowed, insofar as possible, to be the decisive factor in the manner of our going.”

Beyond its descriptions of ruptured embolisms, spreading metastases and bodily functions run amok, “How We Die” was a criticism of a medical profession that saw death as an enemy to be engaged, frequently beyond the point of futility.

In chiding physicians, Dr. Nuland pointed the finger at himself, confessing that on more than one occasion he persuaded dying patients to accept aggressive treatments that intensified their suffering and robbed them of an easier death. One of those patients was his brother, Harvey, an accountant who died of colon cancer in 1990 after receiving an experimental treatment with no reasonable chance of success.

Looking back on that episode, Dr. Nuland wrote that he had mistakenly tried to give his brother hope, failing to acknowledge that disease, not death, was the true nemesis.

nyti.ms/1kXPhzd

 

Condolences TV. Thank you for sharing these thoughts.