by Ken Murray
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.
Good to see you here, Reggie! Yes, I think the biggest monkey wrench (no pun intended) that evolution threw at us is that with our level of consciousness, we are probably the only animal who is fully aware of how finite life is, and that we will die, and what's worse, those we love will die. But without getting all "Lion King" in here, life does has a continuity and we are part of a chain of humans going back for many generations and going forward for many. We will not know our descendants that will be here, say, 200 years from now. But if we hadn't been here first, they would not exist. I rejoice just thinking of what they will know and what they will see! Which is why protecting the environment is so crucial.
As for the medical establishment...there may be bad things going on at the end of life with terminal patients, but at the same time look at all the good the medical (and biomedical) profession does: vaccinations, antibiotics, saving the lives of people who have suffered accidents or violence, and of course also fixing joints :-)
I don't know if having mobile women is that great of a boon. =)
I agree with you wholeheartedly. The good far outweighs the bad. Most people would likely have life ending misery visited upon them at a much younger age without modern medicine.
My mother died when she was 68, but it was a fight to the end to make the hospital cease and desist. She had made clear to my father and I many times over the years what she wanted, and that was that she didn't want to be forced to linger when it was clear she no longer would have any substantial quality of life. She suffered from lung disease and was hospitalized several times, after her last bout on a respirator she insisted that she never be put on one again.
Getting a call in the middle of the night from the hospital, my father gave his consent to her being put on a respirator once again. It was an emergency, he had to make his decision on the spot, she had been on a few times before and had survived, so he thought it best to override her wishes and try to save her life.
There is a limit to how long you can be kept on this machine, and her time was soon to run out. They wanted to do a tracheotomy that would allow her to continue to have a machine breath for her, but my father and I agreed that this would not be what my mother would want. She had dementia that was ever crippling her life, and living in a nursing home in this god awful condition was beyond what I would want her to endure. My father agreed, but her doctor was angry, and tried to fight our decision. After reviewing the case, the hospital ultimately agreed to allow her to not have any further action taken as was her wish.
She passed in her sleep a few hours after the respirator was removed.
I just want to add that it also disturbs me when family pets are left to suffer and linger because the family refuses to accept their beloved animal's death. Either they opt for trying any heroic effort to extend their pets life. sparing no expense or suffering that the animal would endure, despite the intervention not having a high success rate. OR, they hope (?) that the animal would somehow recover, that it's really not as bad as it seems... You got me on this one - ??? As much as I adore my animals and will mourn their loss, I would never, ever, allow them to suffer. Thankfully, at least with animals, we have the choice to euthanize them painlessly.