Links to ponder

Here are links to some articles I’ve found thought-provoking; some are grim, some are controversial, some are plain good sense but sadly not yet commonsense.

How Doctors Die
It’s not like the rest of us, but it should be.
By Ken Murrray, Zocalo, November 30, 2011

Death and despair or peace and contentment: why families need to talk about end-of-life options
Why don’t we talk about death and dying? A simple albeit difficult conversation could mean the difference between a peaceful and undignified death for individuals, between trauma and peace for families.
By Melissa Bloomer, The Conversation, November 24, 2011

Code Comfort
“Do Not Resuscitate” (DNR) does not mean “Do Not Treat,” but dying patients who have chosen a DNR order often feel abandoned, whether they are at home or in the hospital.
By Melissa P. Phipps and John D. Phipps, Harvard Business Review, 9 December 2014

Living death to the full
By Miki Perkins, SMH/The Age, 20 Sept 2014

Why I Hope to Die at 75
An argument that society and families—and you—will be better off if nature takes its course swiftly and promptly
By Ezekiel J. Emanuel, The Atlantic, Sept 17, 2014

We are entering the Age of Alzheimer’s
You and everyone you know will be touched by the disease. How are we going to get through this?
By Kent Russell, The New Republic, Sept 2, 2014

A Life Worth Ending
The era of medical miracles has created a new phase of aging, as far from living as it is from dying. A son’s plea to let his mother go.
By Michael Wolff, New York magazine, May 20, 2012

What Broke my Father’s Heart
The article that became the book, Knocking on Heaven’s Door
By Katy Butler, The New York Times, June 18, 2010

* Katy Butler runs a Facebook public group called ‘Slow Medicine’ – here’s a neat little encapsulation she wrote about the issues it covers:

Distilling many stories posted here, I’ve come up with two common pathways to the end of life. One ends in an ICU or nursing home, the other in a good-enough death (according to one’s wishes in an environment one controls.)
Both start when people enter the “Humpty Dumpty” stage of life (fragility.)
The pathway to the ICU starts with Blue Sky decision-making (ignoring mounting risks of surgery late in life, doctors not being honest about approach of death), which leads to Hail Mary Surgeries (18% have surgery in last month of life, 1/3 in last year of life.)
These risky surgeries are followed by complications (hospital-acquired infection or delirium, infections from intravenous lines, post-surgical dementia, pneumonia from being on a respirator, bedsores, you name it) — which leads in turn to more interventions and complications and doing more and more of what’s not working.
End result: ICU death (20% of us die there) or nursing home admission due to dementia worsened by general anesthesia or open heart surgery or just being too weak to recover.
Pathway #2 requires truth-telling instead of Blue Skying at the Humpty Dumpty stage of life (when one fall or thoughtless intervention can push you over into disability and decline.)
Docs need to explain that “progressive” illness means “getting worse” instead of hiding behind evasions like “I don’t have a crystal ball” or refusing to answer, “what would you do if it was your mother?”
Instead of Hail Mary Surgery, doctors and patients on pathway #2 now take time with decisions, shift into Slow Medicine mode, carefully weigh the pros and cons of interventions, and shift gradually from “curing” to “caring.” This is a great time to bring in a palliative care team.
Emphasis shifts to what docs call alternative “goals of care:” postponing disability, supporting the family & caregivers, managing pain and other symptoms, and making decisions in light of whether they might lead to a good or bad death — or simply worsen disability and other symptoms and make remaining months a nightmare.

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