21 ms·

How Doctors Die (2013)

• statquontrarian 6y ago
  Quick Google Scholar search shows the following study with the conclusion, "U.S. physicians were more likely to use hospice and ICU‐ or CCU‐level care. Hospitalization rates were similar." How U.S. Doctors Die: A Cohort Study of Healthcare Use at the End of Life, https://doi.org/10.1111/jgs.14112 https://doi.org/10.1111/jgs.14112
  • bjornsing 6y ago
    > Inpatient hospital use in the last 6 months of life was no different between physicians and nonphysicians, although more physicians used hospice and for longer (using the hospital: odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.93–1.04; hospital days: mean difference 0.26, P = .14); dying in the hospital: OR = 0.99, 95% CI = 0.95–1.04; intensive care unit (ICU) or critical care unit (CCU) days: mean difference 0.35 more days for physicians, P < .001); using hospice: OR = 1.23, 95% CI = 1.18–1.29; number of days in hospice: mean difference 2.06, P < .001). Clearly contradicts the OP, and looks a lot more factually based.
  • crygin 6y ago
    A 94% male cohort is so wildly disproportionate to the actual population of physicians (60% female) that it beggars belief. There are a number of potential confounding factors that could explain this ("natural" death being disproportionately represented and skewing the age of the cohort being, imho, the most likely), but with this skew against the total physician population... best taken with a whole lick of salt.
    • mlyle 6y ago
      Remember, you're not comparing the distribution of present physicians. You're comparing to the cohort of physicians old enough to die a few years ago. You won't know what the cohort of current physicians will do in old age until they get old.
    • sgent 6y ago
      My 74 YO relative was 1 of 5 in her graduating class of 210 from a US medical school. Women being even a significant minority of US physicians is a new thing.
• dm319 6y ago
  As a haematologist, I find my faith in how well something is going to work is often inverse to how new or expensive it is. Whereas I see many patients who really seem to put faith in a phase II drug or something only recently licensed. New and expensive doesn't necessarily mean good.
  • lr4444lr 6y ago
    With all due respect, the lack of faith in progress this implies to me you have as a doctor is depressing.
    • berberous 6y ago
      I don't think this necessarily implies a lack of faith in progress. If 1 out of 10 new drugs is a miracle drug, that means it's wise not to place faith in any one trial drug, while still being hopeful that advances are being made overall.
      • giardini 6y ago
        berberous says " If 1 out of 10 new drugs is a miracle drug" I think this is a very high estimate, possibly off by 4 orders of magnitude or more.
    • glfharris 6y ago
      And seeing people cling to false hope in their last days of life is equally as depressing.
  • ch4s3 6y ago
    The promise of a miracle fix is understandably alluring. I wonder how many people in such dire situations want to take part in efforts to spare other people their suffering.
    • giardini 6y ago
      This. Had an acquaintance who got a diagnosis of lung cancer stage IV, was told that otherwise she would die in a month and was offered an experimental treatment at one of the very famous cancer hospitals. She took the treatments, promptly swelled up to twice her size, lost consciousness and expired w/o coming to. <sarcasm>Wow, I thought, that really must have helped reduce some other persons' suffering! All hail to the experimenter who cooked up her treatment! <sarcasm> Somewhere in my recent readings doctors were characterized as sadists (I thought HN but can't find the post). Cancer treatment experimenters may be prime candidates for that characterization, which sadly seems more explanatory than I would like.
• howenterprisey 6y ago
  Related, cites this piece: https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/ https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay...
  • andy_ppp 6y ago
    Wow such a captivating article I read the whole extremely long thing. There is indeed no authentic hospital poetry.
• crocsarecool 6y ago
  I can’t find the documentary name, but this article reminds me of it. Basically, a man had chronic pain and spent a decade or more trying to solve it. It got to a point where he realized that even though he had treatments, he was still in a lot of pain and felt like he was just eking out his life just to be miserable every day. At one point, he mentions his grandmother dying of cancer. She’s taking a regimen of pills to stay alive but she’s miserable. She doesn’t have a quality of life, so he eventually asks her why she keeps taking her pills then because they’re basically artificially keeping her alive. By the end of the film, he says goodbye to his loved ones and has an assisted suicide to escape the pain he was in. It was a really touching documentary. As a society, we have a big focus on “fighting” cancer or other big illnesses. I guess there is a quiet, difficult dignity in deciding to face your mortality too, but it’s rarely talked about.
  • kgin 6y ago
    There is an almost entirely invisible world of people who are alive but suffering to the degree that a normal life just isn't possible. It's completely hidden unless you or a loved one crosses over the line into that world. If you do find yourself on the other side of that line, it's an extremely dark place to be, but even more so because of the loneliness. Almost no one back in the "normal world" is willing or able talk about the reality of a situation where the scales have tipped and life honestly might no longer worth living.
    • sokoloff 6y ago
      Watching my previously sharp as a tack and vigorous grandfather’s slow and inexorable decline due to Alzheimer’s convinced me that there are fates worse than death. We lost him 2 or 3 years before the date on his death certificate.
      • klyrs 6y ago
        It was almost 15 years for my grandma, thankfully her body gave out late last year. Awkward for us, she was devoutly religious and she'd have never agreed to an earlier end on account of her faith, even if she knew what she was in for.
• jbrot 6y ago
  Reading this made me think of Sartre's The Republic of Silence [1]. In this article, Sartre claims, "never were we more free than under the German occupation." He explains that, roughly, in the face of death, each choice becomes more meaningful, more "authentic." This goes along with the article's discussion of how doctors, in general, choose to receive far less care than the typical patient when faced with terminal illness. This choice grants an opportunity to live authentically, in Sartre's parlance, for their last months as opposed to going out via the indignity of excessive treatment (e.g., life support machines). [1] https://www.theatlantic.com/international/archive/2014/09/paris-alive-jean-paul-sartre-on-world-war-ii/379555/ https://www.theatlantic.com/international/archive/2014/09/pa...
  • sammalloy 6y ago
    This is exactly correct. The briefest quality time left at the end of life is preferred to a longer quantity of life in pain and suffering. To choose otherwise, is to live in bad faith, according to Sartre. Many people recoil in horror at this realization, because they have bought into the idea sold by our culture that we should continue to extend our lives by any means necessary, no matter the social and human costs.
    • bspammer 6y ago
      It's funny, because I would argue that popular culture is the exact opposite. Any research into slowing down or reversing the effect of aging is seen as folly and vain. Ask someone if they'd like to live to 100 and the majority of middle-aged people will tell you no because they've seen the effects it had on their parents and grandparents. Then you have all the thought-terminating cliches that float around such as "life has no meaning without death", "aging is beautiful", "aging is natural". Society is generally very pro-aging and consequently pro-death. Of course, it's not a crazy attitude at all in our current world where aging is guaranteed. It's much easier to come to terms with something you know will happen for certain. People fear cancer far more than they do aging. The diseases of age are as brutal as they are numerous, and I can absolutely believe that dying is preferable to suffering in many cases. For thousands of years this has been the case, for thousands of years people have had to find ways to come to terms with it. Consequently this idea that aging is actually a good thing is embedded so deeply into our culture that it may as well be part of our DNA. Why aren't we doing more about it? Why aren't billions being invested into research aiming to prevent/reverse aging? We outspend by a factor of at least 100x on treating the diseases caused by aging. We all know why: social pressures make it very difficult to advocate for without being seen as a naive fool scared of death reaching for immortality. The collective, pointless, preventable damage to humanity will continue to rage on.
• mensetmanusman 6y ago
  One thing I hear from doctor friends is how incentivized they are to try everything, because if they forget something our legal system strays towards malpractice. Also they get incentives from various lobbying groups to try this or that.
  • colinmhayes 6y ago
    Our medical system is fee for service, so the businessmen running hospitals work as hard as they can to push medical staff to go overboard on procedures. Medicare's fee per patient strategy is a major reason why it is the most cost effective in the country.
• lumost 6y ago
  I'd imagine that as a doctor you would have grown accustomed to all of the varied pathways that terminal diseases and their treatments take. It would be inevitable to think through how you would view any given path should it be your own fate one day. Someone who hasn't had a lifetime to grow accustomed to how, when, and why humans die is less likely to suddenly become accustomed to what a terminal illness means for them in the days following diagnosis and ahead of treatment. Particular to TFA's pancreatic cancer story, should I be diagnosed with it in a few years I'd imagine I'd want to stick it out for a while just because giving up would feel ... weird.
  • deleted 6y ago
    [deleted]
• Spooky23 6y ago
  Get your living will, DNR, etc done now. My dad suffered from a stroke four years ago. I lost him that day, although he’s trapped in his own body. He’s debilitated and suffering in a way that is awful. He’s a writer who can’t speak or use his fingers; a chef who can barely feed himself. My mom is a former medical professional guilt ridden over calling 911. It’s not anyone’s fault; the doctors and paramedics acted quickly and did their best. But our ability to sustain life is ahead of our ability to save it.
  • nickysielicki 6y ago
    I'm so sorry you're going through that. Everyone should take this advice seriously. My 94yo grandfather passed a few days before Christmas last year and I had been staying next-door, taking care of him for about 2 months leading-up to it (helping him to the bathroom a few times per night, getting him water, etc. Congestive heart failure is not the dignified and pain-free death you might think it would be.) I found his body maybe 5 minutes after his heart had failed, and it took another 20 for the paramedics to arrive. I was really upset to find that when they arrived, without a DNR on file anywhere, they were required to attempt to resuscitate. I was sitting there with my grandmother hoping that it wouldn't come to that, and luckily common sense prevailed and they were able to get a doctor on the phone to sign-off on avoiding CPR. But for a while there, I was really concerned that my grandmother and I were going to have to watch them desecrate his body which had been lifeless for close to 30 minutes. Horrible. By default, liability overrules common-sense when it comes to medical treatment, and absolutely everyone loses.
    • JshWright 6y ago
      That varies from state to state (and certainly country to country). Here in New York I wouldn’t automatically be required to begin resuscitation in a scenario like that, _especially_ if family requesting no efforts be made. It’s possible (if you’re in the US) that the responders were EMTs, not paramedics, and would have had less autonomy to make that decision.
  • mlyle 6y ago
    I'm sorry about your father. But... it's easier in hindsight, isn't it? Obviously futile care on someone old is one thing, but if I had a stroke now, ... I have reasonable odds to come out if it almost OK with some minor deficit, so electing not to be treated would be dubious. And some stroke treatments, like rTPA, do a lot more for odds of disability than they do for mortality. So by declining too much treatment I could be increasing my odds of a bad outcome but surviving.
• anm89 6y ago
  I watched my Grandfather die in a way which was truly horrific from terminal cancer. We have some family members who cared a lot about him and have very deep pockets, so they assembled a team of the best specialists they could find over a variety of disciplines and demanded they throw every treatment possible at him to try to keep him alive. So in his late 80's, with terminal cancer, they have him on chemo, pumped full of an ever changing diet of pills, going through one invasive procedure after another. He was a smart guy too and I think he hated it but didn't have the heart to tell his family who thought they were doing the right thing to stop. All for what? To keep him barely alive hooked up to machines for an extra month or two? It was one of the saddest things I've ever witnessed that that is what the end of his life had to look like.
  • Waterluvian 6y ago
    When my grandfather got to the end I remember the doctors and parents and aunt and uncle talking all about "quality of life." Looking back its clear that was their ultimate measure and how they decided to do what they did (and mostly didn't do). Sorry, not to downplay what you've said. That sounds pretty terrible. It got me thinking about these things.
    • ddingus 6y ago
      My spouse and I talked about this. Quality of life means still willing to be here, able to get more out of it all than it takes from us. We both have agreed the other will do the right thing however painful it may be to who ever gets stuck with it first. We do not know what our survivor does. We fear that.
  • tejohnso 6y ago
    > cared a lot about him I think that part of the conversation should include the possibility that this behaviour is purely selfish, and is not an act of selfless caring.
    • dang 6y ago
      That crosses into personal attack when it's in the context of someone's specific story, so please don't. Especially when it comes to high-emotional matters like family and death. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
• pelagicAustral 6y ago
  Ending up on life support is the biggest fear of my life and no matter how I talk to this with my mother she is just not of the idea that people can just choose not to stay alive. I truly believe she's the kind of person that will keep me plugged into a machine so long as she can still feel like she's doing something to keep me alive. We never, ever agreed on the dignity of letting go and dying in one's terms... Of course, I dont live with her anymore, not even the same country... but one of greatest mysteries for me will always be what her idea of life is, we're both religious, I just dont see any point in keep pumping air and blood into a dead corpse... I would seem to be someone figured a way to make a load of money on grief, which disgust me to no end.
  • MeinBlutIstBlau 6y ago
    I am of the same mind although my parents are religious and I am not. I have a fear that even as a single guy, if I were to slip into a coma, my parents would intervene and want me to stay on. All for the sake of not letting me die just cause pointless suffering is supposedly virtuous. My greatest fear is basically becoming the soldier in the song One by metallica.
• softwaredoug 6y ago
  My Mom just passed two weeks ago from terminal cancer. The Monday ~2 weeks before she passed she was at the hospital, I asked her if this was all really what she wanted. She really wanted to change over to hospice and focus on palliative care. We began advocating for her to switch. She didn't have a ton of energy at the hospital to express/follow up on her wishes without someone there. The hospital seems like they would have erred on continuing treatment until all hope was exhausted. But once we began advocating for this want of her, the gears really shifted. She got all the morphine she wanted, and various other comfort measures. The palliative care team was driving the show. She was eventually able to go home for home hospice, and she had a final weekend of energy before passing Sunday before last. All to say, having an advocate that help you with your wishes when you're in a weakened state feels like it is pretty huge. I can't imagine what would have happened if me and my siblings weren't able to help her. She _might_ have been able to get what she wanted ultimately, but all the follow up, checking in, caretaking etc you really want to have someone there advocating for you.
  • freedomben 6y ago
    My aunt passed from cancer a few years ago but it seems like it was just yesterday. She did chemo for a long time and other treatments and was absolutely miserable. When she finally decided to "stop fighting" many in the family were horrified or even angry, but I get it. I would much rather go out comfortable and early than live a little longer in misery. Quality over quantity.
    • hellbannedguy 6y ago
      My father died of liver cancer, and even with hospice it was a horrid, painful, death. It was 16 plus years ago, and I can’t get his suffering out of my mind. I didn’t even like (I loved him though) my father, but know one should go through what he did. My sister was lowering his dose of medication because she wanted him to spend time with her kids. In all honestly, I believe she wanted him awake, and miserable, so she could get his estate together. Meaning—she wanted more? The whole process was just awful. His death completely destroyed a very fragile family. When he first went into the hospital he was basically given the bad news. He had a huge liver tumor. His stomach was greatly distended. That didn’t stop doctors coming in and palpating the mass. I think they were using my father’s condition to learn what a liver tumor felt like? Multiple people were palpating the mass, even after the scans? I finally said it’s hurting him? He got his death sentence. We left the hospital. A few weeks later a Dr. told him he would operate on him. We went to the appointment. The doctor gave this sanctimonious speech about drinking. My father was obviously very sick. My father said his drinking days were over. I felt the lecture from this doctor was completely unnecessary. My dad left the appointment happy with hope. A week and a half later he got a call from the doctor stating he couldn’t do the surgery. My dad had a Cadillac medical plan, but the doctor said he couldn’t do the surgery. All I can add is California passed a Death with Dignity bill. When it’s my time I will use it.
• softwaredoug 6y ago
  If you want to sidestep the expensive, sketchy funeral home industry 1. Donate your body to science, they'll cremate you for free (https://www.anatomygifts.org/ https://www.anatomygifts.org/) and/or 2. Look into natural burial of your remains (http://www.orderofthegooddeath.com/resources/natural-burial http://www.orderofthegooddeath.com/resources/natural-burial) Preparing for your death now, doesn't somehow influence when you're going to die. But it makes a world of difference to the people that survive after you
  • fctorial 6y ago
    There was a story about a guy whose mother's dead body was sold to military for 5893 and blown up with a bomb.
• kentf 6y ago
  Just shared with my parents and amending my will.
• Laforet 6y ago
  Here is a counter-example. Dr Michael DeBakey, pioneering cardiac surgeon, suffered an aortic dissection at the age of 98 and refused surgery until the decision was made for him by the hospital's ethics committee. Fortunately the surgery was successful and he went back to practice medicine after a lengthy recovery process. From what I could gather he was pretty please with the outcome. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61223-4/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... https://www.nytimes.com/2006/12/25/health/25surgeon.html https://www.nytimes.com/2006/12/25/health/25surgeon.html
  • CapriciousCptl 6y ago
    > From what I could gather he was pretty please with the outcome. Yes! This is, quite literally, survivorship bias. If the dice rolled on "debilitating postoperative stroke," he would have been less pleased. Based on the NYT article, he actually preferred no operation. But it seems there was enough ambiguity that the decision fell on his wife.
• giantg2 6y ago
  My grandma had dementia for the last few years of her life after having some strokes. My dad told me that if he ever gets like that, to buy him a one way ticket to Nome and say goodbye.
• dang 6y ago
  If curious, past threads: How Doctors Die (2013) - https://news.ycombinator.com/item?id=22393335 https://news.ycombinator.com/item?id=22393335 - Feb 2020 (1 comment) How Doctors Die (2011) - https://news.ycombinator.com/item?id=13122408 https://news.ycombinator.com/item?id=13122408 - Dec 2016 (45 comments) How doctors choose to die (2012) - https://news.ycombinator.com/item?id=9260286 https://news.ycombinator.com/item?id=9260286 - March 2015 (81 comments) How Doctors Die - https://news.ycombinator.com/item?id=7446014 https://news.ycombinator.com/item?id=7446014 - March 2014 (2 comments) How Doctors Die (2011) - https://news.ycombinator.com/item?id=5104430 https://news.ycombinator.com/item?id=5104430 - Jan 2013 (94 comments) How Doctors Die - https://news.ycombinator.com/item?id=3313570 https://news.ycombinator.com/item?id=3313570 - Dec 2011 (177 comments) Edit: Just in case anyone's wondering, reposts are ok after a year or so (https://news.ycombinator.com/newsfaq.html https://news.ycombinator.com/newsfaq.html). Listing past threads is just because they might be interesting.
  • canada_dry 6y ago
    Yup... as I was hitting send to forward the article link to friends, it occurred to me that this had to be at least the 2nd time I'd done so.
• koboll 6y ago
  I'm afraid of death. Very afraid. I'm pretty sure we're just meat sacks and when my heart stops beating that'll be the end of all that I am, and that scares the shit out of me. Calling what I feel about death "fear" is almost a category error; it's a five-hundred-foot-tall Godzilla of dread looming just behind me always, and every so often I happen to think about it, I happen to turn and glance at it, and my stomach just drops. The realization that it's all going to end is the ultimate anxiety underlying all others. So when I read something like this, it just seems... so alien. I can't imagine a pain or any feeling, really, worth wishing I was dead over. There can't be anything worse than death. There just can't. Pretty much any amount of bad is preferable to infinite nothing. Maybe the scariest part is that one day, I'm afraid I might change my mind. I'm afraid I might be brought to a point where I think, "Ah, this is it. This is the feeling that's worth dying to escape". The only thing scarier than the worst fear imaginable is the unthinkable idea of a pain so unimaginable that it makes succumbing to that fear seem like a mercy.
  • HashBasher 6y ago
    I also think that there's no afterlife. Soon as the brain stops working, everything goes dark. Eternal peace. I find it comforting in a strange way.
    • Trasmatta 6y ago
      > Eternal peace. I find it comforting in a strange way. I feel the same way. But I didn't always feel that way. It took time, a lot of anxiety, a bit of meditation, some drugs, and reading philosophy to get me to the point where I no long really fear death. Sure, the process of dying itself can still be scary, because of the potential for pain. But I'm not really afraid of what comes after. For OP or anyone else reading this dealing with similar death anxiety: I'd recommend a combination of therapy, philosophy, and some meditation. Psychedelics help some people, but they can also make it worse, so I'd be really careful unless you have a guide that you trust. The anxiety / fear / angst is a state that arises in your brain and body, as part of the survival instinct. It can also malfunction and kick into a much higher gear. It's possible to sort of re-wire your brain in such a way that it no longer responds to the idea of death in the same way. Your brain shapes your reality, and it's possible to change how you perceive and respond to things. It can just take some work, and maybe some therapy and medication in some cases.
• aborsy 6y ago
  When Einstein was ill at age 76 and asked if he wanted to undergo surgery, he refused, saying, "I want to go when I want to go. It is tasteless to prolong life artificially. I have done my share; it is time to go. I will do it elegantly."
• throwawayboise 6y ago
  Having been through the death of both my parents, my observation is that there is death industry engaged in a giant transfer of wealth from dying people to the medical establishment (who are already very wealthy). Long term care insurance is a scam. Don't bother. They will find any excuse not to pay. You'll need to go to court or arbitration and the legal fees will eat up any settlement. When it's my time, I plan to go expediently. No heroic measures, no experimental drug trials. I'd rather my kids inherit what I've worked for in my life than hospitals, doctors, or nursing homes.
  • javert 6y ago
    Aww, sounds like you're an American. Well, I have news for you... > my kids inherit what I've worked for Almost certainly that will also be taken away by the US government by the time you die.
    • tyingq 6y ago
      The federal estate tax exemption amount is $11.7 million for individuals. Life insurance payments are not treated as taxable income, beneficiaries do not pay income tax on them.
      • tesmar2 6y ago
        > $11.7 million for individuals Should be 0. Death taxes are horrible.
        • elric 6y ago
          Would you care to elaborate why? Estate tax (which IMO seems way too low in the US) makes it harder to accumulate generational wealth, and is a good way help prevent inequality.
          • javert 6y ago
            We should not want to prevent inequality through government intervention. We should want to live for our own ends, not for the sake of other people.
• mrtweetyhack 6y ago
  I have non-alcoholic fatty liver disease. I've gone on a diet and lost 30 pounds in 1 month. Why am I telling people this? If you eat junk food(including carbs), you need to exercise to burn it off. If you don't like to exercise, don't eat junk food.
• optimalsolver 6y ago
  Another article written by a doctor giving an unromantic view of death: https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/ https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay... I was particularly struck by this comment from one of the readers: """ My grandmother has dementia to the point that she yells and moans the same thing non stop 24 hours a day, including the phrase, “please help me”. This is continuous except for 15 minute patches of sleep here and there as she no longer really sleeps just dozes. She weighs 90 lbs if that and is eggshell fragile screaming when touched due to degenerative muscle tears compounded by arthritis. Her bowels no longer work and she fluctuates between constipation, where the assistants administer a suppository, or she has explosive diarrhea that must be cleaned up which requires moving her excessively and thus more screaming and claims of pain. She is on peritoneal dialysis and has congestive heart failure with a pace maker, prior to loosing all capacities a few months back she was swallowing nitroglycerin like candy and up until she stopped walking entirely my mom was dragging her to doctors and what not. Even then moving was difficult and required wheelchairs and walkers. Her dialysis port is always sore and semi infected despite meticulous hygiene. She has a raging UTI on a twice monthly basis though she is bathed by attendants and her diaper and garments changed regularly. She is on oxygen though she does not even move about to use oxygen as she can no longer stand nor even muster the strength to hold a sippy cup. She has forgotten how to eat or even swallow and still she is forced to choke down at least 15 pills per day and takes the occasional bite if food which she may stop chewing and allow to fall from her mouth. Her mouth is so dry the pills do not even dissolve when they lodge so she has to be coaxed and coaxed endlessly and given water in a dropper. She has round the clock private care to the tune of a few thousand per month. I had rather this money go to medical research or a non profit hospital. This team also includes a physical therapist which is useless. She is always freezing and has to be by a fireplace or heater or covered in layers of heated blankets so comfort is hard to achieve. She is moved around like a doll with much ado and her screaming in pain which my mom would claim was from her dementia and not so much pain. Finally after months of this torture on her poor failing little body my mother is now considering hospice care mainly due to the cocktail of pain killers and anti anxiety pills no longer soothe her at all-I really have no clue why it has not stopped her heart. It has been surreal to witness this and I feel so bad for people who do not have the resources or loved ones for even this much relief if relief is what you call it. However I think my grandmother would have never considered euthanasia or absence of life saving measures if given a choice while she was cogent because she had an unhealthy fear of death even then. The way we view death is really twisted and I fault religious nonsense with a lot of that phobia. Modern medicine, while mostly positive, can be grotesque because it can extend life past a semblance of life. I personally have had a living will made since this despite being young and can only hope we make strides in having physician assisted suicide legalized so people have options. """
• torgian 6y ago
  If it wasn’t for certain experiences that I’ve had in the past, I’d say that death is the final end. But I’m not so sure.
  • brianjunyinchan 6y ago
    Can't leave us hanging on that
• S_A_P 6y ago
  If I am given a death sentence where I know I have X months to live I want the following things: - I want the right to take some opiates and feel as comfortable as possible - I want the right to refuse medical procedures with a low chance of success - I want to be able to be with my loved ones
  • geocrasher 6y ago
    That's exactly what hospice care is.
• fctorial 6y ago
  Apples?
• itisit 6y ago
  End-of-life memoirs, the type where the author has a terminal illness and knows the end is nigh, are one of my favorite genres. Key takeaways after having read ~10 such books: 1. You will die. 2. Enjoy life. 3. Be kind.
• tyingq 6y ago
  The lead in story isn't terribly surprising to me. Pancreatic cancer is just so bad. Even if you catch it in stage 1 or 2, the median prognosis is under 2 years to live, and it's exceedingly rare to catch it that early. Usually, it's caught stage 4, and the median prognosis there is a few months. I imagine a lot of people with that ahead of them choose to skip chemo and radiation. It's a miserable experience, one you would choose only if it had a marked effect.
• ibic 6y ago
  I almost agree everything said in the article. "Death with Dignity"
  • pvaldes 6y ago
    I will run limping from death like the most despicable and coward opossum. That's for sure.
• SavantIdiot 6y ago
  This is a good example of death phobia. Anyone who is interested in research of someone who has faced death head on over 1,000 times should read "Die Wise" by Stephen Jenkinson. He was in charge of end of life care in Canada health care system for a decade. He despises palliative care and thinks it distances us from the reality of death which makes it all the more worse. This article really emphasizes the extents people will go to hide their own death, or deny it.
  • Yajirobe 6y ago
    How does palliative care distance us from the reality of death? Isn't it in a sense more natural way to go?
    • SavantIdiot 6y ago
      Palliative care is designed to hide the symptoms to make everyone feel better that death isn't really happening. Palliative derives from pall, which means a covering. For example, there is a palliative care drug to hide the "death rattle" from people dying so that it doesn't make the people attending the death uncomfortable.[1] There is language in palliative care that refers to death as "passing" or "moving on", which hides the real word: death. Stephen Jenkinson described the "wretched anxiety"[2] people face who resist their death, which was nearly everyone he counseled. Because they are taught it only happens "later", and then when it happens, it should be quick, neat and tidy. This is passed down to generations when it is ignored. Since it is almost never that way, people suffer horrendously and scrabble to deny it. Death is messy and painful, and it is up to individuals to decide the consequences of trying to hide or fear the most natural of all events. What is the consequence to a culture that decides death should be hidden from sight? [1] https://www.independent.co.uk/life-style/health-and-families/health-news/drugs-prevent-death-rattle-dying-patients-not-justifiable-if-intention-only-reduce-distress-relatives-says-new-guidelines-10422573.html https://www.independent.co.uk/life-style/health-and-families... [2a] https://www.youtube.com/watch?v=8OSGVkpyRfw https://www.youtube.com/watch?v=8OSGVkpyRfw [2b] https://www.youtube.com/watch?v=xLQWM2j3AVg https://www.youtube.com/watch?v=xLQWM2j3AVg
  • kgin 6y ago
• geocrasher 6y ago
  I read this article in full, and I have to say: Amen. This subject has a deeply personal meaning for me. I watched my wife go through similar things. Her stomach stopped working, and even with groundbreaking surgery and one of the top 10 gastroenterologists in the world at her side, nothing could be done. She tried to get treatments that she thought might help, until one day her GP just down the road finally told her what no doctor had the guts to say out loud: "you're dying." That was a punch in the guts. That was late November 2019. She'd just turned 45. She went on hospice care just 4 months later. Hospice care was the best medical care she'd ever received. Finally she was in less pain (but still a lot of pain- starving to death is the opposite of pleasant). Finally able to have one on one care with a nurse who genuinely cared about her. She passed away at home in February 2021 at 46 year old. Nobody tried to violently resuscitate her. Nobody stuck tubes in bad places. Nobody caused her more suffering in order to prolong her suffering. The green paper on the wall said so. One of my own biggest fears was having our home invaded by EMT's and police, with EMT's shattering her frail body to try to save it. But that never happened. So, doctors have it right. Die in peace the old fashioned way, if possible.
  • korax_nyx 6y ago
    I'm really sorry for your loss, I can't imagine losing my partner. Thanks for sharing your experience, like the article, it's quite eye opening.
    • geocrasher 6y ago
      Thank you, and you're welcome. Some good can be had from the experience. Empathy, hope, and the drive to always look for joy even in the worst of our days. It's what my wife was known for doing and it's something I have to give myself permission to do every day.
  • medntech 6y ago
    I logged into HN so I can reply to your post. Thank you so so much for sharing. I can relate to your story in so many ways.
• deleted 6y ago
  [deleted]
• tyingq 6y ago
  For some reason, a intro and video by the author he linked to is giving a 404 error. Here's the wayback copy of the intro: https://web.archive.org/web/20180415050715/https://www.saturdayeveningpost.com/2013/02/14/health-and-family/ken-murray.html https://web.archive.org/web/20180415050715/https://www.satur... And the video on YouTube: https://www.youtube.com/watch?v=_KG8Z428Hpw https://www.youtube.com/watch?v=_KG8Z428Hpw
• ta16676723 6y ago
  Dad was a radiologist, and I found it strange how he believed in the Catholic god. Irish dad I suppose. Strange how intelligent people can be so doggedly unintelligent when it comes to youth brainwashing.
• youeseh 6y ago
  That part about CPR done right breaking ribs seems to be refuted by a lot of the top results that come up when i looked for "Should CPR break ribs?"
  • vickychijwani 6y ago
    https://www.cprcertified.com/blog/what-happens-if-ribs-break-during-cpr https://www.cprcertified.com/blog/what-happens-if-ribs-break... "The conventional wisdom is that about 30% of patients suffer fractures or breaks during CPR. However, a 2015 study published in Resuscitation suggested that this percentage is quite a bit higher. The study analyzed autopsy data from 2,148 patients who received CPR for non-trauma-related cardiac arrest, and the statistics were as follows: * Skeletal chest injuries were found in 86% of men and 91% of women. * 59% of the men and 79% of the women had sternum fractures. * 77% of the men and 85% of the women had rib fractures."
  • rscho 6y ago
    Let's just say that it's really difficult not to break anything during CPR in general. Especially because the patient is often old and fragile. On young people, it's much easier.
• azalemeth 6y ago
  The medical profession spend a long time (rightly) ruminating on death. To die is, unfortunately, a natural consequence of being born: all doctors can hope to do is change the order around a little bit here and there. Yet that does not mean that the practice of medicine is pointless, nor does it mean that death has to be accepted. One of the main medical training "shorthand" books in this country, the oxford handbook of medical sciences, affectionately known as 'prawn cocktail' owing to the similar colour of its binding and a packet of Walkers' [EN-US: Lays] crisps, simply has two double-page spreads on the subject: "death of a parent" and then, following that, "death of a child". No mention is ever made of "death of yourself". I think that doctors spend a long time subconsciously thinking about this subject, and knowing full well that there are some conditions -- like gastro-oesphageal reflux disorder, let's say -- where it is overwhelmingly like that, with the help of the last few decades of technology, be something that you die with, and not of. The difference between refusing treatment may be pain initially, and a preposition to get cancer of the oesophagus later on. Then there are other conditions that are awful death sentences, and have been since time immemorial, diagnoses where a good outcome changes dying at home in four months to dying in a hospital in eight. When I received a spinal injury following trauma, one of my colleagues (a cardiologist specialising in heart failure and transplant, both conditions where unfortunately a sizeable proportion of patients do not survive a long time) simply said to me: "well, this is life -- you're born, bad things happen, and then you die". I found it oddly comforting, and had absolutely no qualms about taking the next dose of morphine...
• throw14082020 6y ago
  > According to the statistics, about 30% of those who survive CPR wake up with a cracked sternum and/or broken rib. The key words there are, "wake up." https://www.cprconsultants.com/is-it-true-that-ribs-can-break-during-cpr/ https://www.cprconsultants.com/is-it-true-that-ribs-can-brea... I did not like it > someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right). Made it seem like it always happens when correct CPR is done.
  • vickychijwani 6y ago
    https://www.cprcertified.com/blog/what-happens-if-ribs-break-during-cpr https://www.cprcertified.com/blog/what-happens-if-ribs-break... "The conventional wisdom is that about 30% of patients suffer fractures or breaks during CPR. However, a 2015 study published in Resuscitation suggested that this percentage is quite a bit higher. The study analyzed autopsy data from 2,148 patients who received CPR for non-trauma-related cardiac arrest, and the statistics were as follows: * Skeletal chest injuries were found in 86% of men and 91% of women. * 59% of the men and 79% of the women had sternum fractures. * 77% of the men and 85% of the women had rib fractures."
  • glfharris 6y ago
    A degree of rib fracture is the assumed outcome from successful CPR. The intended purpose of CPR is to physically compress the heart, which is typically well protected in the rib cage.
    • pvaldes 6y ago
      I would exchange death by a few broken ribs all the times. Seems a fairly good business.
• durnygbur 6y ago
  When two doctors meet, which one receives the outrageous bill?
• throw14082020 6y ago
  I wish the author explained why he generalises to Doctors. Some doctors would say, speak for yourself.
• pvaldes 6y ago
  Not, doctors normally don't die like this. This is a very local point of view that shouldn't be treated as dogma. Of course for assurance is good to put money into convincing every patient to go home, die peacefully and refuse the expensive treatments that they would have to pay otherwise. "Kill-yourself-at-home kit, is good for ya" will be probably the next step. Not trying to ignore the fact that healthcare looks very broken in some parts of the planet, but people has what they voted for.
  • rscho 6y ago
    I am a doc and would absolutely die peacefully at home. You don't understand what aggressive treatments really entail because you've never seen it yourself. FYI, docs would earn more by advising to treat and you are being delusional.
    • pvaldes 6y ago
      > You don't understand what aggressive treatments really entail because you've never seen it yourself. Your opinion about me and my circumstances is very interesting. I appreciate the laugh. Thanks.
      • rscho 6y ago
        Then enlighten us, maybe?
• MrDrDr 6y ago
  Very good article. I think there is an important distinction between acute and chronic disease, with respect to how much time you have to consider the choices you need to make - while you retain the capacity to make them. In the UK there is an initiative to address some of these problems by having a proactive conversation with all patients before they become too sick. The ReSPECT process (https://www.resus.org.uk/respect/respect-healthcare-professionals https://www.resus.org.uk/respect/respect-healthcare-professi...) encourages clinicians and patients to establish a shared understanding of what outcomes the patient values and fears before recommending which clinical treatments they would and would not benefit from. It's adoption here has been very positive - for context there have been multiple problematic issues with the use of DNAR (Do Not Attempt Resuscitation) form - especially during the pandemic.
• _nalply 6y ago
  I wonder what doctors do with their terminal ill children. It's easy to decide to decline treatment for oneself if one knows that there is no reasonable way. But to do same for children?
  • louwrentius 6y ago
    I don’t know the answer. But I can imagine that they would do the same, depending on the circumstances. I think it is not about quantity of life. It is about quality of life.
• thisathrowaway_ 6y ago
  My father had Esophageal cancer. He underwent radiation therapy and round of chemo. Cancer spread and his esophagus was badly damaged from radiation. I was lucky enough to see a prominent oncologist. He went through his file and gave me a few options. Since his esophagus was badly damaged all of them included drilling a hole in his abdomen through which he would be able to eat. Well, I should't say eat. The nutrients would be pored in. Oncologist said it's a procedure he would not wish upon his worst enemy. In those exact words. Knowing my father he would never agreed either. So we switched to palliative care. We never told my mother and grandmother. He died in his home early afternoon on New Year's Eve in 2012. surrounded by his family. He was 55. I often think that, in a way, I killed my father.
  • srean 6y ago
    > I often think that, in a way, I killed my father. No, you saved him a lot of suffering. Its something very kind and brave to do
  • louwrentius 6y ago
    If we even could call it ‘killing’ - which I don’t subscribe to - it was an act of mercy, love. And that made all the difference. It is not about quantity of life but quality of life, I’d say.
• cryptica 6y ago
  The older I get, the more I understand why some people refuse to go to the doctor for any reason. They are not stubborn fools, they are perfectly rational. Some people don't even want to know if there is a 10% that they will die, they's rather just die than face their own mortality. They know their nervous system can't handle that.
• mrwww 6y ago
  We're all scared of death, and fear clouds judgement. It can be so difficult to get small treatments that improve your quality of life done. But when you're 80 and near death, they'll stop at nothing.
• codpiece 6y ago
  My mother died, we bury her on Tuesday (2 days from now). Her last few years were difficult, so we put her in assisted care; wonderful place with lots of social activities and a great restaurant. Well, Covid meant lockdowns and isolation, no friends, no restaurant, just her small apartment with no visitors. We could have 'window visits', like when we dressed up for Easter and waved at her through highly reflective plate glass. Then she had a stroke. Couldn't speak, couldn't swallow. I thought she was going to die in hospital before we got her to hospice care. Tubes, beeps, shouts, blaring TVs, robot-like doctors. When we brought her home -her own bedroom- and my siblings cared for her, she thrived. I designed a board for her to communicate with. She laughed, she ate (sort of) and even had her morning coffee looking out at the lake as she always loved. She died in her sleep, cared for by her children. It wasn't pretty but it was the best anyone could hope for. As for me, I'm going to develop that board and help others with it.
• hypefi 6y ago
  “Whenever a doctor cannot do good, he must be kept from doing harm.” - Hippocrates
• deleted 6y ago
  [deleted]
• robaato 6y ago
  My dad was lucky enough to die in his own bed with my Mum holding one hand and me the other. The last several months he was on morphine for the pain, but overall it is hard to see how it could have gone better (if it was going to happen of course - he didn't have as long with the grandkids as we would have wished). I am also reminded of this book "Final Chapters: A Hospice Social Worker’s Stories of Courage, Heart and Power" which I found very insightful.
• dataminer 6y ago
  Just some words of caution, please don't read this article and think that getting treatment is futile. I was diagnosed with Stage 4B non hodgkins lymphoma 2 years ago, numbers were showing that multiple organs were failing, wasn't able to eat much because the belly got so distended, my PET scan lit up like fireworks after months of diagnostic failure. It took around 3-4 months to get to diagnosis and I was miserable. By that time I had read this article and was thinking maybe I should just go home and die in peace, but my wife told me I need to be strong and not give up. The following one year was tough, initially I was carried around in wheel chair, too much muscle loss by time of diagnosis. At first, my body was so weak that doctors decided I can't even take the first cycle of chemo at once. My arms were so bruised with all the poking that I had to move them carefully. Then chemo side effects started getting overwhelming. But slowly, things started working. One year in I was back on my feet, started working again. Two years in, here I am writing this comment and hoping for a healthy bright future for everyone out there. It's better to get advice of multiple doctors, understand risk vs rewards. Yes, there maybe a point when its time to optimize for quality of life and give up, but that should be after one or two lines of treatments.
  • mbar84 6y ago
    Your age?
    • dataminer 6y ago
      In my 40s
  • throw14082020 6y ago
    Excellent! Great perspective, thanks for sharing. And good luck with your future health. Although the article is written by a doctor, the article portrays medicine/ healthcare as something that doctors (people in the know) refuse, instead of the what really is happening: The doctors know more, and therefore can more easily make an informed decision. In some cases, this means they're willing to stop early when there is a very small (or zero) chance of success. This article is dangerous, because it flips people who default to treatment to default to no treatment, when their default should be to understand and make the informed decision, which has always been the case. My personal experience with US healthcare is to get a wide perspective, asking different doctors (sometimes in different specialties) of their perspective. This is line with dataminer's advice to seek the advice of multiple doctors. In my case, I had 3 types of doctors to contact: Neurologists, Neurosurgeons (peripheral) and Orthopaedic surgeons, and all 3 doctors had different diagnoses. Only the neurosurgeon (who had the specialty in this exact issue) could make a correct diagnosis. The others were honestly, useless. These are experts in the field, and my health issue overlapped across all 3 fields, it was my decision to go to these different experts after doing my research. *No* doctor was telling me to go to a different doctor, thats for sure.
• NotPavlovsDog 6y ago
  From my experience as a rescue-worker, I have instructed my SO to never have me on a machine for life support longer than one week before I'm in my sixties, and no longer than 3 days if I'm over. This is my decision, and I won't go into details, because they are personal and I am not a doctor. Perhaps the point I desire most others get from my post is this: We are all going to die. Usually unpleasantly. Most often, unexpectedly, even with a prolonged illness. Plan your death. Plan your medical treatments. There are things you can control, you need to know & state what they are, and have it in writing.
  • oleander73 6y ago
    Agreed. I have incurable cancer and I very much plan to die pleasantly. The cost of that is that I will probably die much sooner than necessary, but I can live with that.
    • NotPavlovsDog 6y ago
      If I'm in control, i plan to take a nice deep scuba dive, somewhere warm, with blue water. I would prefer to avoid a department keeping me hooked up for stats and fees. Wishing us all a pleasant death! With life being what it is, even some dignity while dying is a great gift.
• tamaharbor 6y ago
  I hope I am strong enough to go with dignity when the time comes.
• deleted 6y ago
  [deleted]
• EVa5I7bHFq9mnYK 6y ago
  I have stage 4 metastatic cancer and this article confirmed what I thought myself - it's not worth it to "put a fight". My life haven't been great, so I am even relieved now it is ending. I'll tell my family only when it's time to load up on oxi.