20 ms·

How Doctors Die

663 points by thomasgerbe 15y ago

derleth 15y ago
cache link: http://webcache.googleusercontent.com/search?q=cache%3Ahttp%3A%2F%2Fzocalopublicsquare.org%2Fthepublicsquare%2F2011%2F11%2F30%2Fhow-doctors-die%2Fread%2Fnexus%2F&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a http://webcache.googleusercontent.com/search?q=cache%3Ahttp%... The site is down for me.
- chloraphil 15y ago
  for the Ctrl-F: mirror
- llimllib 15y ago
  Here's a link to readability: http://www.readability.com/articles/5r2ckztm http://www.readability.com/articles/5r2ckztm
mmmmax 15y ago
Cached version: http://max.mu/uvwxRf http://max.mu/uvwxRf
biesnecker 15y ago
Never been a big tattoo fan, but after reading that, I might consider a big "NO CODE" tat on my chest.
- pefavre 15y ago
  Experience show that it's sometimes not enough, and if no explicit paperwork can be found medics will perform CPR anyway...
  - JshWright 15y ago
    s/will perform/are obligated to perform/ In most cases, EMS in the field is operating under a fairly tightly defined set of protocols. Those protocols define what is or isn't a valid "Advanced Directive"
cturner 15y ago
I spent a lot of time hanging around nursing homes when I was growing up, and decided a long time ago that I'd like to do fast and well before I get to that stage. The NO CODE tatoo is a great idea.
dcurtis 15y ago
I was in Best Buy earlier today and the sales guy who was trying to sell me a TV reminded me a lot of the doctors/residents I was dealing with during a few weeks I spent caring for a family member at Mass General Hospital a couple years ago. I don't think they do it consciously, but doctors try to sell you on their philosophies for healthcare. But it doesn't matter. You're sitting in a small room with dim lights and someone tells you that you have two choices: 1. You can die a certain death, within months, with very little pain, or 2. You can try some heroic measure like chemotherapy for a minuscule chance of a multi-year moderately happy, but extremely painful survival. Humans are programmed to have hope, and, regardless of any logic, the vast majority will choose option 2. It's just like playing the lottery. Even now, as I think about those two options in good health, I am compelled by my nature to choose option 2.
- deleted 15y ago
  [deleted]
- rdl 15y ago
  I can't imagine not doing #2 unless I'd also be non-functional during the extended life period. If I could read, use the Internet, write, talk to people, etc., it seems like it would be worth pain (which will end when you die, no matter what). The only case where I could see #1 being a reasonable choice is if #2 puts such hardship on those around you that their lives become much worse.
  - deleted 15y ago
    [deleted]
  - bad_user 15y ago
    In case of chronic diseases like cancer, #2 does put hardship on those around you and their lives will become much worse.
  - WettowelReactor 15y ago
    It is easy to say that pain would be worth dealing with but in reality the majority of the healthy public has no understanding of what true chronic pain entails. Ask anyone who has worked in long term or hospice care this question and you will likely find an overwhelming majority choosing option 1. The reality is that in the US death and dying are still anathema.
buyx 15y ago
Just this weekend I met a relative on the street (mid fifties), doing some shopping. A few months ago, he had some chest pain, his wife thought it was a heart attack and drove him to the ER. As he was being admitted, he went into cardiac arrest, he was resuscitated, and now his four teenagers have their father back, for a few more years at least (he is back at work, and seems to be living a full and healthy life). What's interesting about this, in relation to the OP, is that his wife is a doctor, and she was the one who resuscitated him. Yes, it's just an anecdote, but a useful one to balance against those in the OP. Obviously the situation differs if you have a terminal illness, or other serious health issues, but I think a blanket NO CODE rule is a little extreme.
- rrrazdan 15y ago
  The situation you are talking about is very very different from what the OP is talking about. But yes I agree, a blanket NO CODE rule is extreme.
- Luc 15y ago
  > I think a blanket NO CODE rule is a little extreme. That's because it's something of your own invention. No one is advocating this, especially not the health professionals involved.
  - buyx 15y ago
    No one is advocating this, especially not the health professionals involved. ...except when they wear bracelets and tatoos stating "NO CODE".
    - Confusion 15y ago
      Making a choice and making sure that choice will be noted when the time of its relevance comes is not 'advocating'.
- sovande 15y ago
  "terminal illness" is the keyword here and what "no code" is associated with in medical terms. A heart attack, a stroke and similar acute traumas should definitely be treated. These patients may live a close to a 100% life afterwards.
fingerprinter 15y ago
So, couple of things. Just had my wife read this (she is a doc) and we chatted about this. We are in our mid-30s and several years ago she was admitted to the ER and then ICU for 7 days for an obviously life threatening situation. (She has a near blanket NO CODE, FYI). She recovered, but there was at least 48 hours where her odds were "much worse than a coin flip" as on of her colleagues told me. So people distinguish the different situations, in that situation she and her colleagues (she was treated at her own hospital...given that it was the best hosp in the country) knew about her NO CODE and still treated her. The reason being that medical intervention was near 100% likely to produce a positive outcome and bring her back to a normal quality of life. However, if given a terminal diagnosis such as in the story, my wife, without hesitation, said she would choose to go without treatment. She went further and wished that this type of article could make its way to the NYT or some other outlet to get normal folks to think about. She, like most doctors, has seen way too many people "try to live" only to saddle their family with huge expenses, not dramatically effect their prognosis and basically make the rest of their lives as painful as possible. Obviously not a fun conversation to have with your SO, but I for sure know exactly what she wants and how to ask the right questions at the hospital just in case. She also knows what I would want and how to make the right decisions.
- celticninja 15y ago
  Re:saddling their family with huge expenses, this is a fairly unique problem in 1st world healthcare situations, in that it mainly applies to people in the US. In most other developed nations healthcare and bankruptcy do not go hand in hand.
  - dmgottlieb 15y ago
    But the money is just as wasted no matter who pays it.
    - ahi 15y ago
      It's not nearly as much money in other countries. 5 figures on bad odds vs 6 or 7 figures on bad odds. If it's cheap maybe it's worth a shot?
latch 15y ago
This is obviously a very personal topic, but I can't help but ask whether medecine benefits from people undergoing "futile care"? Are some diseases only treatable today because 20 years ago someone went through all the crap? The whole thing reminds me of the average mid-90s movie Phenomenon. I could always understand Travolta's character's reasoning, but I still thought it was selfish.
- Cass 15y ago
  Medical research benefits hugely from terminally ill patients who are willing to try anything for even two more months of painful life. There are a lot of of experimental, highly dangerous cancer treatments that could never be justified if not for the fact that even without them, the patient would have about two months to live. That said, there will always be enough patients who want to fight for their life no matter the cost (see other comments on this page for evidence) that if you'd prefer to die in peace, you certainly shouldn't feel obliged to play the guinea pig for science.
- DanBC 15y ago
  Science doesn't work like that. To get meaningful results you need a large sample size, with a control group, with patients not knowing whether they're getting the new medicine or the old medicine[1] and with doctors not knowing either. Then you need to write that up and analyse it. Many patients are happy to take part in such trials, but it's hard to get ethics panel approval. [1] you tend to test against current best treatment, not placebo, because almost anything works better than nothing and by the time you test the treatment in humans you need to know if this is better than what you're already doing. Ethics panels have some weird effects - (http://www.badscience.net/2011/03/when-ethics-committees-kill/ http://www.badscience.net/2011/03/when-ethics-committees-kil...)
  - Cass 15y ago
    That's how it works in the best case. Unfortunately, medical research is not a perfect science. Realistically, with many medical treatments, you can't have a double-blinded study. With chemotherapy, the side effects will often quickly tell you what treatment you're receiving, and a treatment like for example extracorporeal photopheresis can't ethically be placebo-controlled or double-blinded at all. What are you going to do, hook half your patients up to a machine that will do nothing but run their blood around a bunch of tubes for hours for no reason? And you can't get a "large sample size" of patients with rare cancers or diseases by definition. Sometimes, the best you can do is a case study of ten patients who agreed to try your treatment because the other option was death. Quite a few medical advances have been made that way, actually.
jonah 15y ago
Both of my grandfathers died in the past five months. The one who lives halfway across the country was 97. He woke up at his lake cabin the morning before he died complaining of chest pain and shrugged it off but was soon being transported unconscious to the hospital accompanied by his paramedic neighbor. He slipped into a coma and the next day with several of his children at his side, was removed from the ventilator. My other grandfather, who lives in the same town I do, was 93 and had struggled for the past several years with a progressively debilitating illness which increasingly kept him from being able to do the things he wanted to do. A couple weeks before his death his health took a turn for the worse and he quickly began losing connection with the world. He did go to the hospital and tests were done and drugs given, but we soon understood that he wouldn't recover and we brought him home. The hospice nurses and caregivers were wonderful. All his children came as did many old friends. He died in his sleep in his bedroom with his wife and children there. Both had advanced directives requesting minimal effort to prolong their lives. My grandfather here wanted no heroic efforts and "no machines". Even so, a lot of intense discussion among his children was involved in coming to peace and/or acceptance of what exactly that meant, what the moral and ethical implications of different interpretations were, and how best to carry out his wishes. This is what I'm now doing and what I strongly encourage you to do now: * Create an advanced health care directive for yourself. You can get forms and examples online. * Consider the various situations one might end up in and lay out as explicitly as you can what you'd like to be done or not done to you. The more specific you are, the more likely your intentions will be followed and the less your family/loved ones may have to struggle with the interpretation. * Talk to your your family and loved ones about your desires. It's a hard and awkward discussion to have but do it. Be clear and frank. Takeaway: Have an advanced directive. Be as clear, specific, and explicit as you can about your desires. Share your desires with your family, loved ones, and care providers. It is helpful not only you but form them as well.
Cass 15y ago
To everyone considering a "NO CODE" tattoo after reading this story: Don't. If you're really that serious about not wanting to be resuscitated under any circumstances, wear some kind of bracelet or necklace with those words on it, and, just as importantly, a recent date, and contact info for a person who knows your exact wishes. Make sure to update the date regularly. Medicine changes, and so do your life circumstances. If you're presenting an EMT with a ten-year-old, faded tattoo, you're placing them in an awkward position due to the lack of context. Is this a decision you made ten years ago and got stuck with, or are these your current wishes? They might end up disregarding your wishes just to be safe. A bracelet with a recent date will be much less ambiguous. And remember, with all medical decisions, you want the ability to change your mind when medical advances are made or your circumstances change. Tattoo removal sucks.
- janzer 15y ago
  Not to mention that at least where I'm from a tattoo will not and cannot be accepted by EMS personnel as a valid order. Here is the relevant part from our Medical Control treatment protocols on what can be accepted as a valid do not resuscitate order: "Patient is wearing a do-not-resuscitate identification bracelet which is clearly imprinted wit the words “Do-Not-Resuscitate Order”, name and address of declarant, and the name and telephone number of declarant’s attending physician, if any OR The EMS provider is provided with a do-not-resuscitate order from the patient. Such an order form shall be in substantially the form outlined in Annex 1 or 2 and shall be dated and signed by all parties." Anything else and we are required to follow all the regular resuscitation efforts.
  - vacri 15y ago
    How bizarre that they'll accept 'do not resuscitate' on jewellry, but not tattooed across the chest. "Do we think he really meant it? Nah, he just got the tattoo - if he really meant it, he'd be wearing one of those constantly annoying bracelets"
    - mfringel 15y ago
      What if "NO CODE" is the name of a band? You're asking someone to make a quick life-or-death decision on ambiguous data when there is a clearly known and socially agreed upon way to express the sentiment. Having it on an annoying bracelet that is explicitly used to signal medical intent sounds pretty good to me.
VMG 15y ago
One alternative that hasn't been mentioned here is cryopreservation. Once I have the resources and the technology has progressed, I'd certainly choose that option above being treated and "NO CODE".
- Jach 15y ago
  Totally on board with cryonics, it's really depressing that it gets swept under the rug considering it probably has at least 5% chance of working for a patient suspended today. Though your excuses for presently avoiding it seem pretty flimsy unless you're really dirt poor (I'd wager unlikely), especially when life insurance payable to the cryonics company is cheap (you only need $28-$35k for CI) and so are membership fees ($120/yr or $1,250 once for CI; I spend more than $120/yr on fast food). But don't get upset, my excuses for not being signed up yet are pretty flimsy too.
  - VMG 15y ago
    It's not exactly about the money - I'm in Europe and the only providers I know of are situated in the US. The last time I looked into it they needed a DNA sample from me in person, so at least I'd have to book a trip to go there. But from a cost-benefit perspective, it still is pretty flimsy. Definitively one of my worst cases of akrasia.
  - dennisgorelik 15y ago
    Where did you get this "at least 5% chance of working" number for cryonics? It's at least 3 orders of magnitude lower than that: no one was recovered from that frozen state alive so far.
    - VMG 15y ago
      Your estimate hasn't any foundation either. The question is if we can recover people in the future. The chance of that is basically an unknown. However I'd put it above religion and similar things, which makes it worthwhile.
      - 15y ago
defdac 15y ago
Tonight I will tell the mother of our child that if I reason in any way that resembles this article she should slap me in face and tell me to fight for my life. For my daughter and my own sake. In Sweden medical care is free. I can fight as long as I want without them getting in trouble. I also suspect I should fight so hard as if the illnes is truly terminal I will end sooner in flames, not later. I want all the tubing. I want the cracked ribs and surgeons transform me to a piece of blubber and then anlyze the hell out of it so anyone else don't have to go through the same thing. Telling people to give up because of money or some sort of gentleness to yourself or your family is alien to me. Maybe it's our harsh climate uphere. Swedes seems very in tune with our suffering.
- krig 15y ago
  Interesting. I found myself responding to the article in much the same way as you. Also Swedish. The question is: are we being rational or deluded? I have friends who are medical professionals and I don't recognize them in this either: I highly doubt any of them have NO CODE tattoos or anything equivalent. I suspect society shouldering most of the cost might be a factor: with a privatized payment system, there are perhaps incentives to go too far that aren't there when there's no profit to be made? That's pure conjecture, though.
  - Cass 15y ago
    This is not a question of being "rational", and there's no right or wrong answer. People make trade-offs between quality and quantity of life every day. Do I want to quit smoking, drinking, drugs, and take up sports, etc for a chance at a longer, healthier life? Or do I grab all the fun I can, and if it costs me ten years, oh well? The right decision will look different for every person - and it's not black or white, but a continuum. The choice of how much pain is worth it for how much of a chance at a longer life is going to look different depending on your religion, your responsibilities, your age, your experiences with pain, your family, your culture, etc. And yes, of course the cost of treatment will factor into that decision for both the doctors and the patient.
    - 15y ago
Gatsky 15y ago
What's the message here? That people shouldn't have chemotherapy? That we shouldn't do resuscitation? That all advanced cancers should just receive palliative care? This seems to be a rant ie. the author has a strongly held notion that he has disguised as an argument devoid of any nuance. The support for his argument is that doctors secretly run a mile away from hospital whenever they get sick. This is not true and a gross generalisation. Cause guess what, not everyone has a loving family or a house in the hills or a cousin with a big screen TV to go to when they are dying from a terminal illness. Some people want to try and fight their disease, and they are tenacious and brave and admirable and that's dignifying to them and to those that try and help them. This article is an attempted justification from someone who has lost faith in what they do, nothing more.
- antoinehersen 15y ago
  The message is that there is another choice. I read it as giving people a different perspective on end of life care. The system is heavily biased toward all out medical care. This article show the other side, using as examples people who have a better understanding of the tradeoff. This decision will always be a personal one, there is not right or wrong answer, just different possibilities.
OoTheNigerian 15y ago
People should differentiate between terminal illnesses and acute illnesses like heart attacks. For the later, I am sure the OP has no problems with treatment. The leader of the breakaway Republic of Biafra died this week. He was less than a vegetable for 8months until his death. Here was a man who was larger than life reduced to helplessness. At the age of 78, I am wondering why he was tortured for these 8 months so he would be 'alive'. I am certain if he had the choice, he would have preferred to go with dignity. Unfortunately, people never want to prepare for such things. When it happens, their end is determined by others. My President Yaradua, also had the most undignified of ends possible. In theory Ariel Sharon is still alive. http://en.wikipedia.org/wiki/Ariel_Sharon http://en.wikipedia.org/wiki/Ariel_Sharon I want my end to be dignified. If God forbid, I have a terminal illness, it will not be a hard decision to make. Quality NOT Quantity.
rbanffy 15y ago
I was married to a doctor for 10 years. Before that, I lived with my aunt, also a doctor. The one thing that absolutely shocked me is how they thought about aging and death. I kept reminding them their goal should be to find cures for everything, no matter how hard it seems. I approach every engineering problem as solvable. Maybe I can't solve it right now with the tools I have. Maybe I can't figure out a way to solve it and will have to leave it for the next generations. To absolve yourself because something is inevitable is a coward solution. So, no, thank you. If that's what it takes to survive, I want to be cut open, sliced, probed, and, when everything else fails and I finally die, I want doctors to learn something from my death. I want them not to give up and, if they can't treat some condition, go out and invent a way to do it. You don't give up solving a problem just because it's hard. It's their job and it's reasonable for us to expect them to do it.
- DavidMcLaughlin 15y ago
  I think this is a great way to think about it. People who try everything to extend their life do not die in vain. Over ten people in my family in the last ten years have been diagnosed with cancer and so far we've only lost one. The person who didn't make it was the youngest of all the victims, but his tumour was also somewhere the doctor's didn't see that often - the bile duct near the liver. The number of operations and suffering he had to endure still lives with me to this day and I could see why any doctor would choose not to go through this if they had to see such futile attempts at extending life end the same way. They flew in special equipment from the USA that was deemed highly experimental and would cut him open and try it out, only to have to cut him back open a few weeks later to remove what they put in. They tried surgery after surgery in the hopes something would be successful. They did not save his life but I like to think they at least learnt something about a cancer they simply don't see that often, that gave the next person a better shot. When they finally told him there was nothing more they could do, he asked them to stop all further treatment and to let him die on his terms. The outlook for patients with breast, stomach, lung, testicular, skin or any other form of "common" cancer used to be as bad as pancreatic or bile duct cancer, but these days it's not a death sentence and a lot of people had to lose hard fought battles to get to this point.
- gravitronic 15y ago
RobbieStats 15y ago
I'm conflicted about this. On the one hand I don't want to be hooked up to a ventilator or go through extreme suffering to prolong life. On the other hand, my grandmother (who recently passed away) went through late stage breast cancer in her mid-50s, lung cancer in her 60s, had a severe heart attack in her 70s and died in her 80s. It was so bad one time the doctors told us she would die in a matter of days. After she recuperated, she lived another 8 years. She was a tough bird. How many times have we all heard: "The doctors gave him 6 months to live and that was 5 years ago". So if I knew I could go through 3-6 months of severe pain and get another 5-10 years of high quality life with my family, I'd probably do it. The problem is you may go through 3-6 months of severe pain and then die in month 7. Right now being in my mid-30s and with a young daughter I enjoy, I'd take on the fight. If I was in my 80s, probably not.
- mikeash 15y ago
  How was your grandmother's quality of life in those last 8 years after the doctors said she had just a few days left? As for "The doctors gave him 6 months to live and that was 5 years ago," keep in mind that you get a horribly biased sample. People don't generally go around saying "The doctors gave him 6 months to live and he died 6 months later," even if that may happen far more often.
ck2 15y ago
Sometimes knowing too much can be bad for choice making. As a coder, I worry every time I drive that the computer could accidentally fire the airbags because of a bug in a poorly coded sensor (this happens far less frequently now but when airbags were first introduced people were killed/injured periodically http://news.google.com/search?q=airbag+recall+deaths http://news.google.com/search?q=airbag+recall+deaths ). Not the best example but things like this do affect choicemaking and corner-cutting. It's like the fable of the plumber's plumbing, never being in good shape despite his expertise. Hence doctors probably don't always make the best decisions about their own healthcare because they are either over-reacting, or under-reacting.
kghose 15y ago
Some people on this thread have harped on cost (and used it as a way to insert their own agenda about the economics of healthcare) but from my reading of the article it is really about being free to make an informed and personal choice about what the cost/benefit of treatment in terms of life quality vs life quantity is to you. It is true the writer writes from the point of view of his own choice, but on a topic such as this, that is really the only way to do it authoritatively. The point of the article, I thought, was to make us think - what would I do when/if the time comes?
conorh 15y ago
My wife is a surgeon and sees these situations constantly, a patient whose family has asked that everything be done for them. They spent months in the ICU hooked up to machines, incredibly uncomfortable and often, if they are aware, extremely depressed. And then they die. This is traumatic for everyone involved. She (and I) would never go through this by choice. I can't stress that enough. This is not about money, this is about leaving life in the best possible way, on your own terms, with your family and as comfortable as possible.
msimonovic 15y ago
http://xkcd.com/936/ http://xkcd.com/936/
- zeynalov 15y ago
  False. Most of computers don't calculate every digit separately but they start to test most used words then other variables. This means, Igotoschool is much easier to guess than 8h9. Hacking programs have dictionaries and most of passwords are plain words.
thisisnotmyname 15y ago
It would be nice if the author provided a citation or two to back up the sweeping statements he or she is making.
js2 15y ago
Two related stories I thought of while reading this: 1. A Pacemaker Wrecks a Family's Life - http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=all http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.htm... 2. A Tale of Two Hearts - http://thestory.org/archive/the_story_111811_full_show.mp3/view http://thestory.org/archive/the_story_111811_full_show.mp3/v... The second is an audio program.
pingswept 15y ago
"It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment." I strongly disagree with this part. Before patients become patients, the vast majority of us have no interaction with the health care industry and certainly no significant capability to influence it. Doctors, on the other hand, spend their adult lives working as professionals in the industry. To say that they, as a group, are anything but complicit is wrong. Consider the "Fuck passwords" article[1] that's on the HN front page now. As a programmer who has dealt with passwords, the sad state of authentication is, in part, my fault. I could make the same excuse, "Well, the users don't want long passwords, and Facebook and G+ are part of the problem, and blah blah. I'm a victim of a larger system" That would be lame. Like the doctors, I'm one of the professionals in the field, so it's my responsibility. [1]: http://news.ycombinator.com/item?id=3313790 http://news.ycombinator.com/item?id=3313790
dennisgorelik 15y ago
Original URL does not work at this moment. cache:zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/
iguanayou 15y ago
Is it possible that "get medical treatment" or "go in peace" is a false dichotomy?
- radu_floricica 15y ago
  Of course it is. The dichotomy is between going in peace and doing absolutely everything possible, regardless of costs, to live a bit more.
jballanc 15y ago
For everyone contemplating the prospect of hospice care vs "fight to the very end", this study might be of interest [PDF]: http://www.nhpco.org/files/public/jpsm/march-2007-article.pdf http://www.nhpco.org/files/public/jpsm/march-2007-article.pd... The salient point: > For the six patient populations combined, the mean survival was 29 days longer for hospice patients than for nonhospice patients.
pedoh 15y ago
What are the best ways to make our preferences to our loved ones clear? Is it sufficient enough to have a living will, for example? Are there documents out there that I should be carrying in my wallet, and do paramedics seek these documents out in an emergency?
- philwelch 15y ago
  > What are the best ways to make our preferences to our loved ones clear? Tell them. I would recommend going through scenarios with them. Everyone thinks of the persistent vegetative state, but it's very unlikely you'll end up in one. It's more likely you'll be days away from death and passed out in a haze of exhaustion and morphine, with a ventilator doing little more than prolonging this scenario. Do you want the ventilator removed? Do you want CPR if you're hospitalized for a terminal condition? What if you're hospitalized for a non-terminal condition? > Is it sufficient enough to have a living will, for example? It sure helps, so do that. But also make sure to designate one of your loved ones in particular as your power of attorney. Make sure it's someone who understands and is capable of carrying out your wishes. That person will stay in close contact with health care professionals and has the legal right to make any and all decisions should you be incapacitated. In my limited experience, no one even looks at the living will if there's someone with clear power of attorney telling them what to do. This person has an even more important job, at least in the American health care system: they're often the only one who talks to all the doctors and has the big picture. If you're seeing five different specialists, and they're all talking about their own specialties, no one is necessarily in charge of the big picture. In the outpatient world you have a primary care doctor, but when you're hospitalized, this guy's out of the picture. There is probably a hospitalist in charge of your care, but just like the nurses, the hospitalists rotate on shifts, and don't really coordinate with specialists so much as just trying to keep you alive. You need someone to be power of attorney, and to take the job seriously. One of the striking things, to me, about Steve Jobs' biography was that even for him, this was true--his wife was the one coordinating the doctors and keeping in charge of the big picture. > Are there documents out there that I should be carrying in my wallet, and do paramedics seek these documents out in an emergency? No. I've had paramedics at my house for my dad twice, and they never looked in his wallet. On the other hand, I was there both times. The job of a paramedic is to stabilize you, gather whatever information they can, and take you to the ER. They probably don't give a shit about your wallet or your cell phone. Whatever procedure there is for identifying someone's next of kin and finding their advance directives, it's done in the hospital. Most of the time they just ask you, if you're conscious, and they ask whoever is physically with you at the time. They would only resort to searching you and your effects if you were completely alone, or if no one around you knew anything or anyone. So designate your power of attorney and designate that person as your emergency contact at work. If you don't live with that person, make sure a neighbor or roommate or someone else you live with or close to has that person's number programmed into their phone and knows to contact them. You want a person you trust, not just a tattoo or bracelet or document, in charge here.
tptacek 15y ago
The CPR example that's used throughout the article is a bit weird, isn't it? Isn't CPR performed when someone has no heartbeat? What does it matter if you crack their ribs? It's only painful if the person survives. I'm not debating whether people should attempt to prolong their lives with aggressive chemo, just picking a nit.
- wvenable 15y ago
  If I was in an accident or an illness today -- I'd want them to crack my ribs and so on. In 50 years or so, when I'm 80 and in poor health I'm not sure I'd want the same thing.
  - learc83 15y ago
    Yeah that's the author's point. Chronically ill or terminally ill patients receiving heroic care, not an otherwise healthy 30 year old who has an acute illness. If you're 80 and in poor health, recovery from broken ribs is likely to be extremely difficult and painful.
- vacri 15y ago
  CPR is done on unconscious people who are not breathing. They may have no heartbeat, or it may be an irregular one. CPR shouldn't be done on someone that can feel the pain at the moment of the ribs breaking, correct.
AznHisoka 15y ago
can someone please post this entire article or a cached version?? been trying to read what the commotion/drama is all about for the past 6 hours and I'm dying here...
gbak 15y ago
For some reason the site is down and the cache link on google takes a while to load. For everyone that wants to read it I created a public Google Docs file with the article. You can access it here: https://docs.google.com/document/d/1yL1659zNXQ7M9uXIcRrcu9dJ2i0xTHfTHD5hzJCp5ww/edit https://docs.google.com/document/d/1yL1659zNXQ7M9uXIcRrcu9dJ...
boneheadmed 15y ago
I'm a medical doctor and I'll never forget what one of our respected (and elderly) liver specialists said when asked what he would do regarding a patient with a liver cancer with a particularly poor prognosis. During a roundtable discussion, various younger doctors came up with lengthy suggestions and lots of different chemotherapy regimens, tests, etc. When it was this doctor's turn to speak, he said: "Well, if I were to put myself in that man's shoes, I would go to the store, buy a case of fine liquor and drink myself happy for the next few weeks until I'm gone." He had seen enough "therapies" to know enough when to forgo them.
pauncejones 15y ago
Hospice nurses helped both of my parents die as quickly and peacefully as possible. My father had congestive heart failure - a slow death over months, and my mother had dementia, and eventually started losing the ability to control her basic functions like breathing and swallowing. If it weren't for the kind advice of my mother's doctor, who instructed all of her caregivers NOT to allow her to be taken to the hospital or be picked up by an ambulance, she might have ended up in a vegetative state in a hospital as well. He explained how it's a hospital's duty to do everything in their power to resuscitate someone, regardless of whether it's really humane or not. It was awful watching them both die, but sitting with your family while you're given liquid morphine is much better than going through a frightening, painful, lonely death in a hospital.
maurits 15y ago
Very interesting story, but I do wonder if its assertions universally hold. This looks like an excellent research question for the guys at freakonomics (http://www.freakonomics.com/blog/ http://www.freakonomics.com/blog/) to me.
martin1b 15y ago
While this article is interesting, it should make clear that basic necessities for life MUST be maintained. Everybody needs food and water to live by ordinary means, all medical technology aside. However, life support is not required and is considered extraordinary. Quality of life is something to achieve with the inclusion that these basic needs are met. If not, the quality of life is a personal opinion and can be interpreted in any way, from conservative, to ridiculous.

663 points by thomasgerbe 15y ago

cache link: http://webcache.googleusercontent.com/search?q=cache%3Ahttp%3A%2F%2Fzocalopublicsquare.org%2Fthepublicsquare%2F2011%2F11%2F30%2Fhow-doctors-die%2Fread%2Fnexus%2F&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a http://webcache.googleusercontent.com/search?q=cache%3Ahttp%... The site is down for me.

chloraphil 15y ago
for the Ctrl-F: mirror
llimllib 15y ago
Here's a link to readability: http://www.readability.com/articles/5r2ckztm http://www.readability.com/articles/5r2ckztm

mmmmax 15y ago

Cached version: http://max.mu/uvwxRf http://max.mu/uvwxRf

biesnecker 15y ago

Never been a big tattoo fan, but after reading that, I might consider a big "NO CODE" tat on my chest.

pefavre 15y ago
Experience show that it's sometimes not enough, and if no explicit paperwork can be found medics will perform CPR anyway...
- JshWright 15y ago
  s/will perform/are obligated to perform/ In most cases, EMS in the field is operating under a fairly tightly defined set of protocols. Those protocols define what is or isn't a valid "Advanced Directive"

cturner 15y ago

I spent a lot of time hanging around nursing homes when I was growing up, and decided a long time ago that I'd like to do fast and well before I get to that stage. The NO CODE tatoo is a great idea.

dcurtis 15y ago

I was in Best Buy earlier today and the sales guy who was trying to sell me a TV reminded me a lot of the doctors/residents I was dealing with during a few weeks I spent caring for a family member at Mass General Hospital a couple years ago. I don't think they do it consciously, but doctors try to sell you on their philosophies for healthcare. But it doesn't matter. You're sitting in a small room with dim lights and someone tells you that you have two choices: 1. You can die a certain death, within months, with very little pain, or 2. You can try some heroic measure like chemotherapy for a minuscule chance of a multi-year moderately happy, but extremely painful survival. Humans are programmed to have hope, and, regardless of any logic, the vast majority will choose option 2. It's just like playing the lottery. Even now, as I think about those two options in good health, I am compelled by my nature to choose option 2.

deleted 15y ago
[deleted]
rdl 15y ago
I can't imagine not doing #2 unless I'd also be non-functional during the extended life period. If I could read, use the Internet, write, talk to people, etc., it seems like it would be worth pain (which will end when you die, no matter what). The only case where I could see #1 being a reasonable choice is if #2 puts such hardship on those around you that their lives become much worse.
- deleted 15y ago
  [deleted]
- bad_user 15y ago
  In case of chronic diseases like cancer, #2 does put hardship on those around you and their lives will become much worse.
- WettowelReactor 15y ago
  It is easy to say that pain would be worth dealing with but in reality the majority of the healthy public has no understanding of what true chronic pain entails. Ask anyone who has worked in long term or hospice care this question and you will likely find an overwhelming majority choosing option 1. The reality is that in the US death and dying are still anathema.

buyx 15y ago

Just this weekend I met a relative on the street (mid fifties), doing some shopping. A few months ago, he had some chest pain, his wife thought it was a heart attack and drove him to the ER. As he was being admitted, he went into cardiac arrest, he was resuscitated, and now his four teenagers have their father back, for a few more years at least (he is back at work, and seems to be living a full and healthy life). What's interesting about this, in relation to the OP, is that his wife is a doctor, and she was the one who resuscitated him. Yes, it's just an anecdote, but a useful one to balance against those in the OP. Obviously the situation differs if you have a terminal illness, or other serious health issues, but I think a blanket NO CODE rule is a little extreme.

rrrazdan 15y ago
The situation you are talking about is very very different from what the OP is talking about. But yes I agree, a blanket NO CODE rule is extreme.
Luc 15y ago
> I think a blanket NO CODE rule is a little extreme. That's because it's something of your own invention. No one is advocating this, especially not the health professionals involved.
- buyx 15y ago
  No one is advocating this, especially not the health professionals involved. ...except when they wear bracelets and tatoos stating "NO CODE".
  - Confusion 15y ago
    Making a choice and making sure that choice will be noted when the time of its relevance comes is not 'advocating'.
sovande 15y ago
"terminal illness" is the keyword here and what "no code" is associated with in medical terms. A heart attack, a stroke and similar acute traumas should definitely be treated. These patients may live a close to a 100% life afterwards.

fingerprinter 15y ago

So, couple of things. Just had my wife read this (she is a doc) and we chatted about this. We are in our mid-30s and several years ago she was admitted to the ER and then ICU for 7 days for an obviously life threatening situation. (She has a near blanket NO CODE, FYI). She recovered, but there was at least 48 hours where her odds were "much worse than a coin flip" as on of her colleagues told me. So people distinguish the different situations, in that situation she and her colleagues (she was treated at her own hospital...given that it was the best hosp in the country) knew about her NO CODE and still treated her. The reason being that medical intervention was near 100% likely to produce a positive outcome and bring her back to a normal quality of life. However, if given a terminal diagnosis such as in the story, my wife, without hesitation, said she would choose to go without treatment. She went further and wished that this type of article could make its way to the NYT or some other outlet to get normal folks to think about. She, like most doctors, has seen way too many people "try to live" only to saddle their family with huge expenses, not dramatically effect their prognosis and basically make the rest of their lives as painful as possible. Obviously not a fun conversation to have with your SO, but I for sure know exactly what she wants and how to ask the right questions at the hospital just in case. She also knows what I would want and how to make the right decisions.

celticninja 15y ago
Re:saddling their family with huge expenses, this is a fairly unique problem in 1st world healthcare situations, in that it mainly applies to people in the US. In most other developed nations healthcare and bankruptcy do not go hand in hand.
- dmgottlieb 15y ago
  But the money is just as wasted no matter who pays it.
  - ahi 15y ago
    It's not nearly as much money in other countries. 5 figures on bad odds vs 6 or 7 figures on bad odds. If it's cheap maybe it's worth a shot?

latch 15y ago

This is obviously a very personal topic, but I can't help but ask whether medecine benefits from people undergoing "futile care"? Are some diseases only treatable today because 20 years ago someone went through all the crap? The whole thing reminds me of the average mid-90s movie Phenomenon. I could always understand Travolta's character's reasoning, but I still thought it was selfish.

Cass 15y ago
Medical research benefits hugely from terminally ill patients who are willing to try anything for even two more months of painful life. There are a lot of of experimental, highly dangerous cancer treatments that could never be justified if not for the fact that even without them, the patient would have about two months to live. That said, there will always be enough patients who want to fight for their life no matter the cost (see other comments on this page for evidence) that if you'd prefer to die in peace, you certainly shouldn't feel obliged to play the guinea pig for science.
DanBC 15y ago
Science doesn't work like that. To get meaningful results you need a large sample size, with a control group, with patients not knowing whether they're getting the new medicine or the old medicine[1] and with doctors not knowing either. Then you need to write that up and analyse it. Many patients are happy to take part in such trials, but it's hard to get ethics panel approval. [1] you tend to test against current best treatment, not placebo, because almost anything works better than nothing and by the time you test the treatment in humans you need to know if this is better than what you're already doing. Ethics panels have some weird effects - (http://www.badscience.net/2011/03/when-ethics-committees-kill/ http://www.badscience.net/2011/03/when-ethics-committees-kil...)
- Cass 15y ago
  That's how it works in the best case. Unfortunately, medical research is not a perfect science. Realistically, with many medical treatments, you can't have a double-blinded study. With chemotherapy, the side effects will often quickly tell you what treatment you're receiving, and a treatment like for example extracorporeal photopheresis can't ethically be placebo-controlled or double-blinded at all. What are you going to do, hook half your patients up to a machine that will do nothing but run their blood around a bunch of tubes for hours for no reason? And you can't get a "large sample size" of patients with rare cancers or diseases by definition. Sometimes, the best you can do is a case study of ten patients who agreed to try your treatment because the other option was death. Quite a few medical advances have been made that way, actually.

jonah 15y ago

Both of my grandfathers died in the past five months. The one who lives halfway across the country was 97. He woke up at his lake cabin the morning before he died complaining of chest pain and shrugged it off but was soon being transported unconscious to the hospital accompanied by his paramedic neighbor. He slipped into a coma and the next day with several of his children at his side, was removed from the ventilator. My other grandfather, who lives in the same town I do, was 93 and had struggled for the past several years with a progressively debilitating illness which increasingly kept him from being able to do the things he wanted to do. A couple weeks before his death his health took a turn for the worse and he quickly began losing connection with the world. He did go to the hospital and tests were done and drugs given, but we soon understood that he wouldn't recover and we brought him home. The hospice nurses and caregivers were wonderful. All his children came as did many old friends. He died in his sleep in his bedroom with his wife and children there. Both had advanced directives requesting minimal effort to prolong their lives. My grandfather here wanted no heroic efforts and "no machines". Even so, a lot of intense discussion among his children was involved in coming to peace and/or acceptance of what exactly that meant, what the moral and ethical implications of different interpretations were, and how best to carry out his wishes. This is what I'm now doing and what I strongly encourage you to do now: * Create an advanced health care directive for yourself. You can get forms and examples online. * Consider the various situations one might end up in and lay out as explicitly as you can what you'd like to be done or not done to you. The more specific you are, the more likely your intentions will be followed and the less your family/loved ones may have to struggle with the interpretation. * Talk to your your family and loved ones about your desires. It's a hard and awkward discussion to have but do it. Be clear and frank. Takeaway: Have an advanced directive. Be as clear, specific, and explicit as you can about your desires. Share your desires with your family, loved ones, and care providers. It is helpful not only you but form them as well.

Cass 15y ago

To everyone considering a "NO CODE" tattoo after reading this story: Don't. If you're really that serious about not wanting to be resuscitated under any circumstances, wear some kind of bracelet or necklace with those words on it, and, just as importantly, a recent date, and contact info for a person who knows your exact wishes. Make sure to update the date regularly. Medicine changes, and so do your life circumstances. If you're presenting an EMT with a ten-year-old, faded tattoo, you're placing them in an awkward position due to the lack of context. Is this a decision you made ten years ago and got stuck with, or are these your current wishes? They might end up disregarding your wishes just to be safe. A bracelet with a recent date will be much less ambiguous. And remember, with all medical decisions, you want the ability to change your mind when medical advances are made or your circumstances change. Tattoo removal sucks.

janzer 15y ago
Not to mention that at least where I'm from a tattoo will not and cannot be accepted by EMS personnel as a valid order. Here is the relevant part from our Medical Control treatment protocols on what can be accepted as a valid do not resuscitate order: "Patient is wearing a do-not-resuscitate identification bracelet which is clearly imprinted wit the words “Do-Not-Resuscitate Order”, name and address of declarant, and the name and telephone number of declarant’s attending physician, if any OR The EMS provider is provided with a do-not-resuscitate order from the patient. Such an order form shall be in substantially the form outlined in Annex 1 or 2 and shall be dated and signed by all parties." Anything else and we are required to follow all the regular resuscitation efforts.
- vacri 15y ago
  How bizarre that they'll accept 'do not resuscitate' on jewellry, but not tattooed across the chest. "Do we think he really meant it? Nah, he just got the tattoo - if he really meant it, he'd be wearing one of those constantly annoying bracelets"
  - mfringel 15y ago
    What if "NO CODE" is the name of a band? You're asking someone to make a quick life-or-death decision on ambiguous data when there is a clearly known and socially agreed upon way to express the sentiment. Having it on an annoying bracelet that is explicitly used to signal medical intent sounds pretty good to me.

VMG 15y ago

One alternative that hasn't been mentioned here is cryopreservation. Once I have the resources and the technology has progressed, I'd certainly choose that option above being treated and "NO CODE".

Jach 15y ago
Totally on board with cryonics, it's really depressing that it gets swept under the rug considering it probably has at least 5% chance of working for a patient suspended today. Though your excuses for presently avoiding it seem pretty flimsy unless you're really dirt poor (I'd wager unlikely), especially when life insurance payable to the cryonics company is cheap (you only need $28-$35k for CI) and so are membership fees ($120/yr or $1,250 once for CI; I spend more than $120/yr on fast food). But don't get upset, my excuses for not being signed up yet are pretty flimsy too.
- VMG 15y ago
  It's not exactly about the money - I'm in Europe and the only providers I know of are situated in the US. The last time I looked into it they needed a DNA sample from me in person, so at least I'd have to book a trip to go there. But from a cost-benefit perspective, it still is pretty flimsy. Definitively one of my worst cases of akrasia.
- dennisgorelik 15y ago
  Where did you get this "at least 5% chance of working" number for cryonics? It's at least 3 orders of magnitude lower than that: no one was recovered from that frozen state alive so far.
  - VMG 15y ago
    Your estimate hasn't any foundation either. The question is if we can recover people in the future. The chance of that is basically an unknown. However I'd put it above religion and similar things, which makes it worthwhile.
    - 15y ago

defdac 15y ago

Tonight I will tell the mother of our child that if I reason in any way that resembles this article she should slap me in face and tell me to fight for my life. For my daughter and my own sake. In Sweden medical care is free. I can fight as long as I want without them getting in trouble. I also suspect I should fight so hard as if the illnes is truly terminal I will end sooner in flames, not later. I want all the tubing. I want the cracked ribs and surgeons transform me to a piece of blubber and then anlyze the hell out of it so anyone else don't have to go through the same thing. Telling people to give up because of money or some sort of gentleness to yourself or your family is alien to me. Maybe it's our harsh climate uphere. Swedes seems very in tune with our suffering.

krig 15y ago
Interesting. I found myself responding to the article in much the same way as you. Also Swedish. The question is: are we being rational or deluded? I have friends who are medical professionals and I don't recognize them in this either: I highly doubt any of them have NO CODE tattoos or anything equivalent. I suspect society shouldering most of the cost might be a factor: with a privatized payment system, there are perhaps incentives to go too far that aren't there when there's no profit to be made? That's pure conjecture, though.
- Cass 15y ago
  This is not a question of being "rational", and there's no right or wrong answer. People make trade-offs between quality and quantity of life every day. Do I want to quit smoking, drinking, drugs, and take up sports, etc for a chance at a longer, healthier life? Or do I grab all the fun I can, and if it costs me ten years, oh well? The right decision will look different for every person - and it's not black or white, but a continuum. The choice of how much pain is worth it for how much of a chance at a longer life is going to look different depending on your religion, your responsibilities, your age, your experiences with pain, your family, your culture, etc. And yes, of course the cost of treatment will factor into that decision for both the doctors and the patient.
  - 15y ago

Gatsky 15y ago

What's the message here? That people shouldn't have chemotherapy? That we shouldn't do resuscitation? That all advanced cancers should just receive palliative care? This seems to be a rant ie. the author has a strongly held notion that he has disguised as an argument devoid of any nuance. The support for his argument is that doctors secretly run a mile away from hospital whenever they get sick. This is not true and a gross generalisation. Cause guess what, not everyone has a loving family or a house in the hills or a cousin with a big screen TV to go to when they are dying from a terminal illness. Some people want to try and fight their disease, and they are tenacious and brave and admirable and that's dignifying to them and to those that try and help them. This article is an attempted justification from someone who has lost faith in what they do, nothing more.

antoinehersen 15y ago
The message is that there is another choice. I read it as giving people a different perspective on end of life care. The system is heavily biased toward all out medical care. This article show the other side, using as examples people who have a better understanding of the tradeoff. This decision will always be a personal one, there is not right or wrong answer, just different possibilities.

OoTheNigerian 15y ago

People should differentiate between terminal illnesses and acute illnesses like heart attacks. For the later, I am sure the OP has no problems with treatment. The leader of the breakaway Republic of Biafra died this week. He was less than a vegetable for 8months until his death. Here was a man who was larger than life reduced to helplessness. At the age of 78, I am wondering why he was tortured for these 8 months so he would be 'alive'. I am certain if he had the choice, he would have preferred to go with dignity. Unfortunately, people never want to prepare for such things. When it happens, their end is determined by others. My President Yaradua, also had the most undignified of ends possible. In theory Ariel Sharon is still alive. http://en.wikipedia.org/wiki/Ariel_Sharon http://en.wikipedia.org/wiki/Ariel_Sharon I want my end to be dignified. If God forbid, I have a terminal illness, it will not be a hard decision to make. Quality NOT Quantity.

rbanffy 15y ago

I was married to a doctor for 10 years. Before that, I lived with my aunt, also a doctor. The one thing that absolutely shocked me is how they thought about aging and death. I kept reminding them their goal should be to find cures for everything, no matter how hard it seems. I approach every engineering problem as solvable. Maybe I can't solve it right now with the tools I have. Maybe I can't figure out a way to solve it and will have to leave it for the next generations. To absolve yourself because something is inevitable is a coward solution. So, no, thank you. If that's what it takes to survive, I want to be cut open, sliced, probed, and, when everything else fails and I finally die, I want doctors to learn something from my death. I want them not to give up and, if they can't treat some condition, go out and invent a way to do it. You don't give up solving a problem just because it's hard. It's their job and it's reasonable for us to expect them to do it.

DavidMcLaughlin 15y ago
I think this is a great way to think about it. People who try everything to extend their life do not die in vain. Over ten people in my family in the last ten years have been diagnosed with cancer and so far we've only lost one. The person who didn't make it was the youngest of all the victims, but his tumour was also somewhere the doctor's didn't see that often - the bile duct near the liver. The number of operations and suffering he had to endure still lives with me to this day and I could see why any doctor would choose not to go through this if they had to see such futile attempts at extending life end the same way. They flew in special equipment from the USA that was deemed highly experimental and would cut him open and try it out, only to have to cut him back open a few weeks later to remove what they put in. They tried surgery after surgery in the hopes something would be successful. They did not save his life but I like to think they at least learnt something about a cancer they simply don't see that often, that gave the next person a better shot. When they finally told him there was nothing more they could do, he asked them to stop all further treatment and to let him die on his terms. The outlook for patients with breast, stomach, lung, testicular, skin or any other form of "common" cancer used to be as bad as pancreatic or bile duct cancer, but these days it's not a death sentence and a lot of people had to lose hard fought battles to get to this point.
gravitronic 15y ago

RobbieStats 15y ago

I'm conflicted about this. On the one hand I don't want to be hooked up to a ventilator or go through extreme suffering to prolong life. On the other hand, my grandmother (who recently passed away) went through late stage breast cancer in her mid-50s, lung cancer in her 60s, had a severe heart attack in her 70s and died in her 80s. It was so bad one time the doctors told us she would die in a matter of days. After she recuperated, she lived another 8 years. She was a tough bird. How many times have we all heard: "The doctors gave him 6 months to live and that was 5 years ago". So if I knew I could go through 3-6 months of severe pain and get another 5-10 years of high quality life with my family, I'd probably do it. The problem is you may go through 3-6 months of severe pain and then die in month 7. Right now being in my mid-30s and with a young daughter I enjoy, I'd take on the fight. If I was in my 80s, probably not.

mikeash 15y ago
How was your grandmother's quality of life in those last 8 years after the doctors said she had just a few days left? As for "The doctors gave him 6 months to live and that was 5 years ago," keep in mind that you get a horribly biased sample. People don't generally go around saying "The doctors gave him 6 months to live and he died 6 months later," even if that may happen far more often.

ck2 15y ago

Sometimes knowing too much can be bad for choice making. As a coder, I worry every time I drive that the computer could accidentally fire the airbags because of a bug in a poorly coded sensor (this happens far less frequently now but when airbags were first introduced people were killed/injured periodically http://news.google.com/search?q=airbag+recall+deaths http://news.google.com/search?q=airbag+recall+deaths ). Not the best example but things like this do affect choicemaking and corner-cutting. It's like the fable of the plumber's plumbing, never being in good shape despite his expertise. Hence doctors probably don't always make the best decisions about their own healthcare because they are either over-reacting, or under-reacting.

kghose 15y ago

Some people on this thread have harped on cost (and used it as a way to insert their own agenda about the economics of healthcare) but from my reading of the article it is really about being free to make an informed and personal choice about what the cost/benefit of treatment in terms of life quality vs life quantity is to you. It is true the writer writes from the point of view of his own choice, but on a topic such as this, that is really the only way to do it authoritatively. The point of the article, I thought, was to make us think - what would I do when/if the time comes?

conorh 15y ago

My wife is a surgeon and sees these situations constantly, a patient whose family has asked that everything be done for them. They spent months in the ICU hooked up to machines, incredibly uncomfortable and often, if they are aware, extremely depressed. And then they die. This is traumatic for everyone involved. She (and I) would never go through this by choice. I can't stress that enough. This is not about money, this is about leaving life in the best possible way, on your own terms, with your family and as comfortable as possible.

msimonovic 15y ago

http://xkcd.com/936/ http://xkcd.com/936/

zeynalov 15y ago
False. Most of computers don't calculate every digit separately but they start to test most used words then other variables. This means, Igotoschool is much easier to guess than 8h9. Hacking programs have dictionaries and most of passwords are plain words.

thisisnotmyname 15y ago

It would be nice if the author provided a citation or two to back up the sweeping statements he or she is making.

js2 15y ago

Two related stories I thought of while reading this: 1. A Pacemaker Wrecks a Family's Life - http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=all http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.htm... 2. A Tale of Two Hearts - http://thestory.org/archive/the_story_111811_full_show.mp3/view http://thestory.org/archive/the_story_111811_full_show.mp3/v... The second is an audio program.

pingswept 15y ago

"It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment." I strongly disagree with this part. Before patients become patients, the vast majority of us have no interaction with the health care industry and certainly no significant capability to influence it. Doctors, on the other hand, spend their adult lives working as professionals in the industry. To say that they, as a group, are anything but complicit is wrong. Consider the "Fuck passwords" article[1] that's on the HN front page now. As a programmer who has dealt with passwords, the sad state of authentication is, in part, my fault. I could make the same excuse, "Well, the users don't want long passwords, and Facebook and G+ are part of the problem, and blah blah. I'm a victim of a larger system" That would be lame. Like the doctors, I'm one of the professionals in the field, so it's my responsibility. [1]: http://news.ycombinator.com/item?id=3313790 http://news.ycombinator.com/item?id=3313790

dennisgorelik 15y ago

Original URL does not work at this moment. cache:zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/

iguanayou 15y ago

Is it possible that "get medical treatment" or "go in peace" is a false dichotomy?

radu_floricica 15y ago
Of course it is. The dichotomy is between going in peace and doing absolutely everything possible, regardless of costs, to live a bit more.

jballanc 15y ago

For everyone contemplating the prospect of hospice care vs "fight to the very end", this study might be of interest [PDF]: http://www.nhpco.org/files/public/jpsm/march-2007-article.pdf http://www.nhpco.org/files/public/jpsm/march-2007-article.pd... The salient point: > For the six patient populations combined, the mean survival was 29 days longer for hospice patients than for nonhospice patients.

pedoh 15y ago

What are the best ways to make our preferences to our loved ones clear? Is it sufficient enough to have a living will, for example? Are there documents out there that I should be carrying in my wallet, and do paramedics seek these documents out in an emergency?

philwelch 15y ago
> What are the best ways to make our preferences to our loved ones clear? Tell them. I would recommend going through scenarios with them. Everyone thinks of the persistent vegetative state, but it's very unlikely you'll end up in one. It's more likely you'll be days away from death and passed out in a haze of exhaustion and morphine, with a ventilator doing little more than prolonging this scenario. Do you want the ventilator removed? Do you want CPR if you're hospitalized for a terminal condition? What if you're hospitalized for a non-terminal condition? > Is it sufficient enough to have a living will, for example? It sure helps, so do that. But also make sure to designate one of your loved ones in particular as your power of attorney. Make sure it's someone who understands and is capable of carrying out your wishes. That person will stay in close contact with health care professionals and has the legal right to make any and all decisions should you be incapacitated. In my limited experience, no one even looks at the living will if there's someone with clear power of attorney telling them what to do. This person has an even more important job, at least in the American health care system: they're often the only one who talks to all the doctors and has the big picture. If you're seeing five different specialists, and they're all talking about their own specialties, no one is necessarily in charge of the big picture. In the outpatient world you have a primary care doctor, but when you're hospitalized, this guy's out of the picture. There is probably a hospitalist in charge of your care, but just like the nurses, the hospitalists rotate on shifts, and don't really coordinate with specialists so much as just trying to keep you alive. You need someone to be power of attorney, and to take the job seriously. One of the striking things, to me, about Steve Jobs' biography was that even for him, this was true--his wife was the one coordinating the doctors and keeping in charge of the big picture. > Are there documents out there that I should be carrying in my wallet, and do paramedics seek these documents out in an emergency? No. I've had paramedics at my house for my dad twice, and they never looked in his wallet. On the other hand, I was there both times. The job of a paramedic is to stabilize you, gather whatever information they can, and take you to the ER. They probably don't give a shit about your wallet or your cell phone. Whatever procedure there is for identifying someone's next of kin and finding their advance directives, it's done in the hospital. Most of the time they just ask you, if you're conscious, and they ask whoever is physically with you at the time. They would only resort to searching you and your effects if you were completely alone, or if no one around you knew anything or anyone. So designate your power of attorney and designate that person as your emergency contact at work. If you don't live with that person, make sure a neighbor or roommate or someone else you live with or close to has that person's number programmed into their phone and knows to contact them. You want a person you trust, not just a tattoo or bracelet or document, in charge here.

tptacek 15y ago

The CPR example that's used throughout the article is a bit weird, isn't it? Isn't CPR performed when someone has no heartbeat? What does it matter if you crack their ribs? It's only painful if the person survives. I'm not debating whether people should attempt to prolong their lives with aggressive chemo, just picking a nit.

wvenable 15y ago
If I was in an accident or an illness today -- I'd want them to crack my ribs and so on. In 50 years or so, when I'm 80 and in poor health I'm not sure I'd want the same thing.
- learc83 15y ago
  Yeah that's the author's point. Chronically ill or terminally ill patients receiving heroic care, not an otherwise healthy 30 year old who has an acute illness. If you're 80 and in poor health, recovery from broken ribs is likely to be extremely difficult and painful.
vacri 15y ago
CPR is done on unconscious people who are not breathing. They may have no heartbeat, or it may be an irregular one. CPR shouldn't be done on someone that can feel the pain at the moment of the ribs breaking, correct.

AznHisoka 15y ago

can someone please post this entire article or a cached version?? been trying to read what the commotion/drama is all about for the past 6 hours and I'm dying here...

gbak 15y ago

For some reason the site is down and the cache link on google takes a while to load. For everyone that wants to read it I created a public Google Docs file with the article. You can access it here: https://docs.google.com/document/d/1yL1659zNXQ7M9uXIcRrcu9dJ2i0xTHfTHD5hzJCp5ww/edit https://docs.google.com/document/d/1yL1659zNXQ7M9uXIcRrcu9dJ...

boneheadmed 15y ago

I'm a medical doctor and I'll never forget what one of our respected (and elderly) liver specialists said when asked what he would do regarding a patient with a liver cancer with a particularly poor prognosis. During a roundtable discussion, various younger doctors came up with lengthy suggestions and lots of different chemotherapy regimens, tests, etc. When it was this doctor's turn to speak, he said: "Well, if I were to put myself in that man's shoes, I would go to the store, buy a case of fine liquor and drink myself happy for the next few weeks until I'm gone." He had seen enough "therapies" to know enough when to forgo them.

pauncejones 15y ago

Hospice nurses helped both of my parents die as quickly and peacefully as possible. My father had congestive heart failure - a slow death over months, and my mother had dementia, and eventually started losing the ability to control her basic functions like breathing and swallowing. If it weren't for the kind advice of my mother's doctor, who instructed all of her caregivers NOT to allow her to be taken to the hospital or be picked up by an ambulance, she might have ended up in a vegetative state in a hospital as well. He explained how it's a hospital's duty to do everything in their power to resuscitate someone, regardless of whether it's really humane or not. It was awful watching them both die, but sitting with your family while you're given liquid morphine is much better than going through a frightening, painful, lonely death in a hospital.

maurits 15y ago

Very interesting story, but I do wonder if its assertions universally hold. This looks like an excellent research question for the guys at freakonomics (http://www.freakonomics.com/blog/ http://www.freakonomics.com/blog/) to me.

martin1b 15y ago

While this article is interesting, it should make clear that basic necessities for life MUST be maintained. Everybody needs food and water to live by ordinary means, all medical technology aside. However, life support is not required and is considered extraordinary. Quality of life is something to achieve with the inclusion that these basic needs are met. If not, the quality of life is a personal opinion and can be interpreted in any way, from conservative, to ridiculous.