For all those who rely on mainstream medical advice…always looking for a quick fix or a “professional opinion”… this one’s for you. It should make you go “hmm”.
Ken Murray, MD, Clinical Assistant Professor of Family Medicine at USC writes:
Years ago, Charlie, a highly respected orthopedic surgeon and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.
It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.
Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).
Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.
To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent. “How can anyone do that to their family members?” they’ll ask. I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.
How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.
To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not.
The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.
But of course it’s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.
Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman’s terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.
Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.
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. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.
Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack’s worst nightmare. When I arrived at the hospital and took over Jack’s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.
Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of over-treatment.
But doctors still don’t over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.
Several years ago, my older cousin Torch (born at home by the light of a flashlight—or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.
We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.
Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.
My deepest desire is that you make the decision to take control of your own health. Doctors don’t live or die the way the rest of us do and it’s time to stop depending on them for a miracle cure should you face a chronic condition yourself. Do you realize that there are NO CURES FOR ANY DISEASE WHATSOEVER? Doctors are trained to TREAT your symptoms not cure your diseases. If you let that fact sink in…you’re realize that prevention should be your focus and your hope.
Your best “medicine” is within your own control through diet, exercise, fresh air, plenty of sleep AND lots of healthy water. Are you ready to fight for your own health?
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16 Comments Add yours
Really enjoy reading this article…
I’m glad you enjoyed it! Makes you go “hmmmm”.
What a moving article, full of compassion and love. As a pharmacist and lawyer, I spent decades interfacing with end of life medical care. I was present at my mother’s death from chronic obstructive pulmonary disease — at peace in her own bed surrounded by her family — and grateful we could make it so for her. Now, I serve people with “life planning” and a part of that is end of life planning. Virtually all of my clients seek “a doctor’s death” with peace and dignity, pain free. I urge everyone to visit their lawyer, or download a form from the internet, to put their wishes in writing. Expressing our personal wishes is a gift we give to those who love us.
I’m glad that you enjoyed the article. You have a unique perspective as a pharmacist and lawyer for sure…you’ve seen both sides of this battle. My mother died the same way that yours did and I wouldn’t trade it for the world. She was aware of my presence until she took her final PEACEFUL breath. Keep up the good work for your clients. It’s comforting to know that there are still kind-hearted people out there with the best interest of others in mind.
Great article focused on humane medical treatment vs. inhumane prolonging of life. I have a daughter inmedical school and I will share with her in the holes it inspires her to stay on the side of qualitylife, humane medical care despite the advances made in medicine each decade.
I’m glad you enjoyed it. A touchy subject for some but a message worth sharing nonetheless. Since your daughter is currently in medical school ask her if they discuss the CAUSE of cancer (and other chronic disease). When I have posed this question to dozens of physicians and nurses they immediately go to into the CURES or they comment on the obvious things like smoking and lung cancer. It amazes me that this isn’t discussed within the medical community (of course they are more focused on cures than prevention) but we’ve known the root cause since 1923…Dr. Otto Warburg won the Nobel prize for this discovery in 1931. The cause? Acidosis…too much acid in the body. Raising the alkaline in your body (I use Kangen water for this) is a critical component to good health! Keep fighting the fight for wellness!
This is exactly why I had both my daughters OUTSIDE the hospital. The “system” isn’t working in many instances, in death and even in birth (sometimes) letting things naturally unfold is best.
You are SO right. I can certainly understand why you would opt to have your girls outside of the hospital.
My daughter recently gave birth to my first grandson (in the hospital). I was shocked at how things have changed since my kids were born. Some good…some bad. For instance, I couldn’t believe that babies are no longer “allowed” to drink water (not until 6 months old). What? In my day we couldn’t leave the hospital until we could show that the baby WAS drinking water. Big change. The big question is, do they not them to drink water OR are they fearful of the water they’ll drink (bottled or tap)? I’d love to know the answer to that one.
My grandson (along with 8 out of the last 10 newborns that I know) was born with acid re-flux. How can a breastfed newborn have so much acid in the body that it is coming back up the esophagus? Apparently this is a common occurrence in newborns and not many of us care to ask “why”? Sad.
Keep up the good work for your family. They’re worth it! If you haven’t already done so, please “follow” this blog for updates. I think you might enjoy it.
I am a physician and I greatly appreciated this article; I agree with it wholeheartedly.
And I am also a believer in Kangen water.
How refreshing to hear from a physician on the same page! Thanks for your support AND for your “endorsement” of Kangen water. If you have not already done so, please “follow” me on this blog for updates. I would appreciate your input on future posts.
Very poignant article. My wife is a registered nurse at a local hospital and frequently talks about the issues raised in the article about excessive care provided within the hospital setting.People need to think about care issues before the time comes to make decisons about what care they or their loved one receives. People who do so provide the family with a real gift.
Someone wrote that how you die is directly related to how you lived. That is a profound statement. I guess if you’ve lived a full life perhaps it’s easier to roll with the inevitable. I guess we wont know for sure until we get there BUT I’ll vote for quality every time. Be well.
I support the concept of dying with dignity.
Of course, if people like Steve Jobs would have just pursued an aggressive attack on his cancer, he would be with us today. Instead he took a “natural” approach and died for no reason.
As a Mac user, I wish he was still here.
Thanks for your input. I think that you bring up a good point. Those of us who loved Steve Jobs may believe that he should have tried hard (aggressive methods) to beat his cancer BUT HE DIED THE WAY HE CHOSE TO DIE. Personally, I think that he died much more peacefully than if he’d gone the tradition route. A great loss for sure.
Thank you for writing this. With the aging baby boom generation looming large over our healthcare system, not to mention a generally overweight and undernourished population in the U.S., it’s clear that there will not be enough room in the hospitals, nursing homes and rehabs, nor medical staff to address it all. Television and movies tell us tales of heroic medical measures saving lives, with cutting-edge technology and tireless healthcare providers and family members willing to moves mountains, if needed. This is not realistic and will be next to impossible in the years to come. There are exceptions, of course; the young, and the seriously-ill who medicine can help to live longer lives as healthy and productive citizens. What I’m addressing are the chronically or terminally ill who have no reasonable expectation of any real quality of life as a result of medical intervention.
As a baby boomer, I saw my parents receive care in their later years that was far more than I can expect to receive. My parents drained all their life savings for their end-of-life expenses. They were lucky. Many boomers have already lost those funds, and wondering how to afford even the most limited care.
Perhaps it is altogether not such a bad thing to die a ‘natural’ death. Perhaps enjoying the time we have left is far better than putting everyone around us (not to mention ourselves) through prolonged anguish. And, as someone has already mentioned, perhaps knowing that artificially-extended life may not be possible will cause us live our lives with more passion and more purpose. I agree that we should pay more attention to the way doctors live their last days than how they can extend our last days. I respect each person’s or family’s choice in these matters but, for me, I plan to follow the doctors’ example more than their advice. Thanks again for posting this.
Carol – I agree with your comments. There probably won’t be enough hospital space, doctors or money for heath care as we’ve known it. Personally, I will opt for a more “natural” approach especially if it means that I would use all of my financial resources trying to hang on. I’d die more peacefully knowing that my children won’t suffer through a lingering COSTLY process. We can’t avoid the inevitable. At best we can prolong it…but at what cost and with what measure of quality?