Great Atul Gawande article about dying/hospice

[CardiacCoug]

Thought this was a very good article about dying and the kinds of decisions that doctors, patients, and their families have to make and their implications for overall health care spending.

http://www.newyorker.com/reporting/2...urrentPage=all

[beefytee]

That is a good article.

I also liked his Checklist book.

Death is certainly something that most people are not rational about. Even so-called professionals.

It's amazing how many of us see life as a binary thing. alive is good -- Dead is bad.

There really comes a point where death is merciful and life is torture.

I have a co-worker who lost his wife to Huntington's disease. It was before I had met him. It was really tough on him to watch his wife slowly degenerate. I believe (like it this article) she finally got pneumonia and they decided not to treat it aggressive and she ended up passing away. He admits that in many ways it was a relief as she didn't have to suffer anymore.

My wife has always told me to pull the plug on her the first chance I get if we get in such a situation. This bothered me at first, but I have come full circle and believe that life is so sacred that we should n'yartificially prolong it when it isn't really living at all.

Don't get me wrong, I'm against euthanasia, but I think quality of life for the last days of life is the most important consideration for the terminally ill.

[CardiacCoug]

That is a good article.

I also liked his Checklist book.

Death is certainly something that most people are not rational about. Even so-called professionals.

It's amazing how many of us see life as a binary thing. alive is good -- Dead is bad.

There really comes a point where death is merciful and life is torture.

I have a co-worker who lost his wife to Huntington's disease. It was before I had met him. It was really tough on him to watch his wife slowly degenerate. I believe (like it this article) she finally got pneumonia and they decided not to treat it aggressive and she ended up passing away. He admits that in many ways it was a relief as she didn't have to suffer anymore.

My wife has always told me to pull the plug on her the first chance I get if we get in such a situation. This bothered me at first, but I have come full circle and believe that life is so sacred that we shouldn't artificially prolong it when it isn't really living at all.

Don't get me wrong, I'm against euthanasia, but I think quality of life for the last days of life is the most important consideration for the terminally ill.

This is absolutely true. The problem is that it's tough to know exactly when death is going to come and it's human nature to hope for the best and that things will turn around. This is my favorite part of the article:

The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.

More often, these days, medicine seems to supply neither Custers nor Lees. We are increasingly the generals who march the soldiers onward, saying all the while, “You let me know when you want to stop.” All-out treatment, we tell the terminally ill, is a train you can get off at any time—just say when. But for most patients and their families this is asking too much. They remain riven by doubt and fear and desperation; some are deluded by a fantasy of what medical science can achieve. But our responsibility, in medicine, is to deal with human beings as they are. People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come—and to escape a warehoused oblivion that few really want.

[happyone]

That is a good article.

I also liked his Checklist book.

Death is certainly something that most people are not rational about. Even so-called professionals.

It's amazing how many of us see life as a binary thing. alive is good -- Dead is bad.

There really comes a point where death is merciful and life is torture.I have a co-worker who lost his wife to Huntington's disease. It was before I had met him. It was really tough on him to watch his wife slowly degenerate. I believe (like it this article) she finally got pneumonia and they decided not to treat it aggressive and she ended up passing away. He admits that in many ways it was a relief as she didn't have to suffer anymore.

My wife has always told me to pull the plug on her the first chance I get if we get in such a situation. This bothered me at first, but I have come full circle and believe that life is so sacred that we should n'yartificially prolong it when it isn't really living at all.

Don't get me wrong, I'm against euthanasia, but I think quality of life for the last days of life is the most important consideration for the terminally ill.

Oh, so true. I recently lost my mother to cancer and that last couple of months were not good. It was really difficult to see in so much pain, even with the meds. I also agree, it is hard to know when to stop fighting.

Thanks for the article - I kind of wish I had read it six months ago.

[Shaka]

My mom passed from colorectal cancer a few years ago. She suffered and fought for a few years and then said that she'd had it and refused more treatment. She lived for another year and suffered a lot but was also able to do some rewarding things until it was time to go to hospice care. When she arrived at hospice she was still mom just in a lot of pain. After one day it was as someone had flipped a switch. The mom I knew was gone and she died within a week. I've spent a lot of time pondering the very end of her life and have reached no other conclusion than she made the decision that she wanted to get it over with.

Now my dad is in a semi-vegetative state in the ICU trying to fight off a MRSA infection as well as the trauma of having shunts inserted and removed in his head. It will be interesting to see if he makes a similar decision (I'm not sure if he can consciously) in the next few days.

Thanks for posting that article.

[doctorcoug]

My mom passed from colorectal cancer a few years ago. She suffered and fought for a few years and then said that she'd had it and refused more treatment. She lived for another year and suffered a lot but was also able to do some rewarding things until it was time to go to hospice care. When she arrived at hospice she was still mom just in a lot of pain. After one day it was as someone had flipped a switch. The mom I knew was gone and she died within a week. I've spent a lot of time pondering the very end of her life and have reached no other conclusion than she made the decision that she wanted to get it over with.

Now my dad is in a semi-vegetative state in the ICU trying to fight off a MRSA infection as well as the trauma of having shunts inserted and removed in his head. It will be interesting to see if he makes a similar decision (I'm not sure if he can consciously) in the next few days.

Thanks for posting that article.

That sounds terrible. Sorry.

[Shaka]

Thanks man.

[happyone]

Shaka,

best of luck with your dad, I hope everything works out

[dabrockster]

Shaka,

I hope your father is able to make it through to make the decision he wants. I am more than willing to put his name on the prayer list at out Temple. Please feel free to boardmail me his name if you like..

[NorthShoreCoug]

Great article, thanks for sharing it, CardiacCoug.

My father died of cancer in November 2003 at the age of 83. He chose to go the hospice route about a year before he died. My mother died of cancer in May 2007 at the age of 85. She chose hospice in late February. As a result of these experiences, I'm a big advocate of hospice.

In my father's case, my brother called me 15 days before my father's death and told me the doctor thought he had about two weeks left. We packed up and drove from Colorado to Utah to see him one last time. He was weak, not in too much pain, clear-minded, but strong enough to get out of bed a bit. It was a difficult experience to share with my father, mother, siblings, and my own family - yet a very good experience. We had some good, intimate conversations with dad/grandpa with just me and one or two of my children or siblings at his bedside. On one evening, all ten of his children and their spouses gathered for a family meeting, where he expressed his love for all of us, and his testimony of the gospel. When we left to return home to Colorado, I knew I wouldn't see my father again in this life. He died peacefully, in his own bed, surrounded by family. All of my siblings except myself went to visit him that day, even though he was no longer able to communicate. Several of the older grandchildren sat by his bed and sang him songs and said their goodbyes.

My mother's passing was very similar, some of the details differ, but the same overall experience. I was living in Minnesota at the time, and my work let me go to Utah and work remotely for three weeks to spend some time with her before she passed away.

Shaka, I hope your father's situation works out in such a way as to be in the best long-term interests of your father and your family. It's a tough time in the best of circumstances.

[Shaka]

Thanks folks. We have taken care of the temple prayer roll thing but any prayers or good thoughts you folks have are deeply appreciated.