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I Lied When I Said We Did Everything We Could

doximity.com

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Re: I Lied When I Said We Did Everything We Could

#31

Post by furyofantares »

lukeplato wrote: post #25
caprese wrote: post #5

What is "the code" in this context? The article masterfully reveals details slowly over time, but I don't want to lean on my own understanding of what that means.

>"I wanted to tell him that if we had done everything we could she would have gone to the palliative unit or home on hospice." I'm confused by this part. It almost implies that the code also involved intentionally not saving her

It read a bit weird to me as well, but they’re saying that would have been the best option many months prior

Re: I Lied When I Said We Did Everything We Could

#32

Post by fnbr »

whatshisface wrote: post #20
busterarm wrote: post #14

Earlier quoted context omitted.

I know some parents who had a child with an extremely rare degenerative disorder that attacks the nervous system. They were wealthy enough to afford extremely good care and as such, kept their poor suffering child "alive" for 12 years longer than anyone else who had ever had the same disease. Life expectancy of newborns with this disorder is about 1-3 years. At every turn, the doctors and nurses charged with the chil…

> There should be laws preventing family members from prolonging the suffering of their loved ones. I can't think of a way to implement a law like that which wouldn't be fraught with horrible problems. Just imagine the misery associated with doctors deciding to "kill people's children," which in fact in some cases would be unjustified. (Nobody can always get it right, not even doctors.)

Assisted suicide has been legal in Canada for a few years now, and there haven’t been many major issues (other than Catholic hospitals refusing to comply with the law). Doctors aren't fools, and won't do it in cases that aren't blatantly acceptable. Most of the scenarios where it is desirable are cut and dry, and we have ethics boards/courts to handle the other circumstances.

Re: I Lied When I Said We Did Everything We Could

#33

Post by mindslight »

caprese wrote: post #11

> “You all did everything you could, didn’t you?” he asked hopefully. > I wanted to tell him no. I wanted to tell him that if we had done everything we could she would have ... I struggle with things like this. Its like I want to answer accurately, but then have to consciously remember the culture and consequences. Other people are so natural at this

> I want to answer accurately, but then have to consciously remember the culture and consequences. Other people are so natural at this

(elsewhere)

> I had seen this person once a month obviously deteriorating in line with what every prognosis and statistic would say... it was a spot on analysis

IMHO these two are inextricably linked. Most people want to live in their own emotion-mediated reality. By not innately editing your own thoughts based on their emotional implications, you're able to arrive at more correct (but inconvenient) conclusions. But everyone else still has to take the slow road.

And yes, it's very hard to get doctors to break out of that mode when communicating. The vast majority of people they see need that mode, and it's very hard to directly convey that you are non-medical but still highly technical.

Re: I Lied When I Said We Did Everything We Could

#34

Post by Retric »

bg4 wrote: post #18
busterarm wrote: post #14

Earlier quoted context omitted.

I know some parents who had a child with an extremely rare degenerative disorder that attacks the nervous system. They were wealthy enough to afford extremely good care and as such, kept their poor suffering child "alive" for 12 years longer than anyone else who had ever had the same disease. Life expectancy of newborns with this disorder is about 1-3 years. At every turn, the doctors and nurses charged with the chil…

And what's to prevent insurance companies from exploiting those laws to reduce costs and increase profits?

As strange as it sounds that's not really how it works.

It's a competitive industry. So, an insurance company's profit is based on total healthcare costs. The only way for the industry to make more money is to cover more people, or for healthcare costs to rise.

Put another way, if total healthcare spending was 0$, their total profits would be 0$. They can cut internal costs somewhat, but that's about it.

Re: I Lied When I Said We Did Everything We Could

#35

Post by hnuser355 »

jrnichols wrote: post #21
et2o wrote: post #2

Wonderful article. This is a not-uncommon situation in end of life care. It's difficult for a family to accept a tragedy like this, a loved young woman dying in the prime of her life from something untreatable. The families often are in almost some sort of denial (understandably, I'm saying that without judgment) and demand that everything be tried, even when it's futile and ends up making the situation worse like in…

> seems to me like it's a cultural thing as well. This is true. I think that it's also a religious thing as well, and almost Christians. Other religions are more accepting of death, but Christianity has taught many to sincerely believe that Jesus himself would step into the room and heal their loved one, therefore every attempt must be made to save them. This is something I've seen first hand in my years as a Paramed…

I believe this might be more prominent among uneducated folks of (at least in my neck of the woods) non-mainline American Protestant denominations. At least the doctors of the Catholic Church will specifically talk about preparation for death, dying well (also mentioned by Fred Rogers in the documentary I saw about him), etc.

Re: I Lied When I Said We Did Everything We Could

#36

Post by DoreenMichele »

I have an incurable condition and spent about 3.5 months bedridden before finally getting a proper diagnosis. My condition has a significant respiratory component.

While bedridden, I hallucinated wordless conversations with the Grim Reaper. One day, in the landscape of my mind, he rode up to me on a black steed, leaned down and peered into my face, then swirled around and rode off. I ran after him screaming "Don't leave me here! Take me with you!"

That was the last time the Grim Reaper came to see me. With his departure, I knew I would live.

I wasn't happy about it. I knew I faced a long, hard, torturous recovery. Death would have been kinder.

At some point in recent years, I found myself in a group chat. Someone joined. He was a physician who had had a patient die on him that day.

It was a case of 'agreeing to pull the plug.' The man didn't want heroic measures. He knew he was dying.

The physician described this man's final hour and how his breathing slowed, then stopped. It was weirdly cathartic. A lot of stress went out of me and never came back.

Re: I Lied When I Said We Did Everything We Could

#37

Post by gridlockd »

nautilus12 wrote: post #23

Oh man. This type of marketing makes my blood boil. I understand doximity is in the business of preventing situations like this through connecting data systems and I respect that, but are we are at a point in a society that nothing no matter how personal or sacred is fodder for the marketing machine? This is a touching story but in reality...it's sponsored content.

> This is a touching story but in reality...it's sponsored content.

Nobody is selling you anything. Doximity is a social network for health care workers. It's in everyone's interest to get this kind of information out there.

Re: I Lied When I Said We Did Everything We Could

#38

Post by metildaa »

thefifthsetpin wrote: post #28
lukeplato wrote: post #25

Earlier quoted context omitted.

>"I wanted to tell him that if we had done everything we could she would have gone to the palliative unit or home on hospice." I'm confused by this part. It almost implies that the code also involved intentionally not saving her

They did all that they could to save her from death, but in the author's opinion that's not what they should have been saving her from. As an example, they intentionally didn't save her from the agony of receiving CPR.

CPR is brutal, both for the person receiving it and the person providing it. You crack the person's ribs and end up mushifying their chest if you persist in doing CPR too long.

The other thing is without an AED (a defibrillator) the success rate of CPR is quite low, one physician I know equated it to buying time for the brain, as he had never seen CPR alone bring someone back.

Re: I Lied When I Said We Did Everything We Could

#39

Post by callmeal »

lukeplato wrote: post #25
caprese wrote: post #5

What is "the code" in this context? The article masterfully reveals details slowly over time, but I don't want to lean on my own understanding of what that means.

>"I wanted to tell him that if we had done everything we could she would have gone to the palliative unit or home on hospice." I'm confused by this part. It almost implies that the code also involved intentionally not saving her

CPR done correctly can break your ribs. Those broken ribs can then puncture your lungs.

What he means is that they did everything they could medically, at the cost of broken ribs and punctured lungs. But that it was probably not the right thing to do.

Re: I Lied When I Said We Did Everything We Could

#40

Post by diminoten »

I want to go out as a result of a series of violent mistakes trying to save my life. Why would anyone want anything else? Peaceful death is basically suicide.

Why do doctors continually perpetuate this notion that slipping softly into death (palliative care, hospice) is preferable to continually trying to avoid it by way of riskier and riskier attempts at treating the root cause?

At the very least, we could be honest about it and say what the real reason is: we don't have the resources to try everything for everyone, and normalizing a set of not-quite-everything standards is the best way to keep the average level of care up for everyone.

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