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How Doctors die. It’s not like the rest of us (2016)

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Re: How Doctors die. It’s not like the rest of us (2016)

#51

Today's medicine is focused to treat the diseases, refusing to admit that people at 70-80 years old die not from disease, but from the old age. Everybody but a few enthusiasts refuse to treat ageing instead of cancer or heart diseases. People in general refuse to treat ageing as a disease, thinking it is something natural. I would not want a couple more miserable years on earth, I want a few million years of a health…

You could achieve more life by reactivating more regeneration, but DNA replication is costly when you do it over and over again, damaging telomeres.[1]

And uncontrolled regeneration can give you tumors [citation needed], so there is no easy path other than your own genetics or having a good lifestyle.

[1] https://en.wikipedia.org/wiki/Telomere

Even rivers and stars have an end...

Re: How Doctors die. It’s not like the rest of us (2016)

#52
I took two psych classes in University. One was "Death and Dying". Perhaps a morbid class to take in your 20s, but it was a full class. The professor happened to be dying herself as she taught it. Very useful and enjoyable. It's one of the few textbooks I've kept since the long-ago graduation. A very useful course to take.

Re: How Doctors die. It’s not like the rest of us (2016)

#53
post #28
post #5

Earlier quoted context omitted.

Here’s some actual data: “Most physicians would forgo aggressive treatment for themselves at the end of life, study finds” https://med.stanford.edu/news/all-news/2014/05/most-physicia...

Take it with a grain of salt just like any self reported study. Their preference may very well change when they become the patient.

“Everybody has a plan until they get punched in the face.” -Mike Tyson

Re: How Doctors die. It’s not like the rest of us (2016)

#54

I took two psych classes in University. One was "Death and Dying". Perhaps a morbid class to take in your 20s, but it was a full class. The professor happened to be dying herself as she taught it. Very useful and enjoyable. It's one of the few textbooks I've kept since the long-ago graduation. A very useful course to take.

in one view, most everyone is dying, while they read this.. a colleague did some hospice volunteer work for a while, and I made sure to quietly mention to her that I found it commendable and important.

Re: How Doctors die. It’s not like the rest of us (2016)

#55
post #35

I long ago decided that if I got a terminal disease, I would refuse any treatment that would extend my quantity of life at the expense of my quality of life. I've seen what chemo does to people. No thank you. If I get cancer, I'll just self-medicate with whatever opioids I can get my hands on until either the cancer kills me or the pain gets bad enough that the opioids stop being able to do anything for it, at which…

Don't be so quick to decide this now -- consider your options at the time, if such a thing arises. It may not be so cut & dry as "terminal" and there's a huge amount of variability in how cancer diagnoses go. In the meantime, take the best care of your body you possibly can :)

If you don't decide it now and write it down in a living will, you may be unable to make that decision when you need to.

Re: How Doctors die. It’s not like the rest of us (2016)

#56

Years ago, Charlie, a highly respected orthopaedist 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% to 15% – albeit with a poor quality of life. Charlie was uninterested…

Given a long enough time horizon the chance of survival for anyone approaches 0%. At a certain point we got to come to terms with the inevitability of death. It really does not make sense to be performing elaborate, expensive proceedures on the elderly.

Re: How Doctors die. It’s not like the rest of us (2016)

#57
post #10

My mom struggled with lung cancer for two terrible years with cutting edge treatment, and died badly. My dad cared for her through that, and when his turn came five years later, he had no doubts. He refused all but palliative care and died in two months. What he saw once, a physician will see over and over ad nauseam. Having seen one of each, I'm not conflicted over which path I'd take.

On the other hand, my sister was told to put her affairs in order. She did the major surgery and the chemo, and just passed 10 years cancer free. Odds of her outcome were something like 5%. She's well aware of how lucky she is.

Posted article doesn't seem to be accessible right now so apologies if I'm repeating something it says, I couldn't RTFA.

"Being Mortal" by Atul Gawande talks about this. He mentions Stephen Gould's essay, "The Median Isn't The Message," in which Gould says:

> For most situations, however, I prefer the more martial view that death is the ultimate enemy—and I find nothing reproachable in those who rage mightily against the dying of the light.

Which is an idea I think meshes very well with the strategy of chasing low probability , high reward outcomes. Gawande's response makes a lot of sense to me personally:

> There is almost always a long tail of possibility, however thin. What's wrong with looking for it? Nothing, it seems to me, unless it means we have failed to prepare for the outcome that's vastly more probable. The problem is that we have built our medical system and culture around the long tail. We've created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets—and have only the rudiments of a system to prepare patients for the near certainly that those tickets will not win. Hope is not a plan, but hope is our plan.

He also talks about several patients he treated through the years who suffered through futile treatments while trying to become one of the lucky ones and lost what quality of life they might have had in their dwindling time.

I'm glad your sister was one of the lucky ones who had a good outcome as opposed to going through the major surgery and chemo and being one of the 95%. It also seems to me that a different mindset in these sort of situations that educate patients on palliative options and try to make their remaining time as good as it can be would reduce much unnecessary suffering.

Re: How Doctors die. It’s not like the rest of us (2016)

#58

Today's medicine is focused to treat the diseases, refusing to admit that people at 70-80 years old die not from disease, but from the old age. Everybody but a few enthusiasts refuse to treat ageing instead of cancer or heart diseases. People in general refuse to treat ageing as a disease, thinking it is something natural. I would not want a couple more miserable years on earth, I want a few million years of a health…

Is it fair to future generations who are yet to be born to write off the possibility of their ever being born because we're selfish and want to live forever? There is some limit to the number of humans we can support on earth, so if everyone is living millions of years (or more realistically let's say hundreds of years) we would have to drastically cut the world's reproduction rates.

Maybe I'm overthinking it, but I feel like that is the classic hubris of mankind to aspire to become gods. We want to control nature and life, yet our limited knowledge prevents us from understanding the ramifications of our actions until it is too late. (Under a White Sky is an interesting read on the subject)

Re: How Doctors die. It’s not like the rest of us (2016)

#59

What ticks me off no end is the folks who (often successfully) fight against physician assisted suicide. Dementia is the interesting test case, but I think should still be allowed. With all the talk about 'controlling our bodies' in terms of abortion, and I can see both sides of that one, your own life is the one thing you really own. To have that control taken away is the worst kind of insult by the state.

There are organisations in the EU that will assist suicide in certain circumstances.

Sir T Pratchett wrote extensively about being on the wrong end of dementia. He didn't have much to say about abortion when he was dealing with cognitive decline.

Re: How Doctors die. It’s not like the rest of us (2016)

#60

Today's medicine is focused to treat the diseases, refusing to admit that people at 70-80 years old die not from disease, but from the old age. Everybody but a few enthusiasts refuse to treat ageing instead of cancer or heart diseases. People in general refuse to treat ageing as a disease, thinking it is something natural. I would not want a couple more miserable years on earth, I want a few million years of a health…

Is it fair to future generations who are yet to be born to write off the possibility of their ever being born because we're selfish and want to live forever? There is some limit to the number of humans we can support on earth, so if everyone is living millions of years (or more realistically let's say hundreds of years) we would have to drastically cut the world's reproduction rates. Maybe I'm overthinking it, but I…

So you would rather die, and let everybody who live now die, for the sake of the potential future generation?
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