Live data from Hacker News

How Doctors Die

zocalopublicsquare.org

11–20 of 184 posts

Re: How Doctors Die

#11
post #9
post #7

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). Wh…

> 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.

No one is advocating this, especially not the health professionals involved.

...except when they wear bracelets and tatoos stating "NO CODE".

Re: How Doctors Die

#12
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.

Re: How Doctors Die

#13
post #7

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). Wh…

"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.

Re: How Doctors Die

#14
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.

Re: How Doctors Die

#15
post #11
post #9

Earlier quoted context omitted.

> 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.

No one is advocating this, especially not the health professionals involved. ...except when they wear bracelets and tatoos stating "NO CODE".

Making a choice and making sure that choice will be noted when the time of its relevance comes is not 'advocating'.

Re: How Doctors Die

#16
post #6

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…

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.

Re: How Doctors Die

#17
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.

Re: How Doctors Die

#18
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.

Re: How Doctors Die

#19
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".

Re: How Doctors Die

#20
post #6

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…

Well, when winning the lottery means living and losing equals the same thing as not playing; I'm going to play every single time.
Post reply on HN