How Doctors Die • Hacker News Board

Re: How Doctors Die

#21

Post by defdac » Mon, Dec 05, 2011, 9:55 AM UTC

Tonight I will tell the mother of our child that if I reason in any way that resembles this article she should slap me in face and tell me to fight for my life. For my daughter and my own sake.

In Sweden medical care is free. I can fight as long as I want without them getting in trouble. I also suspect I should fight so hard as if the illnes is truly terminal I will end sooner in flames, not later.

I want all the tubing. I want the cracked ribs and surgeons transform me to a piece of blubber and then anlyze the hell out of it so anyone else don't have to go through the same thing.

Telling people to give up because of money or some sort of gentleness to yourself or your family is alien to me. Maybe it's our harsh climate uphere. Swedes seems very in tune with our suffering.

Re: How Doctors Die

#22

Post by krig » Mon, Dec 05, 2011, 10:04 AM UTC

defdac wrote: post #21

Tonight I will tell the mother of our child that if I reason in any way that resembles this article she should slap me in face and tell me to fight for my life. For my daughter and my own sake. In Sweden medical care is free. I can fight as long as I want without them getting in trouble. I also suspect I should fight so hard as if the illnes is truly terminal I will end sooner in flames, not later. I want all the tub…

Interesting. I found myself responding to the article in much the same way as you. Also Swedish. The question is: are we being rational or deluded?

I have friends who are medical professionals and I don't recognize them in this either: I highly doubt any of them have NO CODE tattoos or anything equivalent. I suspect society shouldering most of the cost might be a factor: with a privatized payment system, there are perhaps incentives to go too far that aren't there when there's no profit to be made? That's pure conjecture, though.

Re: How Doctors Die

#23

Post by Cass » Mon, Dec 05, 2011, 10:10 AM UTC

latch wrote: post #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.

Medical research benefits hugely from terminally ill patients who are willing to try anything for even two more months of painful life. There are a lot of of experimental, highly dangerous cancer treatments that could never be justified if not for the fact that even without them, the patient would have about two months to live.

That said, there will always be enough patients who want to fight for their life no matter the cost (see other comments on this page for evidence) that if you'd prefer to die in peace, you certainly shouldn't feel obliged to play the guinea pig for science.

Re: How Doctors Die

#24

Post by sireat » Mon, Dec 05, 2011, 10:13 AM UTC

dcurtis wrote: 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…

Probably most of us belong into "Dum spiro, spero" category, but I have known some non-doctors who have taken option no.1 (painless death) and even accelerated it.

Re: How Doctors Die

#25

Post by DanBC » Mon, Dec 05, 2011, 10:15 AM UTC

latch wrote: post #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.

Science doesn't work like that.

To get meaningful results you need a large sample size, with a control group, with patients not knowing whether they're getting the new medicine or the old medicine[1] and with doctors not knowing either. Then you need to write that up and analyse it.

Many patients are happy to take part in such trials, but it's hard to get ethics panel approval.

[1] you tend to test against current best treatment, not placebo, because almost anything works better than nothing and by the time you test the treatment in humans you need to know if this is better than what you're already doing.

Ethics panels have some weird effects -

(http://www.badscience.net/2011/03/when-ethics-committees-kil...)

Re: How Doctors Die

#26

Post by Gatsky » Mon, Dec 05, 2011, 10:19 AM UTC

What's the message here? That people shouldn't have chemotherapy? That we shouldn't do resuscitation? That all advanced cancers should just receive palliative care?

This seems to be a rant ie. the author has a strongly held notion that he has disguised as an argument devoid of any nuance. The support for his argument is that doctors secretly run a mile away from hospital whenever they get sick. This is not true and a gross generalisation.

Cause guess what, not everyone has a loving family or a house in the hills or a cousin with a big screen TV to go to when they are dying from a terminal illness. Some people want to try and fight their disease, and they are tenacious and brave and admirable and that's dignifying to them and to those that try and help them.

This article is an attempted justification from someone who has lost faith in what they do, nothing more.

Re: How Doctors Die

#27

Post by Cass » Mon, Dec 05, 2011, 10:24 AM UTC

krig wrote: post #22

defdac wrote: post #21

Tonight I will tell the mother of our child that if I reason in any way that resembles this article she should slap me in face and tell me to fight for my life. For my daughter and my own sake. In Sweden medical care is free. I can fight as long as I want without them getting in trouble. I also suspect I should fight so hard as if the illnes is truly terminal I will end sooner in flames, not later. I want all the tub…

Interesting. I found myself responding to the article in much the same way as you. Also Swedish. The question is: are we being rational or deluded? I have friends who are medical professionals and I don't recognize them in this either: I highly doubt any of them have NO CODE tattoos or anything equivalent. I suspect society shouldering most of the cost might be a factor: with a privatized payment system, there are pe…

This is not a question of being "rational", and there's no right or wrong answer. People make trade-offs between quality and quantity of life every day. Do I want to quit smoking, drinking, drugs, and take up sports, etc for a chance at a longer, healthier life? Or do I grab all the fun I can, and if it costs me ten years, oh well? The right decision will look different for every person - and it's not black or white, but a continuum.

The choice of how much pain is worth it for how much of a chance at a longer life is going to look different depending on your religion, your responsibilities, your age, your experiences with pain, your family, your culture, etc. And yes, of course the cost of treatment will factor into that decision for both the doctors and the patient.

Re: How Doctors Die

#28

Post by earl » Mon, Dec 05, 2011, 10:24 AM UTC

krig wrote: post #22

defdac wrote: post #21

Tonight I will tell the mother of our child that if I reason in any way that resembles this article she should slap me in face and tell me to fight for my life. For my daughter and my own sake. In Sweden medical care is free. I can fight as long as I want without them getting in trouble. I also suspect I should fight so hard as if the illnes is truly terminal I will end sooner in flames, not later. I want all the tub…

Interesting. I found myself responding to the article in much the same way as you. Also Swedish. The question is: are we being rational or deluded? I have friends who are medical professionals and I don't recognize them in this either: I highly doubt any of them have NO CODE tattoos or anything equivalent. I suspect society shouldering most of the cost might be a factor: with a privatized payment system, there are pe…

I'm an american and for me, it's not an issue of cost. The issue is how do you want to end your life on this earth. My father died of lymphoma when I was 17; he got it twice. The survivorship rates if the first set of treatments didn't work were not awesome. In his case, he died after multiple rounds of chemo and radiation and surgeries, incisions that didn't heal for multiple months, collapsed veins leading to a shunt installed in his chest, persistent nausea for half a year, so much pain that if properly medicated he was barely lucid, being forced into a wheelchair, having to wear a diaper, bleeding from his eyes and mucous membranes, etc.

Having seen his tour of the medical system, I desperately hope that if I were ever in that position, I'd have the strength to say no: treat the pain and I'll die in peace.

Re: How Doctors Die

#29

Post by janzer » Mon, Dec 05, 2011, 10:27 AM UTC

Cass wrote: post #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 circumstanc…

Not to mention that at least where I'm from a tattoo will not and cannot be accepted by EMS personnel as a valid order. Here is the relevant part from our Medical Control treatment protocols on what can be accepted as a valid do not resuscitate order:

"Patient is wearing a do-not-resuscitate identification bracelet which is clearly imprinted wit the words “Do-Not-Resuscitate Order”, name and address of declarant, and the name and telephone number of declarant’s attending physician, if any OR

The EMS provider is provided with a do-not-resuscitate order from the patient. Such an order form shall be in substantially the form outlined in Annex 1 or 2 and shall be dated and signed by all parties."

Anything else and we are required to follow all the regular resuscitation efforts.

Re: How Doctors Die

#30

Post by lisperforlife » Mon, Dec 05, 2011, 10:30 AM UTC

defdac wrote: post #21

Tonight I will tell the mother of our child that if I reason in any way that resembles this article she should slap me in face and tell me to fight for my life. For my daughter and my own sake. In Sweden medical care is free. I can fight as long as I want without them getting in trouble. I also suspect I should fight so hard as if the illnes is truly terminal I will end sooner in flames, not later. I want all the tub…

My mother succumbed to cancer over 10 years back. I was in my late teens and remember the treatment being way more painful than the cure. The medical care was so bad in india that once the nurse messed up the chemo shot and delivered it wrong. This resulted in oedema. Doctors could offer nothing more than an apology. I still find a lump in my throat when I recollect those days. However, in the end, my mother rejected treatment. She did however wish to live a long life. But she could not bear the treatment. Doctors gave her 2 months. But she lived on for 8 more months on painkillers to maintain as normal a life as possible. She managed to remain cheerful and positive before us kids. Living with someone you love knowing that they would die soon is really painful.

If I am terminally ill, I will probably reject treatment and choose to go peacefully.