A life of quality, not just quantity
Highgate Cemetery, June 2010
Years ago, Charlie, a highly respected orthopedist 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 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.
It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.
Read How Doctors Die. It’s Not Like the Rest of Us, But It Should Be. A thought-provoking piece by Ken Murray, MD.
Answers to questions you might be asking, unless you wandered onto this site purely by accident >>>
February 10th, 2012 at 16:02
Thank you Jessica for posting this in your blog. In the hospital I work in, I have seen families spending the little they have and incurring huge debts to be able to provide for expensive medical procedures and medicines that will only prolong life but not improve its quality eg, spending 5k 3x a week for dialysis for a 76 year old man who clearly would be better off spending his remaining days at home surrounded by loved ones. One of the factors may be that the latter option was not presented to the patient and his family by his attending physicians (at this point in time, the patient may have a family physician, a cardiologist, a pulmonologist, a nephrologist, an endocrinologist attending to him.) A study done in Canada, a first world country, showed that psychiatric residents, whose competency should include palliative care medicine, feel that they don’t know enough about palliative care medicine. If they don’t know enough, it can be safely assumed that they cannot convincingly offer that option to their patients.
Be that as it may, one of the things we can do to prepare to go gentle into the night is to make advance directives, no matter what age you are and no matter what state your health is in. In that document, one can state one’s wishes in terms of medical care and who decides for you in case you can no longer decide for yourself. More about advance directives here: http://www.mayoclinic.com/health/living-wills/HA00014. You might also want to include the theme for your funeral.
You can have your advance directives notarized especially when you have relatives warring over their possible inheritance when you die. Unfortunately, not a lot of lawyers know about advance directives either. We can all get educated together.
February 10th, 2012 at 22:23
i’m reminded of a documentary i saw about medical costs. i forget which canadian channel it was on. one terminally ill old lady they featured had already racked up hundreds of thousands of doctor fees, hospital stay, procedures, etc. when they looked at the details of those charges, one of the procedures done to her was a pap smear. yes, a pap smear on a senior citizen who was dying anyway.
so partly it’s hospitals trying to make money and also partly because of the north american mentality. in that same documentary, the relatives of a very sick (also old) person did not want to refuse treatment even though it had been explained to them that the treatment will not cure, merely prolong the patient’s bedridden, unconscious life. it seemed counterintuitive to them to just let nature take its course or immoral to unplug the breathing machine that kept the patient alive. it seemed like they had to fight every time, to conquer and not accept defeat from death. under certain circumstances, i would fight too, if i had young kids. but if i’d already lived a full life and was a senior citizen, i’d throw one huge party and refuse treatment too.
February 10th, 2012 at 22:23
btw, just to clarify: i saw the documentary on a canadian channel but it was about american medical costs. the 2 cases i mentioned above were americans. =P
February 11th, 2012 at 00:07
I’ve only been hospitalized once in my life and it was only for a day. I had a private room, a TV, and decent amenities but I almost went bonkers. An hour seemed like a week and I always kept asking my cousin what time it was. I just wanted to get out of there. The fun part was when I threw up on the medical technologist.
I’ll repost this in my FB to inform everyone I know. Hehehe.
February 11th, 2012 at 19:13
my mother died in a hospital all alone. but only after one and a half years and thousands of pesos later. i wouldn’t have made this choice for her if i only i were already one of the adults deciding in the family back then.
and now i have an aunt with diabetes with glaucoma as a complication. she’s been through three surgeries for this glaucoma. and she doesn’t want to give up consulting doctor after doctor who are all just giving her false hope in my opinion.
i don’t understand how people cannot sense the “scamming and scheming” pattern in the overly simplified scenarios i’ve mentioned.
February 11th, 2012 at 19:34
I just spent some time in a hospital today. It was at _EU N_MF in Fairview.
I was in line at the XRay Department, with my son who was having an Xray for his asthma checkup.
I saw an elderly woman in a gurney, and I struck up a conversation with her companion; who turned out to be her daughter. I advised her to change hospitals ( I know, I work at that institution and they cost as much as St. Luke’s) and she told me that they had so far spent 1.5 million pesos for their mother. They had used Philhealth, PCSO and had been successful at getting money from relatives overseas. I asked her if it was worth it; if she thought the quality of life and the pain her mother was undergoing was not enough (the poor old lady was moaning for her) and she said “yes” in a heartbeat. She said her mother was a fighter. Her mother wanted to live whatever the cost. I bet she would have sold the shirt off her back to keep her mother living.
I guess we all have different perceptions of life and quality of living. The medical industry is there to keep people employed; same as most industries.
February 11th, 2012 at 20:20
i mean, “hundreds of thousands of pesos in hospital and medical bills later.”
February 12th, 2012 at 00:45
So why do people do it? Is it perhaps to assuage their past or future guilt, with respect to their family members? Or simply because they believe that it the right thing to do, an end in itself?
I am really struck by statements like, “wanting to live whatever the cost.” I don’t get it — isn’t quality of life far more important than mere length?
And then again, we can only think these things because we have been exposed to alternative ideas, different views of looking at these things. For most people, not only in the Philippines but also most everywhere else, prolonging life (their own and their loved ones’), whatever it takes, appears to be an end in itself.