If people could see what we see don't you think they'd see things so differently?

mindlor · Dec 9, 2011

It is up to the doctors to explain the side effects and then for the patient to decide. There are many factors at play obviously so the answer will be highlt variable...

Anisettes, BSN, RN · Dec 9, 2011

Excellent article. I don't want to die at this moment either, but neither am I afraid of it. Only, as the author noted "dying in pain or alone." Though I don't even really mind the alone part either, mostly the pain. I guess because I've never been afraid of death, I don't understand the depth of fear of it that so many people have.

I mean, none of us will ever escape it, why don't we try harder to embrace the concept that none of us gets out alive in the end, some kind of ritual or exercise to prepare us so we can live without the fear of what we cannot stop from coming? We prepare for childbirth, for marriages, for parenting, for careers, etc... but we have no preparation for death, the only absolute commonality all life shares.

FLmomof5 · Dec 9, 2011

It's not just the medical care that doctors refuse for themselves that we see.

I live in SC - the stroke capital. I see a patient, DM2, HTN, bilat AKA, aphasiac from a stroke, obese and fed via G-tube, complete care.....and then go to Waffle House.....and see a local....female, obese....knowing that this woman who is currently a walkie talkie, may just end up like the woman on my floor. She doesn't see how today's choices may most likely land her in that condition. :crying2:

I wouldn't want to end up like that. I want to live until the day I die!

Double-Helix, BSN, RN · Dec 9, 2011

For many people, the hope of a possible recovery or even a slightly longer life is worth the struggle with treatments and the awful side effects. I think that, for me, if the choice came down to dying in the next few months, or enduring chemo or transplants, I would choose the treatment. I still feel like there is so much that I have left to do, and there are so many things that my family still needs me for. It would be worth my pain and suffering if I were able to recover and spend more time with them. If the treatments didn't work, at least my family would know that I fought as hard as I could to survive and stay with them. I'm sure my age plays a huge factor. If I were older, had lived more, felt my life was more complete, I might think differently.

But I don't think people that choose the hospice route are giving up or not fighting. For them, the choice to be comfortable and live out their last days with the best quality of life possible is the best choice. Hospice does amazing work and I do agree that it is the more peaceful option in many cases.

Whether or not to pursue treatment for a terminal disease is truely a personal decision. There is no right or wrong choice.

Guest219794 · Dec 9, 2011

It is generally assumed that if a person cannot make a decision, they would "want everything".

This is bizzare. If it were true, people would say:

"Even if the only sensations I appear to feel are pain and anxiety, keep me alive as long as you can."

"If I am ever so demented that I have no idea what is happening, and you think I might have a UTI, please bring in four people to hold me down, force my legs apart, and stick something inside me."

By the end of today, somebody reading this will have helped facilitate this type of "care". Maybe me.

As nurses in the ICU, we used to periodically present pt's the the health care team, in rounds. When asked what we were doing for Mrs Smith, I responded, "I am not sure I can really answer that. I can lay out what we are doing to Mrs Smith."

In 8 years, I have seen much cruelty inflicted on elderly unable to advocate for themselves. I have never seen it done to the immediate family of a doctor, or any experienced medical professional.

brownbook · Dec 9, 2011

I agree. I worked nights ICU for 5 years. I called it the "torture old people until they die unit," I wanted Do Not Intubate tattooed on my chest.

However later I came to realize I never saw, or thought about, the patients that did manage to make it to med/surg, and go home. Or if I did I visualized them as the intubated, non-responsive, patient I had in the ICU. Not as someone who made it and maybe had a few more quality months to be with loved ones?

Yet at the same time I think families and the public are unrealistic, I love hospice. I wouldn't want to put my loved one through what I saw.

I think acute care bed-side nursing is like a police officer who works in the crime ridden area of a city and thinks almost all people are cruel or vicious, because that is all they are exposed to in their line of work. When in reality it is the small percentage of people, or patients, who skewer our outlook.

KelRN215, BSN, RN · Dec 9, 2011

http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/
If people saw the suffering and the pain that so many treatments like chemo and stem cell transplants cause long term horrid side effects, don't you think they would opt for so much less invasive and costly procedures.
Long ago people never lived through all these diseases and they died much more peaceful deaths.

Working in pediatric oncology and seeing what we do to these patients (right up until the minute they die sometimes) always makes me think "if this ever happens to my child, I hope I'm strong enough to say 'enough is enough'". We have many patients who we make incredibly sick during their treatment but when they're done, they gain their weight back, the have their G-tubes and ports pulled and they go back to being a kid. If my kid ever had one of those diagnoses, I'd treat them. Then there are the other kids... the ones whose diagnosis is terminal from the day of diagnosis. The ones who we KNOW we can't cure. It feels so awful to put these kids through suffering knowing what their end result will be. One of our current patients is in the end stages of her disease (pontine glioma- a tumor that no one survives with a median life expectancy of about 9 months) and because her parents cannot accept that, they bring her in every time she has respiratory distress and she ends up intubated. They currently are pursuing a tracheostomy. Awful. A trach is not going to prevent a brain stem tumor from eventually causing respiratory arrest.

VioletKaliLPN, LPN · Dec 9, 2011

I will admit that right now, the 'healthy' me cannot fathom enduring chemo and invasive treatments for cancer which is metastatic and 'incurable'. When I am actually sick I do not know what I may think or do, perhaps my mind may change due to a fear of dying. Perhaps I may feel a sudden need to fight, regardless of invasive nature of the CA.

SuesquatchRN, BSN, RN · Dec 9, 2011

I can tell you that if I ever get cancer that is discovered only after mets I will do nothing.

VioletKaliLPN, LPN · Dec 9, 2011

^^ That is how I feel right now. I know it is going to kill me, so do I die with painful and debilitating treatments, or live my last months traveling and enjoying my time left.. I think I would rather travel.

leslie :-D · Dec 9, 2011

there are so many considerations in making these types of decisions.

the younger you are, it makes sense to endure these invasive treatments IF they are not deemed futile.

when one designates a mpoa, you really need to ascertain this person will honor your wishes.

otherwise, the mpoa often ends up choosing life at all costs, because they don't want to be 'the one' who made you die.

doctors- another group who fear litigation, and rightfully so.

as the article stated, get a pt's wishes in writing, so in event something happens, you will be protected.

in unexpected, emergent situations - educating families is key, but...

who is going to realistically absorb all this information when feeling vulnerable and emotional?

how does one make an objective decision, when feeling anything but?

as a long time hospice nurse, i can vouch that most pts come to us far too late in their dx.

and now with palliative care on board, these terminal people can continue to seek treatment while receiving comfort measures simultaneously.

we as a society, need to accept death as readily as we accept life.

only then, when we can have mature conversations about our feelings, our expectations, our hopes...

can we make decisions regarding the way we want to live...and die.

great, great article, vtachy.

leslie