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Author: xraymd Big gold star, 5000 posts Feste Award Nominee! Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 121341  
Subject: Re: Unexpected windfall Date: 6/23/2007 1:45 PM
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Modern medical science can keep the heart beating long after the body has exceeded its shelf life. Prepare for it.

I realize that I sound harsh about doctors, and I don't mean to be. I recognize that they are given little preparation for their 100% failure rate. They are trained to cure, and, as Wise Cousin Barbara pointed out after my last trip to the ER with my father, when you show up they assume that you want them to do something.

I thank God daily for people who work in hospice. They were truly a blessing for me.


Greetings, TMFPMarti, though this may be a bit off topic for the board, I am compelled to add my comments to your excellent post. I am an internist who primarily takes care of a geriatric panel (the young and healthy don't need ongoing medical care for chronic issues they don't have!).

EVERY DAY I encounter issues of when to decide not to push forth for what amounts ultimately to futile care. EVERY DAY I need to help a patient and their family decide which interventions are likely to lead to beneficial results - and which ones are little more than time, expense and discomfort without real hope of meaningful recovery.

I work in all areas of the hospital, from the ICU to the wards to Hospice, so I am informed of what types of care are delivered in each of these settings. I have to say that, when finally appropriate, Hospice is a true godsend (and I don't happen to be particulary religious). When there is truly nothing more to do that current medical interventions purport to offer, then the most humane and loving thing to do is - NOTHING - apart, of course, for honest-to-goodness comfort care that alleviates pain and distress and preserves dignity and lucidity as much as possible until the end. I have families truly astonished over how much better their loved ones do in Hospice rather than in the hospital for yet another round of aggressive medical and pharmacologic interventions with daily blood draws, hooked up to monitors, restricted mobility, no peace at night, disorented and uncomfortable - when the outcome, in the long run, is not improved for any kind of secure duration. It's as though we have become so enamored of the idea of even incremental improvements, just because modern medicine CAN, that we lose sight of what do those so-called improvements mean in any realistic context?

Your sister is completely right about the expectation on the part of the hospital MD's that should a patient appear in front of them, they are mandated to do SOMETHING. I have learned that sometimes the SOMETHING ought to be a call to the Hospice evaluator for transfer to Hospice services (whether inpatient or ultimately outpatient) for truly comfort care and to stop the insanity of test after test after test. Sometimes the most meaningful thing I can do is not to order up a firestorm of probing investigations but instead to SIT WITH the patient and the family to explain what actual benefit DERIVES to a patient when he or she can truly no longer provide self-nutrition or self-hydration and take the fear out of the thought that someone "starves to death" or "dies of thirst." Sometimes educating and clearing up misconceptions is really all it takes to confer peace and relief that the inevitable progress towards the end of life can be made with support that is fully directed towards what honestly helps. I love rounding in Hospice, which may sound somewhat strange to say to the uninitiated, but it is without doubt one of the places in the hospital system where there is a god-given sense of actual hope, and the Hospice staff are in my eyes, truly angels - and, remember, I am not religious! Just aware that when there is literally nothing else to do for someone that has acute medical benefit, then the alternative of Hospice is a blessing beyond measure. How ironic that sometimes the creation of the deepest sense of hope for everyone - patients, families and physicians - comes at the end of life when we can finally STOP doing what doesn't help and KEEP doing what clearly does.

xraymd
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