Doctors see much more death than most lay people. I remember the first few times that I stood at the bed side and watched another human being take… the last breath. It was simultaneously awe inspiring and terrifying. Something deep inside of me kept insisting that I “DO SOMETHING!” Instead, I stood quietly and watched them go.
Other times I would be assisting in a code. As a medical student I was always assigned the task of doing chest compressions — I am sorry to say that I broke many ribs of many older people who despite our efforts never had a chance of restarting their heartbeat and breathing.
We would run the codes until the patient had “Harvard Numbers.” What that meant is that the oxygen level, the pH, the potassium results all had to be normal. The patient would be dead but the blood work would be normal.
Perhaps it is because of these experiences that this article caught my eye
Here is a taste of the debate…
And yet, there is good evidence that physicians have thought out end-of-life issues more thoroughly than laypeople and are more likely to decline medical intervention. For example, they sign advance directives far more often than the rest of us do. Less than half of severely or terminally ill patients have an advance directive in their medical records. These are legal documents that indicate the kind of medical care we prefer at the end of life and where we would like to spend our last few days or weeks. Contrast that to a study published a few years back that found 64% of doctors surveyed had signed such documents. Those who had were nearly three and a half times more likely to refuse rescue care, like CPR, compared with doctors who had not signed an advance directive.
Why would doctors be so anxious to avoid the very procedures they deliver to their patients every day? For one thing, they know firsthand that these procedures are most often futile when performed on a frail, elderly, chronically ill person. Only about 8% of people who go into cardiac arrest outside of the hospital are revived by CPR. Even when your heart stops in the hospital, you have only a 19% chance of surviving. That’s a far cry from the way these procedures are portrayed on TV, where practically everybody survives having his heart shocked and undergoing CPR.
This is something I want to emphasize to older people and the people who love them. CPR is medically futile therapy. It does not work for frail older people and it wastes resources. Sometimes being “heroic” means thinking carefully about the reality of death and choosing the path that creates the most comfortable and dignified death.
Forget the TV shows. The blunt truth is that if you are lucky enough to live into old age and your heart stops beating and you stop breathing— that means it is time to go.
Read more: http://ideas.time.com/2012/01/16/what-doctors-know-and-we-can-learn-about-dying/#ixzz1jpG7imlk
Wow. I really needed this article. I am a gerontologist and my mom is in ICU now after a serious fall. My training tells me that lifesaving interventions don't work, but last night at 1 am when the phone rang, it took all my strength to say not to intubation. Thankfully, Mom had an advance directive, reminding us to honor her wishes. She is unconcious, holding her own for now, the next chapter awaits.
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