Doctors do not want to die in the same way as their patients - long, expensive and in pain

2024 Author: Seth Attwood | [email protected]. Last modified: 2023-12-16 15:55

Faced with a fatal ailment, many doctors, well aware of the limited possibilities of modern medicine, choose to abandon the heroic efforts to maintain their lives.

The Power of Medicine, or How Doctors Die

Years ago, Charlie, a well-known orthopedic surgeon and my teacher, discovered a mass in his stomach. The examination showed that this formation is pancreatic cancer. The surgeon who examined Charlie was one of the best in the country; moreover, he was the author of a unique technique for pancreatic cancer that triples the five-year survival rate (from 0% to 15%), albeit with a low quality of life. But Charlie was not interested in all this. He discharged home, closed his practice, and spent the remaining few months of his life with his family. He refused chemotherapy, radiation, and surgical treatment. The insurance company didn't have to spend a lot on it.

Doctors also die, this fact for some reason is rarely discussed. In addition, doctors die differently from most Americans - doctors, unlike everyone else, use much less medical services. Throughout their lives, doctors have been fighting death, saving their patients from it, but meeting death themselves, they often prefer to leave life without resistance. They, unlike other people, know how the treatment is going, they know the possibilities and weaknesses of medicine.

Doctors, of course, do not want to die, they want to live. But they know more than others about death in the hospital, they know what everyone is afraid of - they will have to die alone, they will have to die in suffering. Doctors often ask relatives not to take any heroic rescue measures when the time comes. Doctors do not want someone to break their ribs in the last seconds of their lives, performing cardiopulmonary resuscitation.

Most physicians in their careers often encounter pointless treatment when the latest advances in medicine are used to prolong the lives of the dying. Patients die, cut with scalpels of surgeons, connected to various equipment, with tubes in all orifices of the body, pumped with various drugs. The cost of such treatment sometimes amounts to tens of thousands of dollars a day, and for such a huge amount, several days of the most terrible existence are bought, which you would not wish even for a terrorist. I don’t remember how many times and how many doctors told me the same thing in different words: “promise me that if I find myself in this state, you will let me die”. Many doctors wear special medallions with the words “do not reanimate”, some even get tattoos “do not reanimate”.

How did we get to this - doctors provide help that would have been refused on the site of patients? On the one hand, the answer is simple, on the other, it is complicated: patients, doctors and the system.

What role do patients play? Imagine a situation - a person loses consciousness, he is admitted to a hospital. In most cases, relatives are not ready for this, they are faced with difficult questions, they are confused, they do not know what to do. When doctors ask relatives whether to do “everything,” the answer, of course, is “do everything,” although in reality it usually means “do whatever makes sense,” and doctors will naturally do whatever they can. - it doesn't matter if it's reasonable or not. This scenario is very common.

In addition, unrealistic expectations complicate the situation. People expect too much from medicine. For example, non-physicians generally believe that cardiopulmonary resuscitation is often life-saving. I treated hundreds of patients after cardiopulmonary resuscitation, of which only one got out of the hospital with his own feet, while his heart was healthy, and his blood circulation was stopped due to pneumothorax. If cardiopulmonary resuscitation is performed on an elderly seriously ill patient, the success of such resuscitation tends to zero, and the patient's suffering is terrible in 100% of cases.

The role of doctors also cannot be overstated. How to explain to the sobbing relatives of the patient whom you see for the first time that the treatment will not be beneficial. Many relatives in such cases think that the doctor is saving the hospital's money or that he simply does not want to deal with a difficult case.

Sometimes neither relatives nor doctors are to blame for what is happening, quite often patients become victims of the health care system, which encourages over-treatment. Many doctors are afraid of lawsuits and do their best to avoid problems. And, even if all the necessary preparatory measures have been taken, the system can still absorb a person. I had a patient named Jack, he was 78 years old, and in the last years of his life he underwent 15 major operations. He told me that he would never, under any circumstances, want to be connected to life support equipment. One Saturday he suffered a massive stroke and was taken to the hospital unconscious. Jack's wife was not there. Jack was reanimated and connected to the equipment. The nightmare has come true. I went to the hospital and took part in his treatment, I called his wife, I brought his outpatient medical history with me, where his words about life support were recorded. I unplugged Jack from the machine and stayed with him until he died two hours later. Despite the documented will, Jack did not die as he wanted - the system intervened. Moreover, one of the nurses wrote a complaint against me to the authorities so that they investigate Jack's disconnection from life support equipment as a possible murder. Of course, nothing came of this accusation, since the patients' desire was reliably documented, but the police investigation can intimidate any doctor. I could take the easier route, leave Jack hooked up to the hardware and extend his life and suffering by several weeks. I would even get a little money for it, however, while the costs of Medicare (the insurance company) would increase by about half a million dollars. Overall, it should come as no surprise that many doctors choose to make decisions that are less problematic for them.

But doctors do not allow this approach to be applied to themselves. Almost everyone wants to die peacefully at home, and they have learned to cope with pain outside the hospital. The hospice system helps people die with comfort and dignity, without unnecessary heroic-useless medical procedures. Surprisingly, research shows that patients in hospice often live longer than patients with similar conditions who are actively being treated.

Several years ago, my older cousin Torsh (Torch - torch, lantern) - he was born at home and was delivered under the light of a hand lamp - so Torsch had seizures, the examination showed that he had lung cancer with metastases to the brain. We visited several specialists with him, their conclusion was that with aggressive treatment, which would include visiting the hospital 3-5 times a week to administer chemotherapy, he could live for another four months. My brother decided to give up treatment and was only taking medication for cerebral edema. He moved in with me. We spent the next eight months in a place like we had in childhood. We went to Disneyland - he has never been there. We walked. Torsh loved sports, he enjoyed watching sports programs. He ate my concoction and even gained a little weight because he ate his favorite foods, not hospital food. He did not suffer from pain, he was in a good mood. One morning he did not wake up. For three days he remained in a coma, more like a dream, and then he died. His medical bill for eight months was twenty dollars - the price of a drug for cerebral edema.

Torsch was not a doctor, but he understood that not only life expectancy is important, but also its quality. Don't most people agree with this? High-quality medical care for a dying person should be like this - let the patient die with dignity. As for me, my doctor already knows my will: no heroic measures should be taken, and I will leave as quietly as possible into this calm night.

From comments:

… The feeling of guilt will be in any case, unfortunately, in our society there is no acceptance of death, they do not teach it. Everything should always be only good, it is not customary to think and talk about non-positive things; I think that's why death is such a tragedy for those who stayed. My younger brother died very young, he was 17, 5 years old, 5 days after my 19th birthday, and it so happened that we often talked about death with him; in our family there was no prohibition on death, it was a permitted topic, largely because we spent a lot of time with our grandparents, and they knew how to accept death, knew how to burn off grief, cry it out.

Only this year, 11 years after my brother's death (he fell from the 11th floor, an accident, and if the injury were not so extensive, he would also have been pumped out by all possible means), I learned to cry. I realized that all the "modern" people were at his funeral for the lamentations of all the "modern" people - it was my grandmother who lamented about him, wept, as the mourners did. This year I took a large handkerchief, covered my head with it (separated from the world of the living), and voiced my brother and dad (I took the voices in a book). I cried, burned out, and let me go. Although still, ever, ever, there is a feeling of guilt. I think this is from the realization of the terrible word "never".

I thought about this (about resuscitation, life extension, etc.) a lot, a lot, a lot, when I was planning to give birth at home. Then I came across this article a couple of times, and again I thought and thought … Everything is correct here, I understand a lot for myself in the same way. And still I can't say that I decided something for myself in this regard. Everything still depends on everything. But dying, like being born, preferably at home, is the only thing I almost know for sure.

Oncological surgeon statements that make your hair stand on end

His name is Marty Makarei and he is an oncologist surgeon. Reading his statements, it is important to remember that this is a practicing physician who works in the system and believes in it. This makes his remarks even more shocking:

Every fourth patient in the hospital is harmed due to medical errors …

One cardiologist was fired because of his claim that 25% of electrocardiograms are misinterpreted …

The doctor's profit depends on the number of operations performed by him …

Almost half of the treatments are based on nothing. In other words, almost half of therapies are not based on any meaningful and validated research findings …

More than 30% of medical services are unnecessary …

I know of cases when patients were deliberately not informed about the most bloodless method of surgery so that the doctor had the opportunity to fully practice. At the same time, the doctor hoped that the patient would not know anything …

Medical errors are in fifth or sixth place among the causes of death, the exact figure depends on the methods of calculation …

The doctor's task is to offer the patient at least something, even if the doctor can no longer help. This is a financial incentive. Doctors need to pay for equipment bought on credit … In other words, we have expensive equipment, and in order to pay for it, they need to use it …

Dr. Macarea's hospital colleague is Barbara Starfield. She revealed the following facts to the public:

Every year 225 thousand patients die from the results of direct medical intervention.

One hundred and six thousand of them die as a result of using officially approved drugs.

The remaining 119,000 are victims of inadequate medical care. This makes medical intervention the third leading cause of death.