Congratulations to Martha Mendoza.
He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the Essay about doctor in the country. 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. 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. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs.
All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I have even seen it as a tattoo. To administer medical care that makes people suffer is anguishing. The simple, or not-so-simple, answer is this: To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room.
As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. Then the nightmare begins. The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish.
Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming.
Poor knowledge and misguided expectations lead to a lot of bad decisions. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families.
Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing.
People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment. Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar.
When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable as I would in any situation as early in the process as possible.
If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital. Should I have been more forceful at times? I know that some of those transfers still haunt me.
One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot.
Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery.Next-generation influencers are taking on new, expanded and visionary roles to propel this nation’s healthcare system forward. Healthcare administration leaders, for example, are taking on a dual role; first as innovator and second as educator, bringing forth new ideas for policy, practice and patient improvements.
Bowdoin College Department of Athletics | College Station, Brunswick, ME | () | College Station, Brunswick, ME | () The fact is, I never had a single doubt about having children. Not one, since the day I could understand how families were made. And pregnancy was the glorious beginning of that vision.
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