Tuesday, May 8, 2012

Dying In America

I've seen people die poorly.  I've watched as the family struggled to decipher the writing on the wall as the medical system sucked the marrow out of their unconsciouss loved one and then spit it out indignantly.  We are losing the war against futility.

But how to stem the tide when demented centarians are newly started on dialysis?  How do we explain that chemotherapy will not help when metastatic disease runs rampant and bodies are confined to beds?  I usually start by considering death as a given, then work backwards. 

If I were to tell you that you only had two weeks more to live, how would you want to spend those last days.

Often as the words role down my lips, I can see the stages of grief pass before my eyes.  A family member spits and turns his head in anger.  A husband sputters that the oncologist said years, and I wonder is this denial or just bad advice.  Sometimes a patient falls off the grid and lands squarely on accusation.

Doctor, if only you had checked my labs sooner.

And in my mind I continue the if only game.  If only the cancer wasn't metastatic.  If only you were strong enough to get out of bed.  If only we could live forever.

If death is a tsunami, then futility is the collateral damage.  Cars are upended, houses are flooded, and bodies lay ravaged on the streets.

We've got a problem.

The process of dying in America is seriously flawed.


Diane said...

After finding out our 15 year old had a mitochondrial depletion syndrome(poor health since birth 4 different diagnosis's), we wonder if that day will come where a Dr. will tell us to count her days. Mitochondrial depletions are bad news.

We had a rough winter with her this year, and the look of pity in her Drs. eyes was the most awful thing we have ever faced. I won't forget that look- I love the Dr. and trust that Dr. still..

Our solution- we found a few Drs. who were real, but hopeful- who cheered us on to help in the care of our daughter.

Today, at 17 she has beaten incredible odds- we found the answers to help her from the Drs. who had hope. She is up and moving. Eating- her blood work looks great.

Now, we wonder about the day our Hopeful Drs. will have to tell us to count the days.

Hermes Trismegistus said...

I am Victor, MD, IFCAP, Clinical Pathology/Laboratory Medicine, Salvador City, BA, Brazil.

Dying in South America is at least as flawed as in North America!.. I have heard many such complaits:

- Why is it that my son/daugheer has Sicle Cell disease (or other such preventable inherited disease) and will suffer from it for all his/her life? Couldn't the physicians preview / avoid it? Cure it somehow?
- Why is it that my terminally ill mother/father/grandmother/grandfather must die home? Isn't it better that he/she stays at hospital (where some further futile treatments can be administered, and he/she can be subject to Hospital Infection)?
- Can't the physicians prolong my (brain dead) coma relative's life? Isn't there any hope he/she will come back? dosen't he/she hear when I talk/ sing to him/her?

- There are questions and questions....
- We physicians don't have all answers... who's supposed to have? The Laywers? The midia? The parents??

- We are more than 7 Billion Humans in the globe. Many of those severely ill. Many of those terminally ill. Many of tose in need of intensive care. Somny dy of simple hunger.
- Each day a hopelessly dead person is kept in ICU might mean one more day / hope to someone else in need...

- Again, who shall decide??
Which case is "Orthotanasia"? "Euthanasia"? Plain murder?

In short, It sucks!...