One with Everything
(Note: I had started this a while ago with the intention of posting my definitive take on End of Life Care. I forgot all about it till now. I think its good enough for now.)
I have been working in End of Life care since 1994. And I feel like I "get" most everything. But lately, something I thought I "got" makes even less sense to me than ever. Where am I going with this? Let me get to the point, before I lose you.
On a daily basis, I am confronted with the following scenario. Very sick patient. Patient never going to get better. As they get sicker, medical care gets more aggressive. Why? Because "they want everything". As the patient dies and their breathing begins to stop, they are placed on ventilators. Days pass as we frantically manage lab values. We add pressors to keep their blood pressure within prescribed parameters. Then, when their heart inevitably stops there is a veritable orgy of everything lasting for up to a half hour before the "code is called", which is medicalspeak for: we allowed you to die.
How did we get to this point? When did we start dispensing medical care based not on evidence, but on personal preference? If a particular intervention is known to be ineffective in a certain medical scenario (let say, just for laughs, CPR, for example) why is it a)offered and b)administered? Well, the answer is, wait for it: Because the family wants everything done. Or the patient, when they could still speak, "wanted everything done".
"Oh, my doctor never listens to me" they all say. "He never even comes in the room", they lament. Probably all true, unless you say "I want everything". This, I assure, will be carefully noted in the medical record and repeated with great solemnity as the efforts to give you everything become ever more desperate.
You would be quite surprised at what a conversation stopper this is. Everyone thinks that the medical profession is composed of arrogant, close minded elitists. Everyone thinks the AMA is a collection of narrow minded medical entrepeuners who have choked off creativity to maintain a power hold on health care the world over. Not so! If you tell any doctor that you want "everything", everything is what you will get.
I have been working in End of Life care since 1994. And I feel like I "get" most everything. But lately, something I thought I "got" makes even less sense to me than ever. Where am I going with this? Let me get to the point, before I lose you.
On a daily basis, I am confronted with the following scenario. Very sick patient. Patient never going to get better. As they get sicker, medical care gets more aggressive. Why? Because "they want everything". As the patient dies and their breathing begins to stop, they are placed on ventilators. Days pass as we frantically manage lab values. We add pressors to keep their blood pressure within prescribed parameters. Then, when their heart inevitably stops there is a veritable orgy of everything lasting for up to a half hour before the "code is called", which is medicalspeak for: we allowed you to die.
How did we get to this point? When did we start dispensing medical care based not on evidence, but on personal preference? If a particular intervention is known to be ineffective in a certain medical scenario (let say, just for laughs, CPR, for example) why is it a)offered and b)administered? Well, the answer is, wait for it: Because the family wants everything done. Or the patient, when they could still speak, "wanted everything done".
"Oh, my doctor never listens to me" they all say. "He never even comes in the room", they lament. Probably all true, unless you say "I want everything". This, I assure, will be carefully noted in the medical record and repeated with great solemnity as the efforts to give you everything become ever more desperate.
You would be quite surprised at what a conversation stopper this is. Everyone thinks that the medical profession is composed of arrogant, close minded elitists. Everyone thinks the AMA is a collection of narrow minded medical entrepeuners who have choked off creativity to maintain a power hold on health care the world over. Not so! If you tell any doctor that you want "everything", everything is what you will get.
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