Category Archives: Emergency/Crisis Medical

POST is a flapping of butterfly wings

POST is a flapping of butterfly wings, a little thing, starting.

:- Doug.

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If these are at odds, which do you choose?

If these are at odds, which do you choose?
A. Life sustaining treatment
B. Treatment that provides comfort, relieves suffering, and promotes doing your own activities of daily living

:- Doug.

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Could family and friend caregivers come together…?

Could family and friend caregivers come together to help our national community better support the ones for whom we care? Perhaps we could concentrate on the three main trajectory disease groups: cancers and their cliffs; chronic heart diseases and emphysema and their slow decline punctuated by exacerbating events; dementias and frailties with their longer, slower declines.

:- Doug.

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How will I know I’m dying?

How will I know I’m dying? How will my family know?

:- Doug.

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For cure or for care?

If you are terminally ill do you want to be treated for cure or for care?

:- Doug.

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The uncommonly good

Let’s look among us for the uncommonly good.

:- Doug.

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Alzheimer’s now 6th leading cause of death

According to this NPR report, Alzheimer’s is now the 6th leading cause of death in this country.

:- Doug.

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This is harder on your family:

It’s harder on your family to not have the conversation.

:- Doug.

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“California daughters?”

What if we invited a room full of “California Daughters” to talk about end of life care for Mom and Dad?

:- Doug.

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The case of Lorraine Bayless

The case of Lorraine Bayless is a perfect example: an 87 year old for whom no CPR was given holds a mirror up for us of the complexity of our end of life. We have a 75% idea about CPR (the real number is closer to 17%—for a healthy person.) Why do doctors do more for patients than they do for themselves? Because they might be sued? Why? Because in our society we think everyone can be saved and should be? Why? Always ask Why again. Because we cannot accept death? Because we cannot let go? Because we want someone to blame? Because we are angry? There are probably 101 reasons, all interwoven and tangled. This is the definition of complex. But hear this quite clearly: we do it to ourselves. We are the ones driving this. There is no one else. If we have a lot of bad deaths in our society, it’s up to us to fix it.

:- Doug.

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Three stages of health in our later years

There are three stages of our health in later years: Healthful years with few big issues; Years when bigger things start narrowing our possible issues; Frail times when we are in decline. Lawyers can help folks think generally and without pressure in the healthful years, think about what is important to us to guide our families. In the Years of Challenges, we can help people become more specific in their thinking and their conversing with their families. In frail years and beyond, we can help folks and families keep their resolve and refine it more, live fully to the end, and keep the family together in loving, and help their families reduce and deal with their grief.

How else might we make things better?

:- Doug.

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A good way to die: When is love appropriate?

There is a big difference between working to end life and allowing life and death to take its course without fighting it interminably and pigheadedly. People must be allowed to die their own ways, whether violently and with invasive and intrusive measures, or comfortably and with gentle human touches. More, we must make an effort to help with things like comfort, companionship (no one should have to die alone), and advocacy.

But more than this, and underlying it, we should check at the door our own assumptions about what is a good way to die. We often do not know we have assumptions. Like the woman who made her dying aunt eat her favorite foods when the aunt’s body was shutting down and could no longer tolerate food. Or like the person who remembers the death of his mother and wants or does not want the same thing for his father. We have to have the conversation.

Twice in my life in the last few months young women fell down the steps or crashed their car, and their families were forced to decide to end life support which was not helping. By and large, these situations determine their own decisions.

But what of the chronically ill, frail 90 year old who has pneumonia? Or a gangrene leg? Or whose heart stops? Do we beat on his chest, shock her with so many volts, bring her back with brain damage to suffer seizure after seizure? Or do we let these “old folks’ friends” gently take them where they (and we) are already headed?

“Playing God” is on both sides of this path. Whether we use or do not use modern science to prolong someone’s death (and maybe suffering too), we are intervening in an otherwise natural process. When is it good? How much is good? What is good?

Maybe those are not the ultimate questions. Maybe we could ask: When is love appropriate? How much love can we give? What is loving here and now?

:- Doug.

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Dying post-maturely

We have always faced the risk of dying prematurely—from heart attacks, road accidents, falls, animal attacks. But now we may live too long—with too much medical treatment, too much needless suffering from CPR, respirators, being strapped and tied to beds in confusing, noisy hospitals. We face a real risk of dying not gently and naturally, of dying post-maturely.

:- Doug.

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Take flowers.

Take Flowers: A friend of mine has a secret for getting good care for her uncle at the nursing home and hospital: she takes flowers and says “Thank you” to the staff who are helping her uncle. She takes cookies every once in a while, and puts them out at the nurse’s station, with a thank you note “From the family of….”

Another friend got a birthday cake from the best local bakery, decorated with “Thanks to Mary, Suzie, Bill, Danny for getting Mom to her 92nd birthday!”

Be inventive. Find ways to recognize good caring people. Especially to their bosses.

:- Doug.

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Take names.

Take Names: When you are advocating for your Dad at the nursing home or doctor’s office, get personal. Find out the names of the people who are providing care.

Not to know whom to sue or complain about, but to be human, to put a human face on Dad and you and them.

Not just the doctors: the nurses, the aides, even the person who mops the floors. All are providing care for your family, all know things you don’t, and all have some ways to help that can surprise you.

Use their names when you speak with them. Write them down so you remember.

As Ira Byock says in The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life, “Befriend them if possible. Tell them about your father—what name he likes to be called, what he did for work, what he loves most in life—and bring in pictures of your father in his prime. Let them know you appreciate their care, and thank them for things they do to engage and pamper your father.”

:- Doug.

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Stay put.

Stay Put: What do you do when the doctor rushes out and you did not have a chance to ask all your questions? Ira Byock, in his latest book, The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life says “If the doctor is rushed and leaves the exam room before answering these basic questions, stay put. They need the room and someone will come back to speak with you. If someone in the office gets annoyed, you needn’t raise your voice. If you wish, you have my permission to blame me. Tell them Dr. Byock said it would be unsafe to leave the office before clearly understanding these basic parts of the doctor’s plan for your mother’s care.”

Stay put. Good advice. Unsafe to leave: even better advice. So many people, my mother in law among them, are afraid to question the doctor and other medical staff: if I anger them then what will they do to my husband?

But the fact is most people want to give good care. They are harried by the pressure of modern medical business which says you must see 20 people a day, you must keep moving.

So it is up to you to keep your mother safe. If you are confused, muddling through cannot be good for either of you. Nor safe.

Byock’s advocacy mantra is “Be informed, prepared, polite, and persistent.” Polite and persistent. Sounds almost Zen: Don’t just go and do: stay put. But it is practical. And safe.

:- Doug.

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News: More hospice, more ICU

Friends–

We’re using both hospice and the ICU more at the end of life. Today there is an article in the Journal of the American Medical Association describing a study with these results.

There is a more plain English description of the article in Forbes, here.

Be sure to follow some of the links in the Forbes article.

:- Doug.

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