Monday, September 14, 2009


So many people think that discussing end-of-life care with their doctors is tantamount to those doctors deciding to cut the life support on all the old people just because they're old.

That couldn't be farther from the truth.

I think those of us who work in hospitals understand - being old and being old and sick are two very different beasts. You can be 85 and in very good health with a sound mind. Or you can be 70 and demented, incontinent, bedbound, and doomed to a nursing home.

I can't even count the number of nursing home transfers we get in the ER where the patient is so far gone mentally and physically that I'm not sure how they made it through the night, yet their paperwork clearly states "Full Code." Translation: break Granny's ribs during CPR, put her on a ventilator she'll never come off of, pump her full of drugs her already failing organs won't be able to handle, and send her to the unit where they'll feed turn and water her every day for a month until she dies of sepsis.

So much of the outrageous cost of heath care comes from this futile care. Just because we can keep someone alive, does it mean we should? Where does the line get drawn? When can the doctor step up and tell the family that she'll die either way? When do I get to explain to the family that if Granny had severe dementia before, this little 45 minute CPR battle most certainly isn't going to bring back any mental function?

I think that right now there is no hope of setting limits in health care. Too many people will decry the "death panels," call them doctors who play God and presume to hold the key to life and death. Lawsuits will rain down on those who try to set limits by those who have no understanding of what it is to watch futile care being performed.

Perhaps the only option is to face this head on; to sit down and talk with our doctors over what we want done when we're close to death. Death is never pretty, but it doesn't have to be agonizingly drawn out. I for one will never be a Gomer hooked to a ventilator, drips hanging into IVs, with no hope of recovery. If I've lived a full live, I will make sure everyone around me knows to come say their goodbyes and then let me go peacefully.

I think if we talk about this enough, maybe people will understand.

Here's a start to the talking: a solid Newsweek article titled The Case for Killing Granny. Read it, please. And then go share it.


meghan said...

my brother and i agree... =)

Jamie Lynn said...

i wish there were a "likes this" option like on fb. i'd be hitting it repeatedly right now

Wounded Healer said...

Right on! I just posted an entry on my blog about EOL care in the ED. I'd love to get your thoughts. I'm about to start my preceptorship in an ED tomorrow. I'm going to add your site to my link list. If you like my blog, would you care to add mine to yours?