by Jennifer Black
The Bakersfield Californian
March 9, 2013
“I swear … to keep according to my ability and my judgment, the following Oath and agreement: … I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.” – An excerpt from the Hippocratic oath
As a medical student at USC and a physician-in-training at Kern Medical Center, I remember clearly the times I performed CPR. The experience was certainly not what I’d been led to expect during my CPR class. I recall feeling ribs splinter and breastbones break under my hands; I witnessed teeth crack and lips tear as breathing tubes were forced into victim’s throats. Chests were bruised, skin was burned, and lungs collapsed. I was horrified that I had to subject elderly, frail patients to such violence. Very few patients survived the initial effort; those who did were young, and were usually trauma victims, not elderly patients who’d had a stroke or heart attack. All CPR survivors had neurological damage, abdominal bleeding or ruptured spleens. Most of them died in the ICU — the majority within hours, but a few after several agonizing weeks. I did not know at the time that these are the expected complications and results of cardiopulmonary resuscitation.
Studies show that most people’s beliefs about CPR come from television. As a result, the public’s expectations of CPR survival are extremely high: most of us think at least 75 percent survive. In one study, 81 percent of hospitalized patients over age 70 believed their chances of surviving CPR and leaving the hospital to be more than 50 percent. Well, if these patients had been actors on a TV show, they’d have been right: CPR “works” 75 percent of the time on television!
In reality, success is much less frequent: If CPR were performed on every single patient in the average hospital, just 15 in 100 would survive to go home. Worse yet, if CPR is done out in the community (such as in Glenwood Gardens’ dining room) on an elderly patient with several medical problems, the likelihood of the patient surviving the initial effort is 0 percent to –maybe! — 2 percent. And what is the probability that the rare survivor will return to previous “baseline” function? Almost zero. More
by Erica B. Cohen
January 16, 2013
“Do everything you can, doctor. Do anything it takes to save him.”
These are the unfortunate pleas that too many patients and their families make when dealing with terminal illness and end-of-life decisions. While the use of advance directives helps alleviate this problem by informing doctors in advance about a patient’s end-of-life wishes, there is still an underlying belief that medicine can cure everyone, even those people with the most terrible prognoses.
But doctors die differently than their patients. They often don’t want the fancy treatment, the life-prolonging chemotherapy, or the 2-hour-long cardiac resuscitation (CPR). They know the consequences, and they just say no.
In 2011, physician Ken Murray wrote an anecdotal essay on physicians’ end-of-life decisions called “How Doctors Die.” In 2012, Dr. Murray followed up with a second essay, “Doctors Really Do Die Differently,” which provided statistical evidence of the assertions he made in his first essay.
According to Dr. Murray, one physician friend was uninterested in taking advantage of his own invention to triple the survival rate of pancreatic cancer patients – from 5% to 15% – albeit with a poor quality of life. Instead, the physician left the hospital after his initial diagnosis, enjoyed time with his loved ones, and died a few months later. More
by Terrell B. Vanaken
January 10, 2013
During the holiday season, we often think of giving in terms of tangible, often costly items.
There is, however, an extremely valuable gift that we can offer at any time of year, and which costs virtually nothing. It’s something all of us can offer to our family and loved ones. It’s the knowledge and understanding of what we would want done at the time of a health emergency, when we cannot make decisions for ourselves.
An advance directive, when properly completed, is a legal document that stipulates who should make decisions at a time when an individual no longer can. It also allows you to specify your wishes for medical treatment and just how aggressive medical personnel should be with your care.
At a minimum, an advance directive should name the primary person you trust most to make major health care decisions about your welfare. This person is called your “agent” for health care decisions. You may also name an alternate in case your first choice is unavailable for any reason.
An advance directive can be completed by any adult and is made legal by the signature of a notary public or the signatures of two qualified witnesses. Of course, as we grow older, a directive becomes more and more important, since the incidence of health care emergencies increases as we age.
Many critically ill patients and families who I have met in the hospital have never sat down and actually talked about their wishes before such a tragedy occurs. We all tend to avoid these discussions, but after a stroke, a heart attack or life-threatening event, your loved one may not be able to talk at all or understand these issues. More
by Andrew M. Seaman
December 12, 2012
Dying cancer patients are less likely to want aggressive end-of-life care if they watch a short video about cardiopulmonary resuscitation (CPR) than if they simply hear about it, according to a new study.
“These are huge differences. You will die very differently if you watch the video than if you don’t,” said Dr. Angelo Volandes, the study’s lead author from Boston’s Massachusetts General Hospital.
All 150 cancer patients in the randomized study were thought to have less than a year to live. Of the 80 who were simply told about CPR, 48% said they wanted it, compared to 20% of the 70 patients who also watched a video showing compressions on a dummy and insertion of the endotracheal tube.
“It’s one of the most important issues in American medicine today. People are getting medical interventions that, if they had more knowledge, they would simply not want,” said Dr. Volandes. More