What is Digg?40 Comments
- generaljigger, on 10/12/2007, -0/+20Four months ago my father went unconscious and fell head first about 7m onto rocks. This fall should have been fatal instantly however he was still breathing on his own by the time he reached the hospital.
By three weeks after the accident my father had been moved to a special care unit, where he was being fed through a tube but was sometimes having trouble breathing on his own. The doctor in this unit took my mother, my sister and myself aside and asked us to sign a DNR.
In spite of the fact that we all felt that he was trying to communicate with us through hand squeezing and the like, we decided to take the doctor's advice and sign. A day later the chief neurosurgeon returned from a conference and discovered that the DNR was in place. He immediately went to my mother and asked that she rescind the order since he "strongly" felt that my father had a chance of recovery.
It is now four months later and my father would be have been dead three times if the DNR had remained in place. He is talking and working on walking. He is eating some food and drinking his Tim Horton's coffee black. He still has problems recognizing where he is sometimes but he is improving every day.
The point is one doctor saying it's useless is not the end of the story. Every case is different and each time the family and the doctors have to work together to come to a conclusion. - senseigmg, on 10/12/2007, -1/+17Too many people think they know more than doctors. They think they can decide what course of treatment is best with their 2 year community college degree.
Side Note: Didn't p9 stop digging a while ago? - rocketryguy, on 10/12/2007, -1/+14I think the only point there was that it would leave somebody in a permanent vegetative state, which isn't really alive, just biologically active.
No thanks. I'll go see what that light is all about, but probably forget to report back... - StarManta, on 10/12/2007, -6/+17"the havoc it can wreak on a dying body"?
They're going to be ***** DEAD if you don't do it. THEY WON'T CARE. Trust me. - PlagueMonkey, on 10/12/2007, -0/+9Though you make a good point, it's worth noting that the Hippocratic Oath does not in fact containt the phrase "do no harm"
http://en.wikipedia.org/wiki/Hippocratic_Oath - gill1109, on 10/12/2007, -0/+8I think that if someone is dying then crushing their chest for no reason at all is not respectful of that person. The whole point is that one should not unconditionally want to continue to receive all "treatment" available. That is senseless and unfair to doctors (they are supposed to alleviate suffering, not to inflict it). It is also unaffordable and unethical. We only have finitely many doctors and they only have finite resources. Moreover, it is not the PRIMARY task of a doctor to prolong life. Their primary task is to improve life. Which could mean allowing people to die naturally when their time is up. And the whole thing is made completely sick by this mentality of sueing anyone any time you see any chance to make some money. It doesn't make any difference whether you religious or not (at least, it shouldn't).
- Jwoey, on 10/12/2007, -3/+10dugg up because i like seeing more and more people abandoning the fairy tales of religion. It makes me happy.
Saw one of those ridiculous ribbons on someone's car yesterday that said, "Pray for our troops" which reads a whole lot like, "Do nothing for our troops." because that's what prayer does.. nothing. - mwilding, on 10/12/2007, -1/+8Most people do not realize how brutal real CPR is.
On television doctors lean over the body and push down gently in a rhythmic manner to revivie a patient. In real life, someone climbs onto the bed and straddles the patient and starts to put their entire weight and strength into violently pumping the patients chest. To have ANY chance of surviving, one's ribs will probably be broken.
Now imagine the subject of the article - a frail old man who is dying anyway. Would CPR really give this guy a chance at a longer better life? The families impressions of CPR as a relatively gentle thing and their love-blind desperation to prolong life leads to their pushing the extraordinary measures that do nothing productive. One could actually argue that they are forcing the doctor to violate the most important part of the Hippocratic oath - First do no harm! - Sirocco, on 10/12/2007, -0/+6CPR is a great thing, but there comes a point where resuscitating a body is pointless. Doctors are trained to assess individual situations and make unpleasant judgment calls, like when to resuscitate and when to let it go. Leaving someone in a persistant vegetative state is a clear sign the wrong choice was made... and sometimes it is made by the family rather than the hospital staff.
- btgoss, on 10/12/2007, -0/+6I want to comment on this story.
I am a cancer survivor.
I have been on a vent.
I have been kept alive when I would have died without medical treatment.
But it was not done to the extreme. I had a very bad infection, that caused a high temperature and very rapid heart rate. Thankfully I recovered, but it could have created a situation where, in trying to stop an immediate medical crisis, I could have been left "alive" but brain damaged.
What would my family have done? I don't know and I am thankful I never had to find out.
This article shows at least that some people are being thoughtful about this situation. I applaud the Brother mentioned in the article for using his mind in dealing with this problem. I hope you read the other articles linked to this one, it really presents the whole situation, and the fact that it really is a lose-lose. - Gregd, on 10/12/2007, -0/+5We usually called CPR, "good publicity" as it seldom revived a patient. The family needs to know that you're doing everything you can....CPR falls into that category. Yes it almost always ended up in torn ligaments and broken bones, but damn if it wasn't good publicity...
- ScottAG, on 10/12/2007, -3/+6Rosebud...
- deuces, on 10/12/2007, -0/+3I think people need to remember that you don't start CPR until the person is legally dead. Their heart is not pumping, they are not breathing. All you are doing is trying to get oxygen to the brain. The reality is CPR is there as a last ditch effort to bring someone back, not prolong their life. They are dead already. So, in my opinion it comes down to a DNR order. You want to be brought back, CPR is one of the things they will try if your heart stops. You don't want to take the risk of being brought back with brain damage? Sign a DNR order. It's your choice. If you couldn't sign one before you "died," expect someone to try and bring you back.
- Sirocco, on 10/12/2007, -5/+8Better dead than vegetable.
- bigdaftdave, on 10/12/2007, -2/+5that's true, but if you're 90 years old and you slip out of consciousness towards a peaceful natural death, do you really want a team of doctors sticking tubes down your throat, giving you massive electric shocks, pumping away at your chest until your ribs break and giving you adrenaline injections for the last 30 minutes of your life?
- Hercynium, on 10/12/2007, -0/+3Back when I got certified as a first responder, the instructor made a few interesting points about CPR -
First, the elderly, the very young, and people who have had a serious accident will likely suffer further injuries from CPR - maybe even be killed by it. However, in one's assessment of the situation, it must be taken into account that the average person will be un-resuscitatable (is that a word???) five minutes after the cardio-pulmonary systems stop. (that's what we were taught - who knows, it may be totally wrong)
Second - the instructor insisted that CPR is a misnomer - she said she has never seen a person with cardio-pulmonary failure resuscitated without a defibrillator. However, it is the best way keep the window for resuscitation open long enough to save someone's life.
Here's a wikipedia article that may come in useful: http://en.wikipedia.org/wiki/Asystole - LacY, on 10/12/2007, -1/+3Met any Christian Scientists lately? They believe that faith will heal everything, and refuse any medical intervention.
- grayputer, on 10/12/2007, -2/+4According to the Wiki article quoted:
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I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
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What part of "never do harm to anyone" did you miss? - Jwoey, on 10/12/2007, -1/+3Why is plaguemonkey being dug down? he pointed out a fact that most of us were probably not aware of...
- Murdats, on 10/12/2007, -2/+4but vegetables are usefull for harvesting of organs
- BrettJB, on 10/12/2007, -0/+2What part of the wiki article did you miss?
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It is a common misconception that the phrase primum non nocere, “first, do no harm” is included in the Hippocratic Oath. It is not, but seems to have been derived through Galen from Hippocrates’s Epidemics in which he wrote, “Declare the past, diagnose the present, foretell the future; practice these acts. As to diseases, make a habit of two things—to help, or at least to do no harm.”
---------- - Screwy1138, on 10/12/2007, -0/+2That's fine and dandy, Lacy, but what Christian Scientists do is hardly the justification for making comments on Christianity as a whole (see Islamists)
- oOLiquidNightOo, on 10/12/2007, -0/+1so then, you're saying that scene from the abyss is slightly unrealistic?
- GrayV, on 10/12/2007, -1/+2Doctors should take a moment and ask themselves "What would Kiefer have done in Flatliners?" I think that would stand up in a US court.
- darkdaedra, on 10/12/2007, -0/+1I just want to point out Screwy that I didn't use the word "Christian" once. I meant it in an all embracing sort of way - I guess you could call the net I cast on believers a "catholic" one.
- apiaryist, on 10/12/2007, -0/+1A doctor is more likely to know what's best for you, but they have their limits. As people have pointed out, CPR should only be performed on the clinically dead. A large part of your training is devoted to determination. Can the person get air to the lungs? Is he breathing? Is there a pulse? Did you see them collapse or find them already on the ground? A lot more goes into it, but without training, you cannot help this person. So, they're dead. All you're doing is giving them the best chance at recovery.
Some people want every single option explored, and they should have that right. If you are worried about becoming a vegetable, GET A DNR! Do it today. Tell your friends, family, spouse, S.O., dog, neighbor, mailman, and doctor. Make lots of copies. Wear a DNR bracelet, or like I've seen on some people, get it tattooed on your chest. It's a serious thing that everyone should think about. It doesn't matter if you're 18 or 80. Don't put it off. Do you want to be a burden to your family? - motionblur, on 10/12/2007, -0/+1@generaljigger
"He is eating some food and drinking his Tim Horton's coffee black."
I would fight for life too just to have another black coffee from Timmy's. - ericissimo, on 10/12/2007, -9/+9That's bollocks. God isn't anybody's butler, who just shows up when we pray and does stuff for us. The belief in God isn't what is keeping us alive in this world, it is what is keeping us alive in the next.
In the meantime, we are thankful for all these clever doctors that helps us staying alive, thanks in part to our understanding of biology and evolutionary system. - tahim, on 10/12/2007, -1/+1as a critical care physician...
CPR is only a PART of resuscitation. the concept of DNR incorporates many things... traditionally (and still formally) this includes intubation (breathing tube) and mechanical ventilation (respirator), as well as restoring a normal heart rhythm with a normal blood pressure. the latter two may come at a point of asystole (mentioned by Hercynium) or another dysrhythmia (ventricular fibrillation, ventricular tachycardia, torsades de pointes, atrial fibrillation, supraventricular tachycardias) or myocardial infarction (heart attack) or sepsis (systemic infection).
the matter of reversible causes then come into play as well as "medical futility". a 90 year old person with metastatic cancer with no further available treatment options is served no good by resuscitation. it is a patient like this in which renal (kidney) failure and the need for dialysis, recurrent infections, anoxic brain injury (damaged brain due to prolonged periods of no oxygen), and many other detrimental problems occur... and therefore CPR is futile. it will NOT add anything of quality to the patient who is ALREADY dying. is your god a physician... nor are physicians all knowing. if your god is their for you, then why do people die or even suffer... we are human and therefore finite. it is reality.
families fail to remember that the patient is number one... it is rare to hear "well, he/she wouldn't want to live like this". more often than not, we hear "do everything you can... i/we can't live without him". it is common that families need time to realize the impending death of their loved ones and it is in these situations that treatment is prolonged, so long as no pain or suffering is inflicted on the patient.
many patients walk into a hospital for elective treatments and unfortunately die after a prolonged catastrophic course - they are a very small percentage. many others come into the hospital repeatedly with progressive illness... futility is most likely in their short-term future.
every patient is a person, not a statistic. DNR is an appropriate measure for many, but not all. - tahim, on 10/12/2007, -1/+1actually i am not the one who brought the discussion off topic. my reference to God was not until my second post. in my first post, i referenced the concept of a god, not the specific entity/being of God. the whole thing was additional commentary, in reference to ericissimo (http://digg.com/health/The_Last_Word_on_the_Last_Breath#c3409470)
"That's bollocks. God isn't anybody's butler, who just shows up when we pray and does stuff for us. The belief in God isn't what is keeping us alive in this world, it is what is keeping us alive in the next.
In the meantime, we are thankful for all these clever doctors that helps us staying alive, thanks in part to our understanding of biology and evolutionary system."
as far as my grammar... sure i made a mistake or two in my post, however my education speaks for itself. when you make personal attacks, such as you have, it belittles your opinion.
as for the issue of DNR, your comments/opinions are well taken and i agree it's an individual decision. however, i would like to hear your answer regarding why we suffer? just because i am not religious doesn't mean i don't want to hear your answer. i clearly expressed that i don't know why we do, but it is part of reality and many families and patients don't realize that. this is why end-of-life issues can be so difficult to discuss. families will equate DNR and comfort care as giving up, when it truly is putting the patient first. this is why, as you previously stated, that these discussions need to take place early, not in emergent situations.
remember, this is a forum... a place for discussion, not bashing. - tahim, on 10/12/2007, -1/+1let's keep in mind that this is a forum, not a journal or other publication. therefore, my concern is not punctuation or spelling. i know some folks who have made it to the white house who are not very good public speakers. are you perfect? neither am i.
actually i never bashed God... i clearly referenced "your god". there is a difference. keep in mind that there are multiple religions and different views on the entity/being/concept that is each person's or each religion's god/God.
http://merriam-webster.com/dictionary/god
i wouldn't change my opinions or not present them to prevent offending you. they are merely opinions. don't take them so personally. hiding opinions prevents discussion. homosexuality is becoming (ever so slowly) an understood (yet not accepted) way of life. if not, we may not have understood the various behaviors of HIV - a tragic public health hazard. should i be offended by the overwhelming nature of Christmas? it has nothing to do with my upbringing or way of life. it is a religious-based holiday which has been glorified into something American. people are shocked when they realize that i do not celebrate Christmas. How come? i am an agnostic. i hope that doesn't offend you.
my views on gods or a god or God have nothing to do with my knowledge of medicine. if you cannot distinguish opinions and fact, then this discussion is useless.
so, my question to you diggrific is... why do we suffer? i'm not complaining about it because i think it is a part of life. maybe that is part of a/the divine plan... i don't know. as i said above... physicians (and humans) are NOT all knowing.
excuse my grammar... i am merely a physician. - inajeep, on 10/12/2007, -4/+3I think you miseed the /sarcasm tag.
Some people do feel that their God is on call do do miracles. - Robcataus, on 10/12/2007, -6/+2If the family was /really/ "convinced that the man could communicate", why not ask him how he should die?
/sarcasm - webmonk, on 10/12/2007, -7/+0Leave it up to the family, but be sure to charge *them* (not their insurance company) extra.
- darkdaedra, on 10/12/2007, -23/+15There's an easy way to solve this issue - just get rid of all the medical equipment and have the family pray. That way, God gets to decide if the person lives or dies.
Those of us that don't believe in God, on the other hand, will continue to receive all the treatment available. I like to think of this as natural selection vs. divine selection. Let's see who wins.
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