December 30th, 2010 by admin in Better Health Network, News, Research, True Stories
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Gene Goldwasser died last week. He was 88, and he was my friend.
I wrote previously about a series of conversations I conducted with Gene and Rabbi A.J. Wolf a few years ago. I met Gene one spring day after calling to invite him to sit in on a class I was teaching to a small group of medical students about social issues in healthcare.
I’d read about him in a book called “The $800 Million Pill,” by Merrill Goozner. In the book, Goozner writes the story of Gene’s two-decade hunt to isolate the hormone erythropoietin (EPO).
Part of the story relates how Gene tried to interest traditional big pharma companies in his discovery, only to be brushed aside. Instead, Gene wound up sharing his discovery with what became Amgen. The company went on to make a windfall from recombinant production of the hormone and licensing it as a drug for patients with anemia and kidney failure. Read more »
*This blog post was originally published at ACP Internist*
December 17th, 2010 by DrRob in Better Health Network, Health Tips, True Stories
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Everyone liked him. Though his later years (the only ones in which I knew him) took away his ability to do most things, and though he was in great pain every day, it was easy to see the mischief in his eyes. The subtle humor was still there, coming out of a man who was weak, in pain, dying.
She lived for him. She was always telling me of his pain, frustrated with the fact that he didn’t tell me enough. She was anxious about each complaint of his, wondering if this was the one that would take him away from her. Many of her problems were driven by this anxiety and fears, and she spent many hours in my office giving witness to them through her tears.
As his health failed, I wondered about her future. He was the center of her life, the source of her energy, joy, purpose. How could she manage life without him? How could she, who had so much lived off of the care of this wonderful man, find meaning and purpose in a life without his calming presence?
Then he died. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
July 31st, 2010 by DrCharles in Better Health Network, Medical Art, True Stories
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She coughs
and heaves a breathless goodbye
into the bedside phone.
Her lungs
damp, bloated, sacked honeycomb
wheeze with vanishing bees.
The room
of sensors and startling noise
has not air to float upon.
Morphine
slakes a thirst for breathable sky
and calms the panic within.
The shame
of living, of death smiling,
savoring smoke and ash.
Eyes closed
she imagines her son, boy,
man, precious evermore.
Flowers.
Beautiful white, red, and black
from a husband who waits.
Starstuff
spinning in galaxies far,
with summer lightning bugs.
And then
it is upon her, the moment,
dreaded, practiced, boundless.
We run
through soft sands lit by moonlight,
now tumbling under waves.
All that matters
doesn’t.
And all that happens
matters.
The absence of pain and hunger
the end of struggle and story
mark an indifferent,
yet decent,
finish.
*This blog post was originally published at The Examining Room of Dr. Charles*
September 22nd, 2009 by EvanFalchukJD in Better Health Network, Health Tips, Opinion
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There’s a case for killing Granny? I guess so, or at least according to Evan Thomas’ article in the most recent
Newsweek. Thomas, after sharing the story of his mother’s last days, concludes that
death is the key to health care reform:
Until Americans learn to contemplate death as more than a scientific challenge to be overcome, our health care system will remain unfixable.
Does everything need to have a political spin on it nowadays?
But let’s take Thomas’ advice and talk about death. Not “death panels,” not the politics or the cost of end-of-life care. Just plain old death.
I was reminded recently of how fragile life is. It made me remember something I read after our oldest child was born. I realized that one day she would learn the truth about death. And I thought how bad that was, and how I wanted to protect her from it. But then, by chance, I happened across this interesting little saying.
When your children are young, all you think about is that you don’t want them to die. But when they get older, all they think about is that they don’t want you to die.
It touched me, and it made me think about how my responsibility to protect my children extended even unto and beyond my own death.
It’s a nice philosophical point, but there are very practical things each of us can do to fulfill this responsibility. Here is my list of just a few of the very important things we all should do to plan for our deaths:
Buy life insurance
If you’re young and in reasonably good health you should be able to buy a term life insurance policy for a few hundred dollars a year. You should do this so your family can have your earning potential replaced in the event of your death. Find a good insurance broker and make sure you get coverage that suits your needs. Even if you have a pre-existing condition (like a chronic illness) a good broker should be able to find you some kind of coverage. You won’t be able to buy any coverage at all if you become acutely ill, so don’t wait until it’s too late.
Make a will
This is so much more than just planning for your family’s financial future. For example, if you have children, have you figured out who will take care of them if both you and your spouse die? There are many important and potentially difficult conversations that go along with this kind of planning – but you’re much better off having them now. After you die, those left behind will end up fighting out these issues not knowing your wishes. Find a good lawyer to help you.
Make an advance directive
You need to think about what kind of medical care you want if you become incapacitated and unable to decide on your own. Do you want to live for 30 years on a ventilator, unconscious? Do you want to undergo extensive and painful treatments if you don’t have much hope of a meaningful recovery? Don’t leave your family alone trying to make that decision for you, wondering what you would have wanted. Write down what your wishes are.
Appoint a health care proxy
Pick someone who you trust to make your medical decisions for you if you are unable to do so. Write it down and make clear what you want that person to do, so if the time comes there isn’t any dispute among your family as to who is in charge.
There are many other things you can do, but to me these are four of what I think are the most important things you can do to prepare for your death. Maybe some commenters can add some more that I missed.
Now, with all that said and done, I will still disappoint Mr. Thomas.
Why? Because I still prefer to think of death as a scientific challenge to be overcome. And you know, I’m glad that many other people feel that way, too.
Especially the people who make medical breakthroughs – I’m really glad they feel that way.
*This blog post was originally published at See First Blog*
August 21st, 2009 by Bongi in Better Health Network, True Stories
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Surgeons are not stand back kind of people. They fall more comfortably into the category of charge in where angels fear to tread. I think the work tends to preferentially attract those type of people. But sometimes standing back can be the lesser of two very evil evils.
The call was a standard weekend consultation. The patient had hematemesis and his doctor was worried. Nothing I hadn’t seen many times before. But when he came in the patient’s wife had a few more details to spice the story up a bit.
Just about a year ago he had had a resection of his stomach for cancer. The surgeon had told his wife they couldn’t get all the cancer out because it was growing into some big blood vessels behind the stomach. For some reason they both decided not to tell him this. So when he was referred for his chemotherapy (something that could not be described as awe-inspiringly effective in stomach cancer) he truly thought he was well on his way to full recovery. and now he lay before me, pale and restless.
He was a shadow of what he once must have been. His skin hung loosely as if in remembrance of the large man it once covered. I was not happy with the mass I clearly felt just under his left rib margin. The cancer was back and it seemed angry. I got the necessary drips running and ordered blood. I considered dropping to my knees but due to a back injury when I was still a student I wasn’t sure I’d be able to get up onto my feet again.
The wife called me aside and told me the patient was not aware of the fact that the operation was not a roaring success and therefore that he was essentially living on borrowed time (which I grimly thought he is about to pay back with interest).
“You need to tell him.” I said.
“No!! Doctor!! I can’t do that.” She needed the truth.
“This man, your husband may die here in this hospital within a day or two. you need to speak to him.” But she would hear none of it. She also didn’t want me to tell him things were not so rose coloured (I suppose depending on what colour roses you’re talking about of course).
The next day the patient was feeling much better. Amazing what a bit of blood will do. We chatted a bit. You know, shared a moment. He even laughed at how bad he had felt the previous day in comparison to today. Then it was back to business. In this case business meant I was going to take a long, not so thin pipe and stick it down his throat to take a quick look at the source of the bleeding in his stomach. I sort of lied to myself, telling myself that maybe I’d see something that could be fixed with a knife. In truth I knew what I would see. The palpable mass and the history dispelled almost all my doubt (or hope). But I knew I needed to look. I needed to know for sure how much or how little I would be able to do for him. Maybe I needed evidence for one day after it all when I am called to account.
The cancer was a large fungating mass with a deep necrotic core. It was gently oozing blood but I could see it was capable of so much more. It seemed to me it had stopped its torrent of blood long enough to give me a glimpse as if to taunt me. As if to say you know me and you know you have no power here. It was right.
After the procedure the patient once again started spewing forth blood. I sat with him for quite some time. between his retching we spoke.
“This is not good, doctor.”
“I know.” What more was there to say?
“What are we going to do?”
“We are going to hope the bleeding stops.” What more was there to do?
Then I went against the wishes of his wife. I told him this cancer was going to be the end of him. He looked at me with a calmness and a gentle smile.
“I know.”
He probably had known for some time but I think he felt he had to go along with the charade and maintain the lie with his wife. He seemed relieved that the truth was out. He seemed to relax.
That night the sister called me to tell me he was bleeding massively. I explained the situation and asked her to push blood IV. If that didn’t help, nothing that I could do would. The next morning he was dead.
Somehow when we sit behind our computers and in our nice expensive offices deciding about the futility of certain treatments and who should get what based on cost or whatever, the actual point is lost. The nice old man finally vanquished by the hideous monster called cancer or the old lady with heart disease or whatever who is forced to succumb to the dark inevitable is the point. It is the person, the individual. the one like me. and maybe like you.
I was just left with a sense of how difficult it is to stand back and let someone die when you know what that means. It, I assume, is much easier for the powers that be, snug in their artificial real worlds.
*This blog post was originally published at other things amanzi*
