tag:blogger.com,1999:blog-5883634615775822475.post1295619690701244168..comments2024-03-18T09:00:31.992-04:00Comments on Doctor Grumpy in the House: An opposing viewpointGrumpy, M.D.http://www.blogger.com/profile/09858110332436246760noreply@blogger.comBlogger78125tag:blogger.com,1999:blog-5883634615775822475.post-78344531197818028352010-11-24T04:49:36.792-05:002010-11-24T04:49:36.792-05:00Wow. thanks so my Katharine for calling all religi...Wow. thanks so my Katharine for calling all religious people idiots. Really, I appreciate that greatly. The point of faith is not that you follow your religion blindly, but that you understand your religion fully and decide whether or not it's for you. If you disagree, that particular faith system isn't going to work for you, so pick another. And for the record, JP2 had a DNR and ended up dying of a UTI. He also was a big advocate for end-of-life mercy in not prolonging life without hope of recovery. It's not the religion that says we need to prolong life, it's the emotions.<br /><br />In any case, while I believe that feeding someone is not an "extraordinary measure" seeing as it's a basic human need for everyday life, I do agree with Dr. Grumpy that the end of life should not be prolonged. I've worked in the ICU, the geriatrics unit, and I've had to watch people let their child die in front of them. I understand that families get incredibly emotional, and that doctors seem cold when we tell them that the life is gone. But isn't this a problem on both ends? Shouldn't we, as the health care providers, have these discussions before patients get to this stage? Or maybe figure out how to communicate with this particular family without letting emotions get the better of either side? I've seen this scenario over and over again, but the families that really listen are those whose doctors talk to them like human beings who are suffering, not like cold-hearted torturers.Kitnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-67975752429374348752010-07-13T23:05:19.580-04:002010-07-13T23:05:19.580-04:00Really, really late in the game. I'm a pro-li...Really, really late in the game. I'm a pro-life Catholic. I'm also in medicine. <br />On the feeding tubes for Terri Shivo (sp?) I was taught that the reason it was murder was because she had been alive and it was withdrawn. If it hadn't been initiated in the first place, it wouldn't have been wrong. <br />So basically, you don't have to START extraordinary feeding, but once you do, it is wrong to take it away.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-86026870162722733432010-03-09T06:00:26.140-05:002010-03-09T06:00:26.140-05:00If Terry Schiavo were "alive" today, she...If Terry Schiavo were "alive" today, she'd be lying in bed staring at nothing, most likely being turned every two hours, a little wet sponge stuck in her mouth to keep it moist every two hours, having stool washed off of her with diaper cream applied immediately after, being propped up in a chair every day, with drool suctioned out of her mouth/wiped off her face, and on and on. Is that the kind of life Flaming would accept for herself? I bet not. (That poor woman's parents were nutcases, BTW).Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-80324529933671330672010-03-08T14:18:09.905-05:002010-03-08T14:18:09.905-05:00The problem with your solution Banshee is that thi...The problem with your solution Banshee is that this sort of situation occurs every day, in every hospital, over and over (just not always to the point of getting the press or attorneys involved). If we needed to consult a "panel" every time we discussed any issue that could be considered futile care, we'd all be in meetings all day. Most hospitals already have committees like you suggest, but only for the cases that have already gone too far. The problem is that the public has an inaccurate perception of medicine. You watch TV shows where 99% of CPR victims survive without any loss of function. Reality? 99% don't survive or are severely impaired, especially out of hospital arrests.<br />People feel guilty that they didn't want "everything done" but don't understand that "everything" can include modalities that have no hope for meaningful success and could prolong suffering (ie torture).<br />I had a patient in the past with widely metastatic prostate cancer (to the bones which causes severe pain), end-stage emphysema (such that every breath was a struggle), and severe Alzheimer's disease (he didn't even understand from day to day why he couldn't breath and was constantly hurting), who came in with pneumonia. The one family member, who had not seen or cared for him in years, kept saying "do everything, put him on a respirator..." To what end? None of his underlying conditions would miraculously disappear. What good would meeting with a Panel of Priests do?<br />Bottom line, I'm with you on this one Dr. G.Dr. Dadnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-42418489291498560212010-03-08T11:34:58.921-05:002010-03-08T11:34:58.921-05:00So, I will confess I haven't read all 73 comme...So, I will confess I haven't read all 73 comments. I read the 13 that were there the other day when I first read this post and then thought about it off and on.<br /><br />I see both sides, and what about this?<br /><br />It seems the problem arises when the patient (and family, but hopefully we can focus on the patient) has a belief system that is different from his/her doctors' belief system. Either, they believe more strongly or believe in something different. So, couldn't we have a "death panel" that is composed of the medical folk PLUS a religious representative...priest, rabbi, elder, whatever? That person can weigh in on the religious side and somehow...come to a consensus?<br /><br />I see now how unlikely that sounds...sigh...what a pickle...Bansheehttp://bansheewails.blogspot.comnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-6746254330600377552010-03-08T10:38:55.659-05:002010-03-08T10:38:55.659-05:00It is also not Christian, spritually sound, or mor...It is also not Christian, spritually sound, or morally justified to somehow convince yourself that not actually having any chance of living, and having your body kept alive because your family members are all too sefish to see past their own fear of death isn't toruture. Just ridiculous...but thanks for the interesting post Dr. G.Street Philosopherhttps://www.blogger.com/profile/06254838469569142486noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-46579672920791202102010-03-08T09:28:26.447-05:002010-03-08T09:28:26.447-05:00I'm a little late in the game, but I wanted to...I'm a little late in the game, but I wanted to comment. I also am a pro-life Catholic, and I want to make it clear that extending life at all costs is NOT a mandated part of the Catholic faith. Look up the Catholic directives for End of Life care (specifically nos. 56-58, I believe) to see it written out plainly. When we were expecting my son (born with a severe heart defect,) we went to see our priest about whether the Church supported the decision I was leaning toward, to allow our son to pass away soon after birth. He consulted a priest colleague, who affirmed that yes, such a decision is both in alignment with our faith and is done routinely. Lisa has taken "pro-life" to an extreme and unreasonable level. God created our son perfectly, defects and all. I struggle with guilt daily that I may have said "NO" to God when he asked me to do the most difficult thing ever, to give my child back to Him.<br /><br />ps - Lest you think I'm some heartless monster, God has blessed us over and over through our son, and we love him very much.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-90109657622615968572010-03-08T00:11:13.805-05:002010-03-08T00:11:13.805-05:00Ok, let's see here...
Killer Kevorkian (catch...Ok, let's see here...<br /><br />Killer Kevorkian (catchy, I'll grant you that): we now have legal physician assisted suicide in the states of Oregon, Washington, and Montana. KK was merely ahead of his time.<br /><br />Terri Schiavo: aw, fer chris'sakes! per http://www.religioustolerance.org/schiavo6.htm:<br />"Courts and doctors appointed by the courts ruled that she was in a persistent vegetative state....Unlike patients in a coma, patients in a persistent vegetative state can never recover.<br />Medical Assessment: Leon Prockop, a professor of neurology at the University of Southern Florida, has studied Terri's CAT scans. He believes that Terri's life effectively ceased FIFTEEN YEARS AGO...."Her death occurred some time ago....That brain tissue cannot come back. It never has, and it never will." His view "coincides with the vast preponderance of expert medical opinion...""<br /><br />What, did Schiavo's parents think year number sixteen would be her lucky year? Given her medical condition, if Schiavo's parents couldn't bear to live without her, they should have taken her to a taxidermist and had her stuffed so they could always have her around (yeah, I know that's extremely harsh, but, God-damn it! Brain-dead for 15 years? Time to let go!!! The magic Jewish zombie was not going to be performing any miracles for her). Murder, my ass!<br /><br />Flaming Lisa:"You've all lost your heart!" Yeah, and you've obviously lost your freaking brain and the ability to "get the point."<br /><br />With all the legal documents available today, there is no reason your life should end (or not end) in a fashion NOT of your choosing...you just have to take the time to fill out the paperwork.<br /><br />My entire family has filled out the documents, and further, we have all discussed with each other how we want our end of life to go. And I know that if one of us should find ourselves in a lingering end of life situation, our wishes will be honored and carried out.<br /><br />p.s. to KateA - God bless you and all other compassionate vets who humanely end the irreparable lives of our furry friends.Oh, Lordynoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-70084034712746723712010-03-07T23:29:38.272-05:002010-03-07T23:29:38.272-05:00Lisa-- you are going to die. Me, Grumpy, all the ...Lisa-- you are going to die. Me, Grumpy, all the health care workers who are smarter than you-- we are all going to die. The difference is, I will not bankruupt my family to give me another ten days or ten months of meaningless life. Moron.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-3473364210546810472010-03-07T22:43:27.685-05:002010-03-07T22:43:27.685-05:00I think the point that Lisa is missing is that at ...I think the point that Lisa is missing is that at some point we all have to say goodbye. Sometimes when we are in the middle of a heartbreaking situation, we need a voice of reason to definitively tell us what we refuse to believe. Dr. Grumpy wasn't suggesting that the board of doctors make the decision to pull the plug, but rather they make a decision as to whether insurance should pay to prolong the inevitable. If her husband chose to continue seeking treatment, it would be on his own dime. As much as we all would love to believe that every health care resource will be expended to prolong our lives, it's completely unrealistic. Health care resources are limited, in the same way our natural resources are. We have to use them wisely and efficiently. I personally would rather my insurance premiums go toward vaccinating children (one of the best health care investments out there!) with the outlandish amount of money being spent to torture a poor woman who is long gone. We have limited resources, and it's time America woke up and realized it.AmyBnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-90183167073045345422010-03-07T20:40:36.882-05:002010-03-07T20:40:36.882-05:00I just want to say thanks to both the human doctor...I just want to say thanks to both the human doctors and the animal ones. I for one, see Flaming Lisa as panicked. Who knows what she's going through right now? The vet's post reminded me that I once had been to my beloved dog, what Dr Grumpy's patient's family was. It took a vet to ask me gently, "Why are you doing this? Can't you see your little dog is suffering?" Until that moment, I had thought I was going to find a miracle cure when there was none. <br />And bless the Vet who could inject him and end his suffering.<br /><br />I'm Catholic. Yet I often think we should have the same option as animals - the right to end our suffering. <br /><br />I actually feel sorry for Flaming Lisa. I'm not in the medical profession, but I've watched several people die and luckily for them, their family members had the sense and the backbone to do the right thing. To pull the feeding tube and let the brain dead woman die. To up the morphine on my 95 year old mother in law, so she could go pain-free, not feeling the stomach cancer that had eaten up her inside. <br /><br />My brother in law died at 52 from a brain tumor. It wasn't pretty, but he had a DNR and living will. <br /><br />Something to think about - how you want to go when the time comes.Karen Wnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-38643822177424307192010-03-07T16:22:53.777-05:002010-03-07T16:22:53.777-05:00speaking as a canadian... I gotta point out that t...speaking as a canadian... I gotta point out that the "socialist" label is often misused in regards to the real way in which our healthcare system works... each province has a slightly different way of governing it's individaul healthcare system, and certain test/ procedures are quicker to recieve and certain medications/treatments are more frequently prescribed in some provinces than others depending on wether you are required to pay an additional provincial annual healthcare premium or just the standard federal/provincial tax, but regardless of your province, once you are undergoing hospital care the government does not have the power to "pull the plug." That is a decision left up to a the doctors and the family, if there is a disagreement, just like in the states, the issue usually winds up in the courts and the media. <br /><br />To Tracy specifically- what people generaly do, if they are unable to to attain a procedure or surgery in one province, in an adequate time frame for their liking, is simply move to a province with a higher premium...it may not be a perfect system...but i's say it beat's a country full of people who can't afford to get a basic x-ray or a symple lab test for strep-throatAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-62440175715891854772010-03-07T14:26:10.378-05:002010-03-07T14:26:10.378-05:00And then there are those lovely families who want ...And then there are those lovely families who want everything done for Gramps, because they're wanting his retirement/ pension/SS checks to buy drugs or big screens TVs...<br /><br />Grrrrrrrrrrrrrr...<br /><br />One thing I've found that works well on families who just can't understand "brain dead" is to do the nailbed pressure test on them... they get the idea PDQ!! (Of course I don't use full force on them)bobbiehttps://www.blogger.com/profile/14353836074794786357noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-50091442606601825642010-03-07T13:18:26.163-05:002010-03-07T13:18:26.163-05:00I think Lisa has never had to stand by helplessly ...I think Lisa has never had to stand by helplessly and watch a patient suffer for months on end while the family refuses to stop the madness. Often, it's for a multitude of reasons: guilt, denial or the worst I've seen is that so the family member who makes the decisions can continue to "get her check" for a few more months.Lindahttps://www.blogger.com/profile/08290131458473265824noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-81987650488938046812010-03-07T12:57:57.382-05:002010-03-07T12:57:57.382-05:00For the Canadian who imagines him or herself to be...For the Canadian who imagines him or herself to be an "evil socialist." The difference between your health care system and ours is that we still have to make these choices. In Canada or let's say Great Britain, the choice would be made for you by the gov't. Americans don't think Canadians themselves are socialist but this American thinks their health care system leaves much to be desired. Especially after working for a surgeon for a number of years who did operations at least omce a week on people who were denied care (because of age or health) in their own countries.Tracynoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-71412295398972620332010-03-07T12:54:50.485-05:002010-03-07T12:54:50.485-05:00"As much as you "healthcare workers"..."As much as you "healthcare workers" keep harping that this happens all the time, I have a hard time believing it. I don't see hospitals crammed with people being given every possible test under the sun in these circumstances. It is an exaggeration on your part."<br /><br /><br />This is the part that kills me. She clearly is completely removed from the situation and yet asserts her authority by telling us that we are exaggerating and lying. I really wish she could just come on a few ICU rounds and see how it's done, day in and day out.Chrisnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-32298334017058128722010-03-07T09:57:05.552-05:002010-03-07T09:57:05.552-05:00doc, this resonates with me b/c i just found out i...doc, this resonates with me b/c i just found out i had metastatic cancer. i've calmed down since my news, and this discussion on your blog has convinced me to update all of my end of life documents - though i expect to fight this for quite a long time.<br /><br />Many folks have been calling Lisa various names. I think her opinions are ignorant - but I also think they stem from a lot of fear.<br /><br />When I got my news, my first thought was that no matter what, I wanted to live as long as possible - NO MATTER WHAT.<br /><br />Now i've gone thru the death of my mom in hospice, and my dad in a nursing home. I know the drill and each of them went peacefully without inducements to stay after they were ready to go. I've seen friends allowed to die when they were ready to go. Nonetheless, when i heard MY news, i was briefly Lisa.<br /><br />My point? Have a little pity for her fear. There is a lack of experience in death that underlies her writing. Even with 'experience' in death, it's very easy to understand the dubious attraction of 'do everything to save me/my parent/my spouse/my friend.<br /><br />That said, i won't be clogging up the ICU when the time comes...Unknownhttps://www.blogger.com/profile/05839423631668086139noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-78700831352586559142010-03-07T04:24:32.267-05:002010-03-07T04:24:32.267-05:00I have not read all the posts but from her origina...I have not read all the posts but from her original post and Grumpy's. Thank-you both. I have been on this table before. With a DNR, I would not be here. I was gone after a routine surgery. Because there was an angel on my shoulder according to the charge nurse, I lived to breathe another day.My family went through hell for 3 days wondering if I would "make it" and if they would have to make "the decision" I swore I would not do that to them again. And they will not. Until tonight I was DNR all the way, call the funeral home and order flowers. Even though I might be saved a second time see above about family. My living will soon state. Take extraordianary measures,IF, after 48 hours there is no sign of improvement or hope for a postive outcome. PULL THE PLUG. My family does not have to decide, wil not wonder what if with my previous history and I will not be left to languish and be a burden on my family or the helath care system.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-83397187270850012882010-03-07T04:13:14.264-05:002010-03-07T04:13:14.264-05:00Could Lisa perhaps let us know what her occupation...Could Lisa perhaps let us know what her occupation is? Everybody has been thrashing her (and I don't agree with her!!) but it might give others some insight into her way of thinking. This whole debate has been very interesting, but obviously rather one-sided. Dr Grumpy, I think you are on your way to your 2nd 100 record response hit! You certainly struck a sensitive chord. Keep it up! You make my day, every day, especially when my patients (mostly severe, chronic pain) / practice become a bit overwhelming.Pyndokinoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-43767313524489939572010-03-07T03:18:39.084-05:002010-03-07T03:18:39.084-05:00There's a reason why I can't take people l...There's a reason why I can't take people like "Flaming Lisa" seriously. I could barely continue reading after the second sentence started something like this, "Terri Schiavo would be alive and her murder would never have happened".<br /><br />Seriously? Murder? Certainly NOT. It's distressing when 'removing a feeding tube' is equated to 'murder'. Then we don't end up talking about the same subject and we start talking AROUND each other.<br /><br />Words matter. Drivel and hyperbole spewed forth from self-righteous right-wing zealots always turns me off. I was 17 when the Terri Schiavo incident happened. I agreed with the husband then, and I agree with him now (it was a PRIVATE issue). But then again I'm Canadian, which, for some, means that I'm an evil socialist.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-7310833162485319802010-03-07T02:38:05.972-05:002010-03-07T02:38:05.972-05:00I feel so lucky to be a veterinarian. I can ease ...I feel so lucky to be a veterinarian. I can ease the suffering of any of my patients when their owners feel it is the time. There are many cases that I wish I could have done more tests to get the *answer* but that I didn't do because it would not benefit the pet or change the outcome. <br /><br />This past week, I had a patient that had multiple tumors in the abdomen. He started seizuring. I was pretty sure there was a brain tumor. Did I offer a CT scan? I mentioned it, but more than anything, I advised the owners that surgery to remove the masses in the abdomen or a CT scan would be useless.<br /><br />I have had brain dead animals come in after being hit by a car....owners want me to do "everything" even when there is no hope.<br /><br />This week, our hospital has had more than its fair share of death, ranging from an aggressive animal that was euthanized so it could not harm a child to an immune compromised cat with a horrible infection to the several cancer patients in the last few days. <br /><br />A few months ago, I was euthanizing a dog that the woman claimed was 25 years old. It was skin and bones with bed sores, hind end caked in diarrhea. All of the muscles on his head were sunken in and you could barely see the eyes for the goop. As I gave the injection of euthanasia solution, I petted him and we all told him what a great dog he was. Then the owner turns to me and says, "You must really hate dogs to be able to do that."<br /><br />Talk about ignorance. Since she was dealing with her dog's death, I didn't drop any science on her. I said that death is a gift when life has become to painful to live. Of course, I was not the one that watched this beloved dog, chained to a post outside, dying slowly over who knows how long before finally bringing it in at 3 AM on a Sunday.<br /><br />Personally, I believe in assisted suicide. If that is what the patient wants, and the situation is such that they are only going to experience more pain, it should be offered.KateAnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-84478735688668314242010-03-06T22:03:20.142-05:002010-03-06T22:03:20.142-05:00I also find the Catholic card inappropriate. On t...I also find the Catholic card inappropriate. On the original post, I commented about my mother in law in the end stages of her brain tumor chose not to have a feeding tube because she did not want to be a science experiment. I also mentioned she was an RN. What I didn't mention was she was an extremely devout Catholic who spent the majority of her professional life caring for retired priests in a nursing home.<br />She could never forget the images of her end stage patients curled into fetal positions from lack of movement whose only connection to life was the feeding tubes keeping them alive. Would she remove it herself? No, because her job was to care for the person and inserting the tube wasn't her decision. However, there was no way she was going to permit herself to turn into a dying shell without hope. She had seen it over and over again. In all seriousness, I think that scared her more than dying of the brain tumor.JTNhttps://www.blogger.com/profile/15432367028941353868noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-39078991574230943552010-03-06T21:36:01.940-05:002010-03-06T21:36:01.940-05:00OK I can't resist a final comment;
About Terr...OK I can't resist a final comment;<br /><br />About Terri Schiavo; during that whole episode virtually everyone with whom I spoke (except for my fellow hospice nurses) about her case began by saying "well, I wouldn't want to live like that but....." But what? You wouldn't want to live like she had to, but SHE should be made to? Come on. Sunshine RN is right, food and water by mouth is reasonable, but feeding tubes are extraordinary.Gertnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-47113580899256647702010-03-06T21:04:44.183-05:002010-03-06T21:04:44.183-05:00"just because we can doesn't always mean ..."just because we can doesn't always mean we should" from Joanna is the best comment here.<br /><br />and, I simply wanted to say that the biases should stop. I am a proud Catholic and pharmacist and I would never agree with taking a dying woman to multiple hospitals and doctors to try to get a different answer when it was clear from the start what the real answer was. all people have their own shades of belief and you're wrong to lump everyone together for any reason.Jennoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-60827491971101990842010-03-06T21:00:52.262-05:002010-03-06T21:00:52.262-05:00To Lisa,
Come on down to our LTAC hospital and me...To Lisa, <br />Come on down to our LTAC hospital and meet the patients.screebnoreply@blogger.com