Dr. Ken Murray has offered a follow-up essay providing some statistical support for his claim that doctors really do die differently from the rest of us (that is, they tend to “go gentle into that good night”). Here’s a taste:
When patients of mine would come to my office accompanied by a family member, I often asked the patient how he or she wanted to die. I didn’t do it because the patient was on the brink of death, or even sick. I did it because I wanted the patient to think about the question and also to make sure that a loved one got to hear the answer. Unwanted futile measures, prolonged deaths, and hospital deaths remain commonplace in America and many other places. But they don’t have to be. It just requires our doctors and, no less, the rest of us to come to terms with the inevitable.
As for the statistics he provides, this is interesting:
CPR is rarely as effective as people seem to think. What people have seen on television is at odds with [what] happens in real life. A 1996 study published in The New England Journal of Medicine found that CPR as portrayed on television was successful in 75 percent of 60 cases and that 65 percent of the patients went home. In contrast, in a 2010 study of more than 95,000 cases of CPR in Japan, health professor Hideo Yasunaga and fellow researchers found that only 8 percent of patients survived for more than one month. Of these, only about 3 percent could lead a mostly normal life. A little more than 3 percent were in a vegetative state, and about 2 percent were alive but had a “poor” outcome.
My sense that there’s a yearning among ordinary patients to have more peaceful deaths has been echoed in the research of University of Wisconsin-Madison nursing professor Karen Kehl. In an article called “Moving Toward Peace: An Analysis of the Concept of a Good Death,” Kehl analyzed a collection of relevant articles and, based on their contents, ranked the attributes of an ideal death as follows: being in control, being comfortable, having a sense of closure, having one’s values affirmed, trusting in care providers, and recognizing impending death. Hospitals cannot help with most of these things. Unfortunately, most patients do not see their wishes fulfilled. A 1998 study published in the Journal of the American Geriatrics Society looked at Medicare patients and found that, while most said they preferred to die at home, most died in hospitals.
Whether you seem sick or well right now, the good doctor recommends that you look into setting up an “advance directive or POLST.”
Reading Dr. Murray, I think of the REM song, “It’s the End of the World as We Know It,” which contains in its lyrics the following:
Offer me solutions. Offer me alternatives. And I decline.
“Decline” in this context nicely implies two meanings: to say no and the experience of going down. It might also imply that the solutions and alternatives offered in panic are themselves symptoms of that decline–things to be rejected.
When the vultures begin to circle, fight or be the Buddha?