Saturday, January 21, 2012

Terminal illness to one doctor may be a moment to excel by another.

I will put a hold on my goal setting ideas for today to discuss the article below. I am also still having trouble moving charts and graphs from Pages to my blog page. They transfer initially and then disappear leaving a ? mark. Any ideas ?

I read an article  and comments  in Medscape Connect today discussing "How doctors die". After reading the article and many of the comments , I came away with the feeling that most of the doctors responding would chose to accept the diagnosis of terminal illness and slip comfortable into the beyond without a fight.

    I would like to offer a different perspective based on my over 48 years experience as a physician.
   The first lecture on my first day of medical school was given by an old family doctor. His best advise for us as hopeful new doctors was to " never tell someone when they going to die because that person will probable be kicking dirt in your face" . I have lived long enough to know that he was right. I have had the pleasure of watching people make amazing come backs from what seemed like hopeless circumstances. I have also learned that we doctors are not that good at defining terminal illness. Terminal illness to one doctor may be a moment to excel by another. 

   I have had a very personal experience that high lights my thoughts. In my wife's will she signed a form stating that she wanted no life support. I recall asking her at the time if she really meant that and she said yes. Fortunately I had forgotten about our wills when my wife became ill . About 8 years ago she developed flu like symptoms and within 36 hours was hospitalized with septic shock. Over the next 24 hours she was on total life support , unconscious, bleeding from every orifice , acute renal failure on dialysis, gangrene of both lower extremities ,requiring respiratory and BP support . She had multiple surgeries including bilateral below the knee amputations and was in ICU for 2 months.
   I refused request to talk about end of life care. Thanks to the doctors who chose to excel rather than yield to the easy choice of death, my wife now is healthy and enjoying life ,walking up to 2 miles each day on her new titanium legs. She has sense told me that dying would have been easy because the has no recall of anything after getting in the ambulance. She also has a better understanding of "do not resuscitate "and has now changed her choice to; allowing family and her doctor to make the decision if she is unable do do so on her own. 

She is thankful for being given the opportunity to spit in deaths face. 

 David Calder,MD 

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Your comments and questions are appreciated. David Calder,MD