Tuesday, January 20, 2009

The American Way

There was an article in the New York Times today titled "A Front-Row Seat as a Health Care System Goes Awry" (http://tinyurl.com/7y8urf). The article is an interview with Dr. Robert L. Martensen, a former ER doctor. Dr. Martensen has written a book called “A Life Worth Living: A Doctor’s Reflections on Illness in a High-Tech Era.” I have not read the book yet, but I will be interested to see what his reflections are.

One thing he does talk about in this interview is the American way of dying. I have seen what he talks about far too many times, and I'm glad to see that at least one doctor recognizes the disservice that happens too often as patients and families face end of life issues. Dr. Martensen talks in the interview about doing ethics consults where there is no hope of recovery, and yet the doctors involved are reluctant to tell families this, in the name of keeping hope alive.

I will never forget the family I worked with some years ago. I don't even remember the initial problem that brought their mother to the hospital, but by the time she reached my unit she had several systems failing. This was shortly after HIPAA was enacted, and up to that point no one had talked to the family at all about what their mother's condition or prognosis was. When I took the intiative and talked to them about her condition, they were so relieved that someone was finally talking to them they didn't even care it was bad news.

A few days later, the physician agreed that a hospice referral was for the best, and I ended up having to talk to family about this over the telephone. While the way I had to deliver the information was less than ideal, the family was just glad that someone was finally telling them what to expect and what needed to happen next. I was able to get her transferred to an inpatient hospice unit, and as happens so often, she died just a few hours after getting there.

Dr. Martensen feels that doctors should be realistic, and I agree completely. I have seen 91 year old people put on dialysis, and people with end stage lung disease put on ventilators. I know that it is hard to tell people that there is nothing more than can be done, other than comfort measures; I've had to do it. I have also seen how hospice can be a tremendous support for patients and families, and how it can allow people to have the good death that Dr. Mortensen talks about.

It is my hope that as we start looking at ways to repair our broken health care system, we can work to make sure that more people have the option of a good death made available to them.

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