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End of life discussions are hard enough

I posted this several years ago. I think that it is worth posting again.(Besides, I don’t know what to make of Rick Santorum.)

When Sarah Palin wrote, “the America that I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death penalty’ so his bureaucrats can decide, based on a subjective of judgment of their ‘level of productivity in society,’ whether they are worthy of healthcare. Such a system is downright evil,” I got physically nauseated. The only reason that former Governor Palin said this was to derail healthcare reform and to try to elevate her own status in the conservative movement. The statement had no basis in reality. My nausea stems not from a lie, but from this person unknowingly making my job harder. Speaking with real patients about real end-of-life issues is incredibly difficult.

The following is an example of an end of life discussion. It has been fictionalized to protect patient’s privacy. A 80-year-old man presented after a fall at home. The patient had been in declining health for some time. He has an abnormal heart rhythm and congestive heart failure. He is on blood thinners because he is at increased risk of developing clots in his heart. The patient is awake and alert on arrival. A CT scan is obtained of his brain which reveals blood between the brain and the skull — subdural hematoma. The patient is admitted to the intensive care unit for observation. Medications are given to reverse his blood thinners. The patient does well overnight in a repeat CT scan (standard practice) performed to see if anything new has shown up. The patient has a new contusion (bruise) on his temporal and frontal lobes.

The patient, who was lucid throughout the night, is now somewhat confused. He is having some problems finding his words. His son, who is an orthopedic surgeon, had been with the patient through the night. The son is now extremely concerned. He wants to know what happened. I review the CTs with him and point out that the contusion is in the area of the speech center of the brain. This should explain his difficulty finding words.The son wanted a repeat CT scan, in spite of the fact that the second scan was only completed four hours ago. I asked whether, if we find a surgical lesion (something that can be operated on), he would like me to call a neurosurgeon. I asked if he wanted his father to undergo brain surgery if it is necessary.

I think this question is more than reasonable. Thankfully, the son never had to make that decision. The repeat CT scan was the same as the second scan. Neurology was consulted. Over the next several days, the patient slowly improved and was able to be discharged to a rehabilitation center.

You know our society is in trouble when a physician has not thought about end-of-life issues concerning his 80-year-old father who has a bad heart. From a medical standpoint, I just want to do what is right for the patient, which is to follow that patient’s wishes. Yet so very few families have talked about end-of-life issues. You don’t want to be in the position of the son where you’re having to make a decision while looking at a CT scan in the middle of an ICU. Instead, you would like to be able make decisions in the privacy of your physician’s office.

I deplore any politician that makes this situation harder. Emotions are overwhelming when families are faced with these types of decisions. Exploiting end-of-life issues for political gain should get those politicians a special place in Dante’s Inferno.

By |2012-02-08T05:57:03-04:00February 8th, 2012|Congress, Healthcare|Comments Off on End of life discussions are hard enough

Sarah Palin's speech is really poetry

The Tonight Show with Conan O’Brien has figured out Sarah Palin. I think they deserve an Emmy for this, because I have been read her speeches and I just get a headache. (The headache may or may not come with nausea.) O’Brien believes that Palin is poetry. This explains a lot. I didn’t understand half of the poetry that I read in college. I think that he may be on to something.

William Shatner reads Palin:

By |2009-07-29T22:37:11-04:00July 29th, 2009|Fun, Party Politics|Comments Off on Sarah Palin's speech is really poetry

Why would they treat this problem any differently?

The Bush Administration has fairly well managed to ignore or mismanage nearly every problem that has arisen on its watch. I know that sounds fairly strong, but I’ll wait for a while for you to come up with something that they dealt with in timely and efficient manner.

Nope, I can’t think of one either.

Well, now they’re meeting the food-safety issue with that same dazzling efficacy. The FDA issued its “Final Guidance for Safe Production of Fresh-Cut Fruits and Vegetables” today. It’s a totally voluntary, non-binding resolution that says that fruit and vegetable processors should adopt food safety plans similar to those in the meat industry. There are no mandatory rules, no role for inspections, no punishments for violations and really, nothing other than recommendations of common-sense issues that the industry is already aware of. Some of the choice excerpts:

“FDA recommends that supervisors be trained to recognize the symptoms of active infectious disease; these symptoms are vomiting, nausea, diarrhea, and abdominal cramps. We recommend that employees with these symptoms be excluded from any operations which may be expected to result in contamination of fresh or fresh-cut produce or food contact surfaces, including equipment and utensils, until the medical condition is resolved.

“We recommend that firms maintain an adequate supply of bandages that provide protection from any wound. A wound containing pus (such as an open and draining boil or other infected wound) that is located on a part of the body that could contact fresh produce or fresh-cut produce, processing equipment, or tools, presents a risk of contaminating fresh-cut produce.”


By |2013-11-03T18:31:34-04:00March 13th, 2007|Bush Administration, Environment|Comments Off on Why would they treat this problem any differently?
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