Dying comfortably is not easy.

in #life6 years ago (edited)

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Imagine this for a second: you are selling something that all your customers want, but it's something you would never use yourself. What would you do? Would you try to dissuade the customer from using it? Even if your bottom-line is affected?

Now let's make the question even harder: your customer believes that the product is great. They believe that if they use it, they will have tried everything and appreciate you for it.... AND you make more money? Also, if you try to tell them to not use it, they might hate you for that advice - even if it's the right thing? What then?

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Welcome to the Do Not Resuscitate and the Do Not Intubate conversation.

If you ask most doctors how they want to die... more than 80% of them will say, comfortably. What does that mean? It means practically all of us want to be DNR and DNI. Why, you ask?

In my 10 years of practicing medicine, I can count on one hand that number of people that survived a code. And, literally one person actually walked out of the hospital. This isn't because I am not around code blues. I personally run them around once every two or three months. It's because they very-rarely work. Period.

So, if code blue was a product and "a good quality of life" was it's purpose, then it's got horrible returns!

Common complications due to CPR are rib fractures, sternal fractures, bleeding in the anterior mediastinum, heart contusion,hemopericardium, upper airwaycomplications, damage to the abdominal viscera − lacerations of the liver and spleen, fat emboli, pulmonary complications − pneumothorax, hemothorax, lung contusions.

Do you expect to walk out of the hospital after that?

The crazy part in all of this is if you sign a DNR, you might actually live longer.

But then why do patients and families keep asking to get resuscitated? Maybe it's the unrealistic expectations from tv or maybe it's the hope that you will be the same as that one patient, that I know, who walked out after resuscitation.

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If it's the the latter then I want to tell you, she got lucky.

Her ventricular tachycardia occurred, and was caught on the monitor, while her physician was in the room talking to her. The patient was in the process of being transferred for defibrilater placement; her heart then went into the very rhythm you need that device for and, as she already had temporary shock pads on her chest, the physician shocked her and saved her. Very lucky. Very rare.

Physicians in America usually don't even ask the DNR/DNI question because it's received badly, misunderstood as "death panel" talk or patients think that death will never come for them. (Good luck with that!)

My unsolicited advice: think about it, tell your family, your friends and then sign a document with your wishes.

In this one case, do as the doctors do, not as they say.

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