How Doctors Die | this is my inspiration.

by Ken Murray, MD

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient?s five-year-survival odds?from 5 percent to 15 percent?albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn?t spend much on him.

It?s not a frequent topic of discussion, but doctors die, too. And they don?t die like the rest of us. What?s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Of course, doctors don?t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They?ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen?that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that?s what happens if CPR is done right).

Almost all medical professionals have seen what we call ?futile care? being performed on people. That?s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, ?Promise me if you find me like this that you?ll kill me.? They mean it. Some medical personnel wear medallions stamped ?NO CODE? to tell physicians not to perform CPR on them. I have even seen it as a tattoo.

To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they?ll vent. ?How can anyone do that to their family members?? they?ll ask. I suspect it?s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it?s one reason I stopped participating in hospital care for the last 10 years of my practice.

How has it come to this?that doctors administer so much care that they wouldn?t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.

To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They?re overwhelmed. When doctors ask if they want ?everything? done, they answer yes. Then the nightmare begins. Sometimes, a family really means ?do everything,? but often they just mean ?do everything that?s reasonable.? The problem is that they may not know what?s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do ?everything? will do it, whether it is reasonable or not.

The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I?ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who?d had no heart troubles (for those who want specifics, he had a ?tension pneumothorax?), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.

But of course it?s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.

Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman?s terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.

Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn?t restore her circulation, and the surgical wounds wouldn?t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.

It?s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they?re asked, with little feedback, to avoid getting in trouble.

Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack?s worst nightmare. When I arrived at the hospital and took over Jack?s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.

Even with all his wishes documented, Jack hadn?t died as he?d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack?s wishes had been spelled out explicitly, and he?d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It?s no wonder many doctors err on the side of overtreatment.

But doctors still don?t over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had ?died peacefully at home, surrounded by his family.? Such stories are, thankfully, increasingly common.

Several years ago, my older cousin Torch (born at home by the light of a flashlight?or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn?t had in decades. We went to Disneyland, his first time. We?d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn?t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don?t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.

The Health Care Blog / The Insider?s Guide / Published: August 6, 2012
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Source: http://suefan.wordpress.com/2013/01/09/how-doctors-die/

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Texas school can force teenagers to wear locator chip: judge

SAN ANTONIO (Reuters) - A public school district in Texas can require students to wear locator chips when they are on school property, a federal judge ruled on Tuesday in a case raising technology-driven privacy concerns among liberal and conservative groups alike.

U.S. District Judge Orlando Garcia said the San Antonio Northside School District had the right to expel sophomore Andrea Hernandez, 15, from a magnet school at Jay High School, because she refused to wear the device, which is required of all students.

The judge refused the student's request to block the district from removing her from the school while the case works its way through the federal courts.

The American Civil Liberties Union is among the rights organizations to oppose the district's use of radio frequency identification, or RFID, technology.

"We don't want to see this kind of intrusive surveillance infrastructure gain inroads into our culture," ACLU senior policy analyst Jay Stanley said. "We should not be teaching our children to accept such an intrusive surveillance technology."

The district's RFID policy has also been criticized by conservatives, who call it an example of "big government" further monitoring individuals and eroding their liberties and privacy rights.

The Rutherford Institute, a conservative Virginia-based policy center that represented Hernandez in her federal court case, said the ruling violated the student's constitutional right to privacy, and vowed to appeal.

The school district - the fourth largest in Texas with about 100,000 students - is not attempting to track or regulate students' activities, or spy on them, district spokesman Pascual Gonzalez said. Northside is using the technology to locate students who are in the school building but not in the classroom when the morning bell rings, he said.

Texas law counts a student present for purposes of distributing state aid to education funds based on the number of pupils in the classroom at the start of the day. Northside said it was losing $1.7 million a year due to students loitering in the stairwells or chatting in the hallways.

The software works only within the walls of the school building, cannot track the movements of students, and does not allow students to be monitored by third parties, Gonzalez said.

The ruling gave Hernandez and her father, an outspoken opponent of the use of RFID technology, until the start of the spring semester later this month to decide whether to accept district policy and remain at the magnet school or return to her home campus, where RFID chips are not required.

(Editing by Daniel Trotta and Peter Cooney)

Source: http://news.yahoo.com/texas-school-force-teenager-wear-locator-chip-judge-021126100.html

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Stocks close lower ahead of earnings season

15 hrs.

Stocks finished lower for the second session Tuesday, dragged by telecoms, as investors remained on the sidelines ahead of what is expected to be a weak fourth-quarter earnings season.

The?Dow Jones Industrial Average?slid 55.44 points, or 0.41 percent, to end at 13,328.85, led by?Boeing?and?Verizon.

The?S&P 500?erased 4.74 points, or 0.32 percent, to close at 1,457.15. The?Nasdaq?declined 7.00 points, or 0.23 percent, to finished at 3,091.81.

The?CBOE Volatility Index (VIX), widely considered the best gauge of fear in the market, ended below 14, closing lower for the sixth-straight session.?

Most key S&P sectors finished in negative territory, dragged by?telecoms?led the laggards, while?materials?eked out a gain.

"We're going to have some improvement about perceptions of growth?we need just a little bit of confidence," said Bob Doll, chief equity strategist at Nuveen Asset Management. "I'm using the phrase: muddle-through economy and grind-higher equity market?it's not going to be a gallop."

S&P 500 companies are expected to post earnings growth of 2.8 percent for the fourth quarter, up from the barely positive 0.1 percent growth in the third quarter, according to Thomson Reuters.?

"[The earnings expectation] bar is so low that it's almost impossible?not to beat it," said Kenny Polcari, director at O'Neil Securities. "The China?story is what we're going to hear going forward."

Alcoa?was slightly higher ahead of its earnings report. The Dow component and aluminum producer is expected to post earnings of 6 cents a share on revenue of $5.6 billion, according to analysts polled by Thomson Reuters.

Boeing?slumped after a Japan Airlines 787 aircraft returned to its gate prior to takeoff at Boston's Logan International Airport?after a fuel leak. No fire or injuries were reported. This comes a day after a different Japan Airlines 787 Dreamliner aircraft caught fire at Logan airport.

Monsanto?rallied after the agricultural biotechnology company boosted its earnings outlook for fiscal 2013 and handed in better-than-expected quarterly results.?

For-profit education company?Apollo Group?is also expected to post earnings after the closing bell.?

Yum Brands?slipped after the fast food company reported that its China sales would be down more than expected due to a government review of the country's poultry supply.

Sears Holdings?dropped following news that CEO Louis D'Ambrosio will step down and will be?replaced by Chairman Edward Lampert.

Apple?edged higher after DigiTimes reported that the tech giant is planning on manufacturing low-cost iPhones for emerging markets in the second half of 2013. The low-cost alternative will include a larger display and a new exterior design.?

Separately, the Consumer Electronics Show in Las Vegas kicked off Monday night. Chipmakers such as?Intel,Nvidia?will be in focus. Large manufacturers such as?Samsung,?LG,?Sony?and?Panasonic?are expected to unveil new gadgets throughout the week.?

AT&T?declined even after the wireless communications company said it sold more than 10 million smartphones in the fourth quarter, topping its previous record of 9.4 million a year ago. The company is expected to post earnings results on January 24. Rival?Verizon?also traded lower.

GameStop?slumped to lead the S&P 500 laggards after the video?game retailer said it expects to post a decline in same-store sales for the fourth quarter due to a weak holiday season.

The government auctioned $32 billion in 3-year notes at a high yield of 0.385 percent. The bid-to-cover was 3.62.

On the economic front, small business sentiment was?mostly unchanged in December, as owners expect business conditions to deteriorate over the next six months, according to a National Federation of Independent Business survey. The December reading was the second lowest since March 2010.

Consumer credit gained in November by $16.05 billion, rising for the fourth straight month, according to the Federal Reserve. Economists polled by Reuters had forecast consumer credit rising $12.75 billion.

European shares briefly dipped?following market chatter that France's sovereign debt rating would be downgraded by Standard & Poor's. However, a senior French official said the rumors are "erroneous," while the ratings agency said it does not comment on market rumors.

Source: http://www.nbcnews.com/business/stocks-close-lower-ahead-earnings-season-1B7895490

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Head of Libya's parliament survives assassination attempt

TRIPOLI (Reuters) - The head of Libya's parliament survived an assassination attempt unharmed at his home in the remote desert interior of the country, his spokesman said on Sunday.

Mohamed al-Magariaf's residence in Sabha, 800 km (500 miles) south of the capital Tripoli, came under gunfire on Thursday evening. "(He) was unharmed and escaped the attack but three of his guards were injured," spokesman Rasmy Burwein said.

Magariaf was in Sabha for meetings with local officials and community leaders after Tripoli declared the region a closed military zone to try to curb rampant lawlessness.

Sabha and the rest of the Saharan south has been plagued by tribal violence since the start of the armed uprising in 2011 that ousted and killed veteran dictator Muammar Gaddafi.

Tribal power is much stronger in the south than on the Mediterranean coast. Porous borders with neighboring states and the easy availability of arms have turned the south into a security headache for a weak central government.

It is still struggling to curb a myriad of armed militias that emerged powerful from the anti-Gaddafi insurgency.

(Reporting by Ali Shuaib; Writing by Hadeel Al-Shalchi; Editing by Mark Heinrich)

Source: http://news.yahoo.com/head-libyas-parliament-survives-assassination-attempt-151132665.html

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Thumbs For Food: Hoshino Coffee (Dhoby Ghaut) | ThumbsForFood

Hoshino Coffee is a new Japanese Restaurant that is brought over to Singapore. It is famous for it's hand-dripped coffee as well as it's souffle. Being a dessert fan, I was eager to try out it's desserts! So, we went to Hoshino for tea time.

?It is not a restaurant that is enclosed. In fact, it has an "open-concept" situated in the new, air-conditioned, Plaza Singapura Extension. As such, you don't have to be worried about the heat from outdoors. Somehow, Hoshino gives me a cafe feel, especially given that it specializes in coffee. However, they do serve main courses such as curry, pasta and stuff as well. I guess I would return to try it's main courses.

They have a variety of Matcha drinks available. So, we decided to try their Matcha Latte with Softee (about $10). I guess for the price, I was expecting more or something different. Well, it tasted very normal. The matcha flavor wasn't as rich as I was hoping for. The softee was really just a scoop of vanilla ice-cream that made the drink more milky. Guess I won't be ordering this in future.

Green Tea Souffle with a scoop of softee ($9.80) was picked as our dessert because we really like green tea. I like that it was baked nicely with the top layer a bit crisp and the insides soft and fluffy. And yes, we ordered Hoshino Blended Coffee ($5.80).?Well, it's coffee is said to be hand-dripped. It really is quite a strong coffee in terms of caffeine. It will be a favorite among dark coffee lovers. Also, there is 50%off if you need a refill.

Overall, we felt that the prices of drinks and desserts are really quite high. So, I would say that the price does not befit the food served. Ambience wise, pretty noisy and since it's new, you got to queue. I don't think the desserts and drinks were memorable. But, since, many others have said that their pasta and curry is not bad, I shall visit it again another day. Till then.?

Our Rating: 6.5/10

68 Orchard Road

#03-84 Plaza Singapura

Tel:?63383277

Love, Y

Source: http://thumbsforfood.blogspot.com/2013/01/hoshino-coffee-dhoby-ghaut-thumbsforfood.html

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Microcurrent Facials - get your two free reports

The baby boomers that started the campaign to look young even at the age of 50 have inspired many people to join in the anti-aging movement. Many baby boomers are content to fight the signs of age with basic commercial moisturizers while others resort to more drastic measures such as injections and cosmetic surgery. But for those who aren't happy with topical products yet can't stomach the thought of facing a needle or scalpel cutting into their face, is there another alternative? Fortunately, there is.

Article by Health-and-Fitness:Anti-Aging Articles from EzineArticles.com (c) Health-and-Fitness:Anti-Aging Articles from EzineArticles.com - Read full story here.

The baby boomers that started the campaign to look young even at the age of 50 have inspired many people to join in the anti-aging movement. Many baby boomers are content to fight the signs of age with basic commercial moisturizers while others resort to more drastic measures such as injections and cosmetic surgery. But for those who aren't happy with topical products yet can't stomach the thought of facing a needle or scalpel cutting into their face, is there another alternative? Fortunately, there is.

Article by Health-and-Fitness:Anti-Aging Articles from EzineArticles.com (c) Health-and-Fitness:Anti-Aging Articles from EzineArticles.com - Read full story here.

Source: http://anti-aging.fitnessthroughfasting.com/anti-aging/microcurrent-facials-could-they-be-the-answer-to-looking-younger.php

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