9 Suggestions for Physicians Dealing with Terminal Patients
I know two people who are in the late stages of terminal illnesses right now. One of them is lucky enough to have a doctor who's reasonable and understanding … the other one doesn't. Well, at least not until today, when one of his physicians finally admitted the fucking obvious: that he's actually, really and for-truly, dying.
So, based on their experiences, here's a few suggestions to doctors dealing with terminally ill patients:
- Do your fucking homework … Don't prescribe Tylenol 3 to a patient with a liver problem (ibuprofen: bad bad bad for the liver). Don't prescribe drugs that are going to conflict with other medications and cause artificial dementia. Yes, I know other doctors might be prescribing things without consulting you … I know it'll be a terrible pain in the ass for you to keep track of everything … You poor, poor, well-paid, perfectly healthy jackass. But maybe you remember something from early in your career, called the Hypocratic Oath? "Do no harm," is the gist of it, I think?
- If you keep telling your patient they need to relax and avoid stress, either be willing to send them to a nice Carribean resort on your dollar, or give them some fucking anti-anxiety meds, asshole. Chronic pain is stressful enough on its own … dying in pain is even worse. Especially if the patient isn't surrounded by the most emotionally strong, supportive family in the world … and a lot of people aren't. Just because you deal with death all day doesn't mean everyone else is so terribly cavalier about it.
- However, that's no excuse to blow sunshine up your patient's ass about everything. Chances are they figured out they're dying before you polished up your balls enough to say it. They've probably been through a round of treatment or three. They definitely know whether or not the treatment worked. And if it didn't, they pretty much know they're dying … but knowledge often doesn't turn into acceptance until the final word from you. Don't leave them hanging until they've got a month to live, for fuck's sake … even fucking bloodless mortgage companies give people more warning than that before they foreclose.
- If you're a General Practitioner, I understand you're not an expert in everything. No problem. That's why they have these doctors called "specialists," and you're allowed to write things called "referrals." If you're consistently unable to answer your patient's questions, or do anything useful at all for their general comfort and well-being, write the fucking referral already! Honestly, it won't make your penis shrink, and if admitting you're not God does give you impotence, you can always dispense yourself some Viagra.
- On the other hand, if you're a GP and you've already written a prescription, and the patient says they need it bumped up to a slightly higher dose, don't fucking tell them they have to go to a psychiatrist to get it. Imminent death does not automatically make a person mentally defective (unless they have mad cow, or alzheimers, or a brain tumor, I suppose) … YOU wrote the first prescription, and the odds that there is some obscure law preventing you from writing a bigger one are very, VERY, very slim. As in, you're full of shit.
- Most terminal patients spend quite a many years living with their pet disease. Many of them will learn things about it … possibly even things you don't know. This is also no problem. You're human (theoretically), you have limited time for research, and most doctors have many diseases to study and deal with. Your patient (in most cases) only has ONE. Give them some credit. Especially with the internet out there, a reasonably intelligent person can learn a lot on a focused subject in a fairly short time … quit masturbating with your fucking diploma and try listening for a change. You might learn something.
- Start lobbying to legalize marijuana (or donating to lobbying groups who are), at the very LEAST for terminally ill patients. You're a doctor. You ought to know DAMN well that pot works better than any bullshit "appetite stimulant" pill made by a drug company doing their damndest to keep it illegal. And no, from what both people I know have said, even if you can prescribe THC pills, they don't work as well. AND even if you're the kind of uptight prick who's afraid your walking-dead-man patient might become a Xanax junkie … POT ISN'T ADDICTIVE
- Sure, narcotic painkillers and benzodiazepines and hard-core sleeping pills are addictive. So fucking what? Let the patient be a fucking drug addict! It. doesn't. matter. Fucking hell … even if they want so fucking much morphine they're a drooling idiot for most of the day, let 'em! Whatever side effects the drugs may have in the long term is COMPLETELY fucking irrelevant. There IS no long term here. Hell, in some cases, there may not even be enough time to get well-and-truly addicted. THE PERSON IS GOING TO DIE … they'll have all the time in the world to detox when they're dead.
- If, on the other hand, you're not prescribing adequate quantities and types of medication because you're afraid your patient might commit suicide … might I just remind you, THIS. PERSON. IS. DYING. ANYWAY. If they decide they really don't want to suffer through the last part of the ordeal, who the fuck are YOU to say otherwise?! When a person's pet is dying, in constant pain, and unable to do any of the things it used to enjoy, people look at the owner like some kind of monster if they keep the poor thing alive and suffering until the sorry end. So, if euthanasia is considered the only decent thing to do for a dying pet, how is it that a human being with free fucking will isn't allowed to make the same choice for themselves?! (And may I add to that, my sincere wish that you find a doctor as stingy as yourself in your final days.)
Yeah, I think that about wraps it up. Besides … it's 4 in the fucking morning. I need to sleep.
Ooh, you hit a sore point here for me. Medical institutions are just a money making racket. Both my dad en my wife's dad died due to hospital incompetencies. But that's not all of it, the bad experiences we had during my wife's labour with our one son, or the fucked up way they once refused my other son treatment is just part of a long list I have against the medical profession. I say fuck'em all – throw them in a pit with the lawyers and let's fucking start over. Alternative Health is way better than these fucking monkeys who just don't give a fucking shit.
23rd May 2008 at 3:10 am | permalink |My mother was a hospice nurse for about 15 years. During that time I learned quite a bit about good and bad doctors, and appropriate and inappropriate ways to deal with terminal patients.
One of the critical elements in hospice care is competence, pure and simple. If a nurse or a doctor isn't capable of making basic cause and effect connections, then they probably shouldn't be in the profession. Yet there are many that are, and these are the ones that can't comprehend that addiction is not an issue for a long term patient, or that they ultimately have no say in the outcome of the disease.
As for pain meds, anti-anxietals, and the like, my mother had no issue with dealing those out as necessary—specifically for the reasons you describe. She could walk into a pharmacy and pick up a bottle of morphine for a patient without issue (and did). Or any other med: Xanax, Haldol, Valium, Ativan, Prozac, Vicodin, Percocet, etc.
I once discussed physician assisted suicide with my mother (a devout Catholic) and she had an interesting point. Most patients have access to enough opiate-based pain meds that they could kill themselves at just about any time they want. Take a bunch of Vicodin, wash it down with a bunch of Valium, and drift of to oblivion. However, this doesn't take into consideration those patients who are not allowed access to their meds by their health care professionals, or simply not prescribed appropriate meds to accomplish the task. Nor does it take into account those who are physically incapable of ending their suffering, such as those with ALS. On these points she deferred to the Catholic church's "sanctity of life" position.
Medical marijuana? Abso-freakin-lutely. Addiction? Who cares? I think about some of this stuff and I'm reminded of a recent XKCD post about science. One character makes a comment about how "Mythbusters" (one of the best shows ever) is entertaining but isn't really science. Zombie Feynman shows up to retort that "'Ideas are tested by experiment.' That is the basic core of science. Everything else is just bookkeeping."
If I'm terminally ill, let me have a say in my treatment. Let me participate in the decisions which will affect my life. Let me be educated and informed. And above all, let me have the final say in what treatments I do and do not want. Feel free to settle the books when I'm gone and use my mistakes to further science, if they're useful.
Sanctity of life is bullshit because it only means something to those who don't have a dog in the fight. Quality of life is far more relevant and primarily predicated on and dictated by the patient. Above all else, the first and most inviolate realm of sovereignty is that of the individual over themselves, and if someone wishes to terminate their own suffering (directly or by request) there is little to no basis for anyone else to object.
23rd May 2008 at 6:09 am | permalink |@fabrulana: I consider myself lucky that I haven't had any personal medical fuckups … but my ex and his youngest daughter have a couple of ridiculous stories from the local hospital here.
You wonder what in the hell good medical school does, when common sense would dictate against some of the fuckups doctors make on purpose.
@Becca: A nurse recommended hospice care to one of the people I know today, so he could avoid the headaches one of his doctors gives him about medication.
Of course, having someone recommend hospice is about the same as your doctor saying "you're going to die" … but if that's the situation, their attitude about medication is such a blessing.
And "sanctity of life" … yeah, utter B.S. Sanctity of choice is much more important in situations like that. Well, fuck. In ALL situations.
23rd May 2008 at 10:39 am | permalink |@alpha – intellect doesn't help squat it is wisdom that makes the difference. I really hope that you don't have the experiences we had, but unfortunately many people do. And I am just your average Joe.
@Becca – I have great respect for nurses as they have to put up with a lot of the fuckups doctors do, and I would know … both my Mom and my sister are nurses. Sometimes they just do what doctors tell them and then when something goes wrong they are under suspicion rather than the real culprit, or even worse having to sit with the consequences of trying to help patients out of a wrong decision. As to choice over life and death, for sure I would place it in the hands of the person, except if they are irrational. Look, we aren't talking about a person here …who is trying to jump of a building because life is working on their tits. These are people who can't stand the pain of day after day physical incapability and watching it destroy them and their family (emotionally and financially), who needs to take a rational decision – that amounts to bravery rather than cowardice. How difficult is that to see.
23rd May 2008 at 10:57 am | permalink |@fabrulana: Instead of taking the Hippocratic Oath, doctors should be required to have this quote from Socrates tattooed on their forearms: "The only true wisdom is in knowing you know nothing."
23rd May 2008 at 11:01 am | permalink |Want an excellent, topical read? Check this post by a friend of mine from AZ.
23rd May 2008 at 11:38 am | permalink |@Becca: That's fantastic. :-) As soon as I figure out why my OpenID is all screwed up, I'll be posting a comment to it.
23rd May 2008 at 12:57 pm | permalink |*stands up an claps*
Brava, brava.
I think you really hit the nail on the head here. I watched my grandfather die a slow and painful death with incompetent doctors treating him like a lab rat. Although I was only a young child at the time I still understood his pain and could not believe that a piece of paper and some supposed higher education would make someone such an asshole. I do have friends that are doctors, but the few that do manage to keep their roots can't take any more patients because they're so flooded already. I think that the cock-waffle gene might be an implanted when doctors mate, making a smaller doctor. Makes me wonder what really goes on in medical school.
23rd May 2008 at 5:35 pm | permalink |Nice post. I wouldn't disagree with any of the comments above. Unfortunately, I have a couple of similar horror stories in which my family has had to endure medical professionals who seemed completely void of any common sense (amazing) and showed very little, if any compassion. On the other hand I would be remiss to not mention some of the wonderful, caring and sincere people I was lucky enough to find along the way. People like Becca's friend(thanks Becca).
It seems the health care industry isn't immune to societies fuckwads. Every profession has them; IT, auto mechanics, politicians, teachers….etc.
One of my friends has a brother who is a General Practitioner. Obviously he has very good book smarts but he couldn't carry on an intelligent conversation if his life depended on it. I'm sorry, but common sense, common courtesy, common decency are anything but common these days. It seems more like a fucking superpower.
@alpha- I wish you and your friends the very best!
23rd May 2008 at 5:35 pm | permalink |Excellent post again alphabitch, your right, I am thinking of printing this out and giving a copy to our GP's, all three of them [with your name and URL on of course, I have seen Dr Wright perusing the Internet whilst having his midmorning coffee with ten zillion biscuits].
My nan [RIP 1992] knew she was dying, the cancer specialist said not to tell her as she would "give up", she already knew, she had her stuff ready for dying, all organised. They gave her chemo when there was no hope, personally I would have shorter time well then poorly if I knew it would only make 6 weeks different.
I agree about cannabis, a joint is miles better than a pill, they should make it prescriptive or better still let you grow your own, it brought great relief for one patient and one I know who has joint problems. It got me of two years of anti-depressants within 4 weeks.
My mother had those diet pills, she went nuts. In the end it is still speed / whizz / fet, but a more expensive blend? Maybe, I have no idea.
My next door neighbour is terminally ill, both her parents died of cancer, she said she knew she had it. Our GP said she was "just getting a bit fat" and to do some exercise… she worked all her life, ate a balanced diet and went to the gym and swimming. Her cancer count is now going up, up, up, the chemo has stopped working, had our GP sent her for tests earlier the "fat" which turned out to be a large tumor, could have been operated on and the chemo would have worked. She smiles all the time, she has faith and has accepted it. I could still cheerfully wring our GP's neck, got to save NHS expenses seems to be their motto.
Why? To pay for the damn biscuits.
The last person I would want to see if I was dying would be a psychiatrist.
Haha about the diploma / masturbating thing, your so right.
Thanking you and thinking of your two friends. Helen
26th May 2008 at 6:32 am | permalink |I humbly present you with >9000 internets, good sir.
My grandfather was terminally ill due to lung cancer… the doc was just as much a prick to him as you've described.
26th May 2008 at 12:56 pm | permalink |I hope HIS doctor refuses to give painkillers, too.
@Rick, Jen & Stardust: Thanks everyone. It's funny how abso-fucking-lutely EVERYONE completely agrees … except the fuckwit doctors. I think it is a matter of common sense being anything but common. Especially, it seems, after years of specialized training. It's as though they don't have room left in their heads for common sense after med school.
@helen: If you do print it out and give it to your doctor, you MUST come back and tell us what his reaction was. ;-)
26th May 2008 at 4:31 pm | permalink |A good book on this subject which can recommend is : http://www.momscancer.com/
26th May 2008 at 9:44 pm | permalink |A-fucking-men!
Only caveat I will entertain is that when a doctor must make a decision without the patient's input – and only in that situation – they should always err to length of life over quality of life. That said, when the patient is requesting a non-standard treatment that might work to cure a fatal disease, go ahead and try it and document it (but do screen out any crap from known modern snake oil salesmen).
27th May 2008 at 8:23 am | permalink |4 in the morning? Don't you think it's past your bedtime? Hehe.
27th May 2008 at 5:05 pm | permalink |@fabrulana: Hopefully someone else will see the link and read it and get something good out of it … I personally am a bit worn out by the whole thing, and am just "hanging in there" trying to do whatever I can to help my Dad (yeah, there I go, I've outed the whole thing … this piece is mostly about my Dad and his primary care physician) have a decent quality of life. :-\
@Xaos: Without the patient's input? I'm of mixed opinions … no patient input could mean the patient is unable to communicate, comatose or vegetative or whatever, and in those cases, I think comfort would be more important, unless there's some realistic hope of recovery …
@Aimee: It was definitely past my bedtime, but I was in a different time zone, and under very weird emotional stress at the time. ;-)
30th May 2008 at 2:12 am | permalink |@alpha – precisely what the book is about… written in comic book format.
30th May 2008 at 2:25 am | permalink |@fabrulana: Once again, up past my bedtime … but I did click through to the site. :-) Looks great … I'll totally buy a copy when I have some money again. :-)
30th May 2008 at 3:19 am | permalink |