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Old 01-23-2014, 05:39 PM   #1
The future is unwritten
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Doctor's Personal Choices

We've discussed this before but it's a good reminder to do some serious thinking and make your feelings known.

For 55 years Johns Hopkins has been sending out yearly questionnaires to it's medical graduates. Like a nagging Auntie they want to know how everyone is feeling, but unlike Auntie, they want specifics.

Members of the School of Medicine classes of 1948 through 1964, they've volunteered to keep a running medical chart of their entire lives, providing detailed annual updates, and in the process have created an extraordinary trove of medical information.

This mother lode of data has yielded some fascinating and important results over the years, including landmark studies correlating high cholesterol in early adulthood with later heart disease, as well as links between mental depression and heart attacks.

Hopkins scientists using the data were also able to show links between coffee drinking and heart disease, and youthful obesity and later diabetes.
Now doctors know the symptoms of a lot of bad things that nobody wants to consider, and it's harder for them to dismiss symptoms with some half-assed explanation. They've seen how those bad things play out, with all the variations.

So when you ask a bunch of doctors the how they want to play their last hand, you can eliminate John Wayne(whack it off, I'll bite this anvil), and Mrs Doubtfire (Oh, I don't want to be a bother, dear). Asked if they would want various interventions at the bitter end. The only intervention that doctors overwhelmingly want is pain medication.
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Old 01-23-2014, 06:09 PM   #2
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never had cancer but had about eight pneumothorax, cardiac valve replacement 30 years ago, an arterial aneurysm in a leg that needed a bypass (and learning to walk again) and some other scary shit.
i can cope with all of that with decent analgesia, and doctors have finally realised that when your chest has been split open and they expect you to wake up in recovery and cough to clear your lungs, two paracetamol ain't going to do the business.
my latest chest drain hurt like a bitch and I was given IV morphine, codeine, and paracetamol which took the edge off, much better than writhing in agony as in years gone by.
The only dumb question is the one you didn't ask.
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Old 01-23-2014, 07:35 PM   #3
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With the recent shit my FIL has gone through, it's clear to me that pain meds are probably the most important thing.
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Old 01-23-2014, 07:56 PM   #4
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Pain meds. When I get my Stage 4 comeuppance, I want pain meds. I might take some chemo options, as the options at Stage 4 can be less horrific than those for Stage 2. Stage 4 women can live for years. But - I won't tolerate any worse side effects than what I've already lived through. Beyond that, it's pain meds.

Antibiotics? Yes, if there's a fighting chance I'll rally from whatever infection is challenging me. If there's no chance I'll ever come off the ventilator, then let me go.

Surgery - I've been through multiple iterations of that shit. Sometimes it's lifesaving; but I'd never book an elective surgery again. Things can always go wrong, and it's not necessarily anybody's fault. Just the nature of the beast and our current microbiological environment.

CPR entirely depends on whether there's a great chance of coming back to pre-arrest function, which means: arrest in hospital with immediate code and CPR. An arrest out of hospital? Let me go. The chances of meaningful recovery are less than 5%, and that's optimistic.

Dialysis is the pits by all reports, but I can't say yea or nay, having never experienced it. After all, chemo is also the pits but I made it through and have most of my neurons intact. For me, the jury is out on dialysis.

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Old 01-24-2014, 04:30 PM   #5
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I can't wait for surgeries. I have a LIST of em! But I want good pain drugs.
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Old 01-28-2014, 11:51 PM   #6
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Be careful what you wish for.
The greatness of a nation and its moral progress can be judged by the way its animals are treated. - Ghandi
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