Notes from the Waiting Room

April 3, 2009

Clearing the Forest, Seeing the Trees

Filed under: Notes from the Waiting Room — bartwindrum @ 5:04 am

Yesterday Terry Gross (Fresh Air on NPR radio stations) hosted Dr. Robert Martensen, a well-rounded ER doc and bioethicist who’s authored a book about reforming how we approach dying and death: A Life Worth Living. Having read an array of books on end-of-life matters including a number by providers, Dr. R’s comments and viewpoints are among the most accessible and relevant I have encountered by a provider (I’ve yet to read the book; I’ve reserved it).

The 39 minute show, The Ethical Way To Heal American Health Care, is at http://www.npr.org/templates/story/story.php?storyId=102638208. If you’re willing, I’d greatly appreciate your support by going to the page and clicking the “recommended” flag on each of my 3 consecutive posts—if you feel that they warrant that designation.

Dr. R actually said a few things that so sorely need articulating. I’m a proponent of straight talk, which is required for clear thinking. How refreshing to hear a doctor mention things like:

• we need ample lead time to parse the many issues around how we die in America
• the science behind technological interventions that work for middle aged patients does not exist in regards to elder patients
• the very phrase “life support” is troublesome: doctors don’t tell us that the goal of life support technologies is extended physiological functioning (i.e., docs use euphemistic language, the point I start from when discussing how to advocate for hospitalized loved ones)

And then an eye (well, ear) opener: hospitals are building freestanding “chronic intensive care unit” facilities to (ware)house the interminably dying (my phrase), and the government is supporting these through ongoing reimbursement for services provided there.

Hearing kind, wise, experienced and humane doctors is always a joy. A fear accompanies the hearing, however: I fear that people will experience mental palliation, believing that the docs will figure it all out for us. Of course nothing is further from the truth. Palliation at end of life in hospitals still occurs in hospitals. We have to request an initial consult and switch to this pathway, and we will receive treatment, and die, in a hospital bed in whatever unit we happen to be in. That’s how it plays now, and for X years into the future.

As we clear this metaphorical forest, we need to keep in mind the old saying: can’t see the forest for the trees. What role do you play in this metaphor?

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