Overkill: America’s Epidemic of Unnecessary Care –

Overkill : America’s Epidemic of Unnecessary Care – a new Gawande must read!

Will your next medical procedure help you? do nothing? or even cause harm? What about the procedure  being recommended for an elderly friend or relative?

early a.m. dafs 015

(I’ve been so busy with local events that this blog has been sorely neglected.  This morning with the soft pink of dawn peeking through the corner of the curtain I decided to get up and get back in touch with the bigger world.  The link to this long and thoughtful new article by Dr. Gawande felt like my reward. I have only read it once so far and quickly. I will read it again.)

 

DO read it! Dr. Gawande is so clear about the truly good-hearted desires that push both doctors and patients toward unnecessary and often NOT helpful care!

Read Gawande’s explanation about the “turtles” and “rabbits”  in the world of cancer – the turtles being cancers which are highly unlikely to ever cause a problem and would be better off undetected. Instead of ensuring a better life, tests and treatments on the “turtles” can CAUSE problems.

You may not need this information right now but my bet is that someone in your life does!  If you feel up to sharing your own tale please do.

 

 

Living Fully, Aging Well, and Befriending Death

Puerto Rico 2014 240It’s January  2015!  A full four years since I attended a community meeting on Advance Care Planning and set foot on my path toward Sustainable Aging LLC.  Little did I know how rich a journey lay ahead.

Next Tuesday I will facilitate the first Brattleboro meeting of Living Fully, Aging Well and  Befriending Death – a group where the challenges and joys of each of these can be openly discussed  This is just one of  many steps in this  journey. I’m very much looking forward to the sharing I know will happen.

You don’t have to travel alone.

My desired destination? our community becoming a place where everyone knows as much as they can about  choices and possibilities at the end of their earth-bound road;  A community where all stages of life are openly discussed and decisions are made which are as loving, just, and enriching as possible.

Please listen to this beautiful  three-minute VPR talk by my friend and colleague Evangelina Holvino or read the text for a taste of the discussion.

May this be an amazing year for all ~

 

 

Atul Gawande’s megaphone by Paula Span

Microphone

The potential for brilliant collaboration!

 

Paula Span’s blog  yesterday, A Doctor Discovers Dying , hit it on the head as she so often does.  She points out that Atul Gawande’s BEING MORTAL is not new news  — but that it is eloquently penned and that he  has phenomenal  media coverage.

I just wrote this comment:

“YES!!!! You are right, Gawande is the megaphone! I pray that the time has come to make the new old age go well with a brilliant collaboration!

Imagine the power of a project:

1) funded by the same anonymous visionary whose support resulted in 506 pages of research on DYING IN AMERICA

2) calling on the fantastic megaphone Gawande- who is part of the web savvy Conversation Project

3) in liaison with Dennis McCullough whose My Mother, Your Mother: Embracing “Slow Medicine: The Compassionate Approach to Caring for your Aging Love Ones” so beautifully lays out a caring path and 4) Byock and 5) Sloan 6) Butler and 7) Dr. Bernard Hammes from LaCrosse Wisconsin!

Gawande’ s 2010 New Yorker article LETTING GO led me to the Respecting Choices® project in LaCrosse Wisconsin. In April this year CBS news picked up the LaCrosse story . The IMO report states:

“An early review of Respecting Choices describes six ways in which this program differs from conventional advance care planning initiatives, which help account for its success in achieving care in greater accord with patient wishes.”

Hammes has spent more than 25 years developing a systems approach that successfully addresses each part of the dilemma: the medical community and the people they serve; cost, time ,resources, and careful research.

These wheels don’t need to be reinvented. They should be used with Gawande’ s megaphone making the announcement!’

I hope YOU dear reader will dive into any of the above sources !

 

Being Mortal – in the news!

Photograph of Atul Gawande, author of Being Mortal

Atul Gawande, M.D.

 

Being Mortal: Medicine and What Matters in the End, by Dr. Atul Gawande, surgeon and writer is in the news!  The book might well tip the balance of how doctors treat aging and how our entire culture views death.  He compares three very different experiences in his own family as well as doing extensive research on how we have arrived where we are now.

As the jacket says “when it comes to the inescapable realities of aging and death what medicine can do often runs counter to what it should.”  Gawande describes the history of care of the infirm elderly with no illusions of a former golden era.  At the same time he makes it clear that we simply can’t continue on our current path.

The topic is timely, his writing is exquisite, and our present situation is hungry for his humanity and expertise.

 

 

 

Here are a few of the numerous articles and interviews about the book:

The Best Possible Day Gawande’s own NYT article

Don’t Spoil the Ending An excellent NYT critique

WBUR article by Carol Laciofano

Daily Show  Live interview with John Stewart

How Medicine Can Improve Life and Death  Live interview with Leonard Lopate

Democracy Now – Interview

We Have Medicalized Aging and That Experiment is Failing Us  Mother Jones interview

 

I am currently devouring the book, join me!

Atul Gawande: “We Have Medicalized Aging, and That Experiment Is Failing Us”

– See more at: http://portside.org/2014-10-11/atul-gawande-we-have-medicalized-aging-and-experiment-failing-us#sthash.hE6jB7oD.dpuf

Atul Gawande: “We Have Medicalized Aging, and That Experiment Is Failing Us”

– See more at: http://portside.org/2014-10-11/atul-gawande-we-have-medicalized-aging-and-experiment-failing-us#sthash.hE6jB7oD.dpuf

An Explosion of Research and Articles

SouthPond. Fall 004There is an explosion of interesting research and articles about end-of-life care. Here are recent resources for you to read.

Dying in America

Dying in America, the bipartisan, anonymously-funded report from the Institute of Medicine released September 17, 2014,  calls for a major overhaul of how we mange end-of-life care.

Here’s the NY Times article about it:

Panel Urges Overhauling Health Care at End of Life – NYTimes.com

Here’s The Institute of Medicine summary: Report Brief.pdf

Here is the link to the five-hundred page report. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life – Institute of Medicine which you can download for free.

Why I Hope to Die at 75

At almost the same time, the Atlantic magazine published, Why I Hope to Die at 75 – The Atlantic. The author, Ezekiel Emanuel, M.D. makes as case for his own decision not to rely on medicine to extend his life after 75.

Tom Ashbrook devoted a show to these two publications.  End of Life Care Needs an Overhaul.

Worth Considering

All of this is grist for the mill.  Read and learn so that you can make choices for yourself and initiate conversations with those you love.

What are your thoughts?

Ninety Percent of Doctor’s Say, “For me, allow natural death.”

Hear why the choice of so many doctors is, “No Code: Allow Natural Death.”

Recently there have been several articles discussing the reality that doctors do not die like the rest of us. It’s a bit different hearing the data rather than reading it.

Doctors say that their personal wish in many medical situations is pain medication ONLY. They don’t want most of the modern interventions.  Rather, their wish is to “allow natural death.”  Radio log has recorded this information in a back and forth conversation. Somehow, hearing the different voices, accents, intonation, makes the information even more striking.

“A study at John’s Hopkins University was started in the 1940s to 1950s tracking all kinds of information about 1337 medical students. Now these doctors are in their sixties to eighties and are being asked about their future death. Ninety percent of them said that in a scenario like severe dementia they would NOT want CPR.  The interviewer asks why! The answer, “CPR doesn’t work very well.”

Click on the link below to hear the mind boggling facts and figures.

http://www.upworthy.com/the-way-doctors-think-about-death-is-pretty-different-from-the-way-their-patients-do?g=2&c=upw1

It’s 21 minutes long but it’s worth it.

 

Allow Natural Death, Sunset image

 

 

The Toxins in Your Body When You Die

Picture of Jae Rhim Lee

Jae Rhim Lee

What is the best way to dispose of your dead body?

For a long time I thought that the most practical, cost effective, and environmentally sensitive way of someday dealing with my deceased body was cremation. Then I heard Jane Brody, NY Times health correspondent, say that she is planning is donate her body to a School of Medicine.  Since then I have talked to several physicians who confirmed the importance of a cadaver as a milestone in their training and how awesome the gift of a body is.

If your body is accepted by a school, it is cremated after they use the body. They will then either bury the ” cremains”  or send them home to your loved ones- whichever you have requested. It costs your family nothing.  Given that as a kid I wanted to become a doctor and there are many stories about how cadavers were instrumental in both art and medicine, I was inspired by this option and decided it was the best choice for me. I think it probably is still.

BUT- the other day I discovered the “mushroom lady,” Jae Rhim Lee, whose TED talk is provocative. Lee, a 2011 TED Global Fellow, studied at MIT and Wellesley College, and her work has been exhibited in the U.S. and Europe. She is working on the problem that our bodies are full of toxins, that traditional undertaking puts even more toxins into the corpse, and that in the decomposition process these toxins are added to the ecosystem.

Her solution? To develop mushrooms that will aid the decomposition of the body and process the toxins to neutralize them. She has a weird suit, that looks like “Ninja pajamas” with crocheted, white lines in patterns in which the mushroom spores would be contained. This is the “death suit” that she is prototyping.  It is definitely Out There and offers a very different approach to death from the current funeral home scenario. It may not appeal to you at all but it’s an idea.

Here is the Ted Talk.

What do you think?

 

 

Making a Bucket List at 65 ?

Kayaks stackedHmmmmmmmm.  It did not feel weird or pessimistic to be making a bucket list. In fact, it could be another new game for the baby boomer generation.

This morning I took my friend Barbara, to the Kingston train station after a brief vacation together.

Last night  after we had dinner she said, “Let’s play a game.”  I was surprised.  I had been thinking about suggesting we play Parcheesi. We have been friends since 1955 and a childhood game seemed like a fitting way to end our visit. But I remembered that she doesn’t usually choose to play games.  She said, “It’s a game that you don’t win or lose. Let’s make a list, take turns saying what we’d like to do before we die.”  I agreed to try it.

People have said to me,  “I’m too young to make a bucket list. I’m not going to die anytime soon.” A few have said,   “I’ve done what I want, I don’t need to make a bucket list.” I would say you’re never too young to make a bucket list: to put dreams on paper. Also, as Barbara and I discovered that night, it’s  fun to think of what else you might want to do.  Some things we came up with:

  • Spend a whole summer by the ocean.
  • A southwest trip to Bryce, O’Keeffe place/Grand Canyon etc.
  • Put a collection of my poems in a chap book

Putting these thoughts on paper gives them a much better chance of happening. And it’s fun!

To play this game here are some guidelines.

A game without winner or loser: Take turns saying something we would like to do if we could before we die … acknowledging that

  1. some of the items depend on other people agreeing to participate so are not totally within our personal control and
  2. the list may change at any point.

Adapted from “Before I Die” – (http://www.cnn.com/2013/11/29/living/before-i-die-walls-book/)

 

The Wake Up to Dying Project

This looks like a great event! I’m so happy to know that others are working on this issue too.

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Click here to view flyer for the event

OR

Click here to go to the website.

The Wake Up to Dying Project is an action and awareness campaign that encourages people to think and to talk about dying. We do this by recording and sharing audio stories about death, dying, and life. We believe that we can use story to help people be more prepared to face this shared human experience, and to pay more attention to the way we choose to live.