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DIY Death Panel

Saw the doctor today about my persistent cough. Diagnosis: somethin’ done shook my bronchial tree. She gave me an inhaler. I’ve never had an inhaler before. I feel like Nerdly von Geekburger. Sadly, it doesn’t seem to contain any form of narcotic. Or work.

I’d’ve settled for some codeine linctus.

Completely unrelated (but medical), I ran across this fascinating article at Small Dead Animals earlier. It’s about how doctors choose to die. The short answer is: as far away from a hospital as possible.

Guys who have seen it a thousand times don’t want any part of modern medicine’s lurid pull-out-all-the-stops end-of-life snuff theater. (Also, people who opt for home hospice over ICU care live longer, on average, with a much higher quality of life. Go figure).

Something the article didn’t make clear — from my experience of medical people (and I have a few in the family), if a condition is curable or even satisfactorily treatable, they’ll grab all the modern medicine they can get. They aren’t anti-medicine. They’re anti-the-horrible-things-we-do-to-the-hopeless-as-they-fade-away.

Even if the topic gives you the willies, I highly recommend you read the article. And then put some future bureaucrat out of a job by making arrangements for yourself.


Comment from S. Weasel
Time: December 6, 2011, 12:09 am

One of the smartest things I ever did was talk this all out with my mother years before she was sick. Then when she was suddenly diagnosed with something terminal, the topic didn’t even have to come up. Huge relief.

He’s not kidding, BTW. People really do get Do Not Resuscitate tattoos.

Comment from S. Weasel
Time: December 6, 2011, 12:14 am

Also interesting to read that people don’t often come through CPR in any kind of enviable state.

Kinda sorta related: 17th C London death stats on display.

Comment from OU_Gryphon
Time: December 6, 2011, 12:21 am

From what I hear, you either come back with CPR right away – meaning it wasn’t all that necessary (~30%) – or you die/end up a vegetable because your condition was not survivable anyway (most of the rest).

Comment from S. Weasel
Time: December 6, 2011, 12:32 am

That makes me feel less guilty for not learning CPR.

Comment from Mysterion
Time: December 6, 2011, 12:32 am

I had a very persistent cough earlier this year but I seem to be allergic to mold and/or dust mites. It only seemed to stop after we went a long period without rain. It wouldn’t hurt to try a dehumidifier, non-allergenic pillow case and mattress covers and stuff like that. When I start to cough it is usually time for me to clean the mold out of the shower.

Comment from OU_Gryphon
Time: December 6, 2011, 12:39 am

Good point – most asthma is allergy-related.

Comment from Oldcat
Time: December 6, 2011, 12:39 am

I tend to get coughs that last long after the cold that triggered them as the coughing itself irritates my throat.

My home remedy for this is cinnamon hard candy. Its cheap, and seems to soothe the throat even after you finish eating one.

Comment from Christopher Taylor
Time: December 6, 2011, 12:44 am

I remain convinced that the desperation to cling to just a few minutes more of life, no matter how awful, costs billions every year and is probably better spent elsewhere. If I’m hopeless and dying I’d rather curl up under a bush somewhere like a cat and die than lie on a bed and suffer endless attempts to keep me going just a bit longer for thousands and thousands of wasted dollars.

Comment from S. Weasel
Time: December 6, 2011, 12:44 am

The doctor seemed surprised there was no asthma in my family. Banging around the web tonight, it looks like asthma (and exzema, which is apparently related) are hugely on the rise in the UK in very recent years.

Prolly some new mold.

Comment from S. Weasel
Time: December 6, 2011, 12:48 am

I’m with you, Christopher. I have yet to write up my living will (apparently they’re not legally binding in the UK), but my verbal instructions are…I want *all* the pain and anxiety meds I can hold, and that’s it.

Y’all are my witnesses.

Comment from Sven in Colorado
Time: December 6, 2011, 12:58 am

Been a woodworker for 35 plus year….eating all kinda dust. I know the feeling.

First off, flush the major body systems with Fenugreek and Golden Seal. Across the pond here, we get them in organic raised and harvested, slow dried, gelatin caps.

That shit gets right after the program.

Follow with mullein and chamomile, along with belladonna (in very small amounts! That shit is an hallucinogenic alkaloid) and the distillation of Horehound plant…great for lung and bronchial troubles.

DISCLAIMER: I am not a doctor or health professional, nor do I wear a white lab coat and play one on the tele.

Just know it works for me.

Comment from Stark Dickflüssig
Time: December 6, 2011, 1:09 am

Seriously overproof* rye gets the job done.

*Thomas Handy Sazerac at 127.5° seems about right.

Comment from Alice
Time: December 6, 2011, 1:35 am

The point of having an Advanced Medical Directive (living will, etc) is so YOU get to make the decisions on how much, how little, what kind of interventions should be made for YOURSELF. It’s not primarily for people who want to cling to life for two more excruciating and expensive minutes – it’s so the doctors and insurance people can’t override your wishes, and so your family doesn’t have to bear the burden of making life/death decisions for you.

Of course – I don’t have one, either. Any day now. Any day.

Comment from Nina from GCP
Time: December 6, 2011, 1:58 am

Oh, I’ve had these conversations with my kids and they know EXACTLY how I feel about it. My late husband’d probably STILL be alive if I hadn’t done the merciful thing and unplugged him from the many machines that were keeping him alive after an accident scrambled his poor brains. It was not even slightly hard to make that decision thinking of 26 year old him living like that for any length of time at all, 19 year old me, or 4 month old daughter. And given the peace with which he slipped away, it was obviously the right choice.

Now with my dad, 30 years later, they did it differently. When it became clear that he was trying very hard to slip the mortal coil, we put a DNR on him and they took him off everything but the morphine. He too slipped away peacefully. Who were we keeping him alive for? Us or him?

With that said I’m fighting this dang cancer tooth and nail. It might take me down but I’m going all Dylan Thomas on it first.

Comment from Oceania
Time: December 6, 2011, 4:06 am

Increase retinoic acid and vitamin C … and start an exercise regime. Check for pulmonary hypertension.

Comment from Some Vegetable
Time: December 6, 2011, 5:14 am

Then into the village influenza came
Slow death, coughing out the Devil’s name
To take away the old and weak
And then to younger victims seek
They’re the tastiest for death to feast on –
Those the years have worked the least on…

Comment from beasn
Time: December 6, 2011, 5:49 am

I ‘came down’ with asthma after a particularly nasty flu in my twenties. Made my tubes extra twitchy. Had an inhaler off and on until I got pregnant with my son.
Another bug a few years later had me on the inhaler again…until I got pregnant with number 2. That was almost 20 years ago.
I am paranoid about ‘bugs’ and careful about exposure to ‘fine dusts’, dander, and mold.

Oh and I must say that I had exczema as a child and a history of bronchitis. Since I’ve cut our dairy, no itchies/no scratchies, little to no mucus to hack up.

Comment from beasn
Time: December 6, 2011, 5:51 am

And I had no idea CPR can/should break ribs. How come they don’t tell you that when you go through those courses? (was required to take the class as a teacher/care giver).

Comment from Feynmangroupie
Time: December 6, 2011, 5:52 am

The comment section for that article is just as interesting as the article itself.

Regarding the efficacy of CPR

Comment from The Jannie
Time: December 6, 2011, 8:10 am

Before you add any more wonder cures to your arsenal, are you taking ibuprofen – or whatever expensive name might be on the packet? It gives all our family a dry cough and I believe other anti-inflammatories do the same thing.

Comment from Ric Locke
Time: December 6, 2011, 1:13 pm

I’m currently facing (or, rather, cravenly retreating from) a similar decision. I have no advice (see second word beginning with “c” in previous sentence) except for one thing:

Be very, very wary of people offering to help by making the decision for you on Best Available Current Scientific Grounds™©(Reg. US. Pat. Off.) Shooting them out of hand is probably the best response overall, but is likely to get you talked about down the pub.


Comment from S. Weasel
Time: December 6, 2011, 1:17 pm

Eh. Good luck, Ric.

Comment from sandman says ‘nothing to see here’
Time: December 6, 2011, 1:26 pm

The reason they don’t tell you about the rib cracking and breast bone popping fun of actual CPR is that you would be more reluctant to use it then.
That said, we’re finding out more and more that external respirations and such (CPR) is only moderately effective. The thing is so up in the air they (Red Cross, American Heart,etc) change their CPR procedure every few years as the latest intel comes to light. Also justifies new expensive CPR manuals but that’s another story for another day.
That said, I ahve worked in trauma and ERs and crunched quite a few sternums in my day. The longest was over an hour but did not make it, even with advanced ER help and being in his fifties. Sometimes the wagon comes around, the guy drones “Bring out yer dead” and that’s just that.

All I got. Been in health care too long and looking for a gentler way to earn my living in the future. I’ll get back to you.

Comment from Ric Locke
Time: December 6, 2011, 2:14 pm

The matter isn’t immediately pressing, Stoaty, for which thank $DEITY, as it allows my procrastination function full scope. Putting it off is probably the best strategy anyway, as there’s a vanishingly-small but nonzero possibility that the horse will sing.


Comment from Becca
Time: December 6, 2011, 2:21 pm

My grandpa died at home, in his own bed, and if a death can be considered beautiful, his was.

His wife, children and grandchildren stayed by his bedside, talking, comforting and laughing with him.

Near the end, his wife of 64 years got into the bed and as she held him, whispering words of love, he died.

Other than the birth of my child, it was probably the most precious moment I’ve ever witnessed.

That’s the way I want to go.

Comment from BigBluBug
Time: December 6, 2011, 4:23 pm

Hey Stoaty,

Look up methacholine challenge. Even if you do not have asthma, you get to feel exactly what a severe attack is like. The recovery time is the metric. Knowing that you are most likely to have asthma means you take seriously the caveat of carrying a rescue inhaler. Trust me, it ain’t a big deal until it’s really a big deal; not being able to breath blows llama dick. And the first attack may come without really having any serious asthma symptoms. I’m really not trying to be a dbag about getting you paranoid.

Full testing means breathing in different different mixes of gases which is kinda cool. I take something called Symbacort which lets me do shit like running and beating hippies.

I killed my lungs with cigarette smoke and cocobolo dust but the drugs make things pretty good.

And woodworkers, especially turners of exotic wood (or red ceder, a Racal Airmate is the best investment you’ll ever make.


Comment from Redd
Time: December 6, 2011, 4:36 pm

I’ve had inhalers prescribed several times after particular bad bouts with the flu. Loved them. Being oxygen deprived is no pleasure.

Comment from Bob Mulroy
Time: December 6, 2011, 10:50 pm

Did you get a spacer with your inhaler? It makes it work better.

Also, you might try a vaporiser for a few days. Indoor air is much dryer during the cold season.

Comment from Sven in Colorado
Time: December 7, 2011, 12:39 am

Dad Anthony had horrible allergies, sometimes resulting in asthmatic reactions. He refused to use inhalers until his first stroke. Of course, it didn’t help that Mom smoked like a damn chimney sweep.

What BBB said. Years of tobac smoke and breathing exotic wood dust have compromised pulmonary lung function. What I said above has made big difference. A naturopath suggested the regimen…. Go figure.

Comment from Rich Rostrom
Time: December 7, 2011, 2:20 am

I understand and sympathize with people who want to avoid aggressive, expensive, uncomfortable, largely ineffective end-of-life care.

But I also hear way too much about euthanasia (voluntary and, ahem, involuntary). I see things about the rise of involuntary euthanasia in some countries (notably the Netherlands).

I get the impression that many doctors get… casual about death. They see it a lot, they even cause it a fair amount. (A physician I knew told of the lecture he got as a new resident. It included the flat statement “You’re going to kill a hundred people in the next two years.” He particularly quoted that; he added that the speaker added “You’ll save the lives of thousands.”

The point is that for most people, causing someone’s unnecessary death would be a dreadful shock. Many people have been overwhelmed by guilt from such a failing. For a doctor, it’s all in a day’s work. It’s not that they don’t care – but they are responsible for thousands of individual lives, they can’t be right every time, and they have to be able to process failure without going mad from guilt.

And once the importance of life and death is minimized, it gets a lot easier to view death as less bad than, say, large expenses or heavy use of critical resources.

Some twenty years ago, a Dutch government report disclosed that there were over 1,000 involuntary euthanizations each year, and that thousands of other patients were given massive overdoses of painkillers to “help them along”. I doubt if the practice has declined since.

And then there are the occasional mad doctors – I am thinking of that appalling ghoul Kevorkian. By accounts coming out since his death he was a genuine death freak; from his first days out of med school he showed a morbid attraction to dying patients and deathbeds.

The attitude of doctors toward their own ends is informative, but not IMHO dispositive.

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