A frail elderly women has a leaky heart valve. It caused her legs to swell and increased her work of breathing when she pushed her walker around the house.
One doctor wanted to relieve her suffering. She suggested palliative care; she wanted to make her disease less severe but without removing the cause. Other doctors said no, the answer was to cut the bad valve out and fix the disease.
It’s America; you know what happened.
After heart surgery, which was successful in relieving the leaky valve, her health deteriorated. (My wife Staci talks often of the elderly and the house-of-cards analogy.)
A prolonged post-op course led to a nursing home stay, then more hospital admissions, for infection, falls, fractures, then more infections, a blood clot, chronic pain, and, after eight trips back to the hospital in her last 18 months, this women died an American death: hospital lights blaring, tubes attached, monitors beeping. Delirium added to her family’s suffering. During all this, while her humanity leaked away, the repaired heart valve remained perfectly competent.
You could tell the same story with a different surgery, or chemotherapy for cancer, or many other scenarios of death denial. But it does not have to go like this.
BJ Miller is a doctor. He is also a patient.
The title of his talk is: What really matters at the end of life.
It’s worth 20 minutes of your time.
JMM
David Dougherty says
After 12 years as a paramedic, I think Miller hit it right on the head. He makes me think of a carpenter who is so practiced that one blow from his hammer sinks a nail completely in. Dying in an ED is not pretty.