ManicDDaily

What to write about when your mind is blank and Robert Pattinson is managing to keep out of the lime light?  (It seems that Vancouver, where Pattinson is now filming, is somehow a more polite city than New York.  Who woulda thunk it?)

How about DNRs?  Do Not Resuscitate orders.

Now there’s a subject for the brain dead.  (Sorry.)

What do they mean exactly?

Does putting in a DNR mean that they won’t put those duckfeet paddles to some one’s heart if it’s just missed a bit or two?

Or do the DNRs only come into force after death has held sway for a full two or three minutes?

(Do those paddles even work after two or three minutes?)

In other words, how open to interpretation is a document like that?  Do hospital staff obey it as a matter of rote?  Is it a bright line?  Black and white?

Or can it become applicable only when the person will no longer be himself if resuscitated?  Or is already not himself?   Or is being tortured?  Or is really really likely to be tortured?

I have read that an extremely significant portion of medicare payments goes to the payment of health care costs incurred in the last month of life.

On the one hand, this makes perfect sense.  The last month of life falls at just about the time someone is sickest.

But some studies (such as the one discussed below by the National Hospice and Palliative Care Organization) also seem to indicate that a portion of these expenses result from patients not having discussed their “end of life wishes” with their doctors, (of not having, for example, a DNR).  This type of discussion would ostensibly allow doctors to avoid a situation of having the patient suffer a medically-extended death (rather than life).

I’ve talked to many people about health care proxies, living wills, final wishes.   At least 95% of the ones I’ve talked to say that they do not want their lives to be extended when there is no chance of recovery to a meaningful life.   (There’s also the occasional person, sometimes a medical professional who is insured by and employed by the hospital in which they expect to receive treatment, who says that they want to be kept alive at all cost, with every possible form of treatment, and collecting their full salary.)

Weirdly, it’s not even clear that all the extra treatments do prolong life.  A study of advanced cancer patients by the National Hospice and Palliative Care Organization reported in the March Archives of Internal Medicine, suggested that people who receive less invasive and aggressive treatment live longer than those who receive the more “comprehensive” care.

I have to say that I’ve never heard of the National Hospice and Palliative Care Organization and that such an organization may well have a bias against aggressive care.   Still, the study makes a lot of sense to me (a confirmed disbeliever in advanced institutional medical care).  My dad, for example, hospitalized at the moment, is in danger of being sent to rehab (for who knows how long) to recover from the damage that a day in the ER and a day and a half of hospital care have done.  The hospital’s occupational therapist said that they wanted him to get back to “where he was” before he started their treatment, which consisted almost solely of tests.  I, however, do not believe that rehab is the place for this; “where he was” before they started “treatment” was at home.

Still, it’s all very confusing.   Especially the bit about the DNR.   The doctor asked me about one.   “I’m not saying it’s likely to happen right now,” he said, “but what should the staff do if they go into his room and find that he’s died?”

It’s a harder question to answer than one might think.  First there’s the whole problem of finding one’s voice.

Maybe a little counseling would help.

Except, wait a second.  Aren’t the counselors on these issues the notorious “death panels?”

Scratch that.