Saddest Netflix Document For those of us Getting Older (and older)....

[+ newguy]

https://www.netflix.com/watch/80106307?trkid=13710079&MSG_TITLE=80106307&lnktrk=EMP&g=BAF3DAD9A77D44328BAEBEEA79D6B001645281A0&lkid=TITLE2_WATCH

[+ newguy]

https://www.netflix.com/watch/80106307?trkid=13710079&MSG_TITLE=80106307&lnktrk=EMP&g=BAF3DAD9A77D44328BAEBEEA79D6B001645281A0&lkid=TITLE2_WATCH

If that link does work look for "Extremis" on Netflix, or try the link below...

 

NG

https://www.netflix.com/title/80106307

[+ Funguy]

Luckily...in 39 years of practice in Pediatrics i have been faced with this only twice. it was not fun.

[+ purplekow]

I have counseled many people through these types of situations, more than I care to remember. I have no idea why people would want to witness this. , Whether the critically ill person was a saint or a sinner, the family at the bedside is put through severe emotionally charged decisions which tear at the heart and leave the soul weeping.

In the US, health care in the last year of life uses somewhere about 50% of funding for medical care. Undoubtedly, we need to do a better job in informing people on how to handle the inevitable decisions which must be made regarding end of life care. We cannot be afraid to speak of death and end of life choices We cannot be frightened by legislators who think that advising families about end of life decisions is tantamount to encouraging assisted suicide, On the other hand, I will not go out of my way to put myself through watching as others go through one of the most traumatic episodes in life. So this is a no for me, sight unseen.

 

By the way, at some point we have to stop giving financial incentives to hospitals and doctors in extending the death process. The longer people hang on, the more services which are used and the more money is generated for the care givers.

[+ OliverSaks]

I had posted about this documentary in the thread "Old age ain't for sissies."

 

Glad some more people are watching it!

[+ bashful]

I have no idea why people would want to witness this.

 

Agree. No intention of watching either. Such a painful and private time to be the one who will be left behind, but still having to respect the wishes of the other in the present. If it serves any purpose, it will hopefully show people they cannot bury their heads in the sand, but stand up to deal with the reality.

 

stop giving financial incentives to hospitals and doctors in extending the death process

 

Never had ever heard of the term "salvage chemo" used by an oncologist, hope to never again.

[+ OliverSaks]

People need to watch things like this because the conversation around EOL has been woefully inadequate for a long time - if you are enlightened enough on this topic already, then you are probably not the target audience.

 

Additionally, some doctors probably get financial incentives for futile procedures and treatments, but I think a lot of the issue just deals with looking at the overall goal of medicine being focused too much on longevity and not quality of life.

 

We are trained to cure disease, but all too often, the patient becomes lost in our singleminded focus. This is a mentality adjustment that needs to be rectified as early as medical school for future physicians, and conversations that stem from pieces of media, like this documentary or the book "Being Mortal," are ultimately a big step in the right direction.

[+ poolboy48220]

I don't think I'd like to watch this either, too many memories of my mother's death. She was smart and had filled out a living will years earlier, and there was no prolonged attempt at keeping her alive once it was clear she'd never get off the breathing tube or even regain consciousness. Mom's wishes were clear, I intend to make mine clear, and don't think I could handle watching people in worse situations.

[kewtex]

People need to watch things like this because the conversation around EOL has been woefully inadequate for a long time… and conversations that stem from pieces of media, like this documentary or the book "Being Mortal," are ultimately a big step in the right direction.

 

OliverSaks makes a good point. Everyone needs to address end-of-life health care treatments. Many states have directive to physician forms that can be used as a starting point for thinking about, and discussing, the available options.

[+ sniper]

People who have filled out all the forms can tell you they don't mean jack at the time something happens. And doctors aren't blunt enough about what they are asking people. My mother had a DNR but when she had a heart attack at dialysis they did CPR on her and worked on her for several hours before she flatlined.. And I was over an hour away when they called me and I didn't understand that the doctor was waiting for me to say "Stop" over the phone. I misunderstood and thought I had to be there(I was 28 at the time). I'm still bothered by the fact she went out in a painful way with no family around.

 

They SHOULD have simply let her go without doing the CPR Failing that, when they called me to let me know what was happening, someone needed to explicitly tell me "We will stop if you tell us to" and be sure I understood that. I would have told them to stop.

[+ purplekow]

As a physician, I had had a long conversation with my mother and she was adamant about having everything done. I went throught the details of what that might include and her informed consent was that she wanted everything done. She had surgery at the hospital at which I was an attending physician. I received a phone call the night after the surgery to say she had a cardiac arrest and they were working one her. If the decisions was mine, I would have said to stop, but instead I told them I would be right there. 15 minutes later, as I walked in the ICU, the resident told me they had managed to get her heart restarted and she was on a respirator. This resulted in my arguing with my family to continue to give treatment when they (and I) wanted to stop. Eventually she was weaned off the respirator and after six more weeks in a coma, she finally passed away.

I respected her wishes even though I knew her wishes were not practical.

[kewtex]

As a physician, I had had a long conversation with my mother and she was adamant about having everything done. I went throught the details of what that might include and her informed consent was that she wanted everything done. She had surgery at the hospital at which I was an attending physician. I received a phone call the night after the surgery to say she had a cardiac arrest and they were working one her. If the decisions was mine, I would have said to stop, but instead I told them I would be right there. 15 minutes later, as I walked in the ICU, the resident told me they had managed to get her heart restarted and she was on a respirator. This resulted in my arguing with my family to continue to give treatment when they (and I) wanted to stop. Eventually she was weaned off the respirator and after six more weeks in a coma, she finally passed away.

I respected her wishes even though I knew her wishes were not practical.

 

To have advocated for your mother's wishes despite your personal feelings and professional knowledge shows courage, ethics, and strength on your part.

[Nvr2Thick]

"Saddest Netflix Document For those of us Getting Older"

 

I thought you were talking about this one:

 

https://www.netflix.com/title/80151370

[+ purplekow]

I was aware my 91-year old mother needed a feeding tube to stay alive. She was suffering from dementia and could not speak for herself. I knew from many conversations she would not want a feeding tube.

 

Try communicating her wishes to the hospital. The staff were not insisting on anything in writing; they just believed it was the wrong decision.

I knew her doctor (in another state) agreed with me, so I finally prevailed. While I praise @purplekow greatly, I do not agree with his decision.

 

It was not my decision, except in so far as exercising my mother's wishes as she requested, You situation was more straight forward. In your situation you had someone who was no longer capable of making a decision and you decided for her based on your thoughts about her wishes. In my situation, I had someone who could make a decision, so expressed that decision after prolonged conversation and then when the time came, I carried through her wishes, even though I did not agree with them.

 

I am not sure which is the decision of mine is the one with which you disagree, as the only decision I made was in deciding to carry out my mother's expressed and considered desires. That, it seems to me, is the purpose for the conversation about en of life care.

[+ WilliamM]

It was not my decision, except in so far as exercising my mother's wishes as she requested, You situation was more straight forward. In your situation you had someone who was no longer capable of making a decision and you decided for her based on your thoughts about her wishes. In my situation, I had someone who could make a decision, so expressed that decision after prolonged conversation and then when the time came, I carried through her wished, even though I did not agree with them.

 

I am not sure which is the decision of mine is the one with which you disagree, as the only decision I made was in deciding to carry out my mother's expressed and considered desires. That, it seems to me, is the purpose for the conversation about en of life care.

 

I deleted my post before reading your response because it was wrong for me to judge you.

[+ OliverSaks]

PK's decision, based on his mother's wishes, was the right thing to do based on the medical-ethical principle of autonomy.

 

Whether or not the care was futile, it was not his decision to make.

[Epigonos]

Truly sad.

 

I'm one of the lucky one. My mother passed away in her sleep during the night of December 22/23 1995. According the attending physician she didn't suffer a heart attack her heart simply stopped beating. Up to her death she had been extremely active even though she lived in a beautiful assisted living facility. Two nights prior to her death my sister, brother-in-law, a friend of mine, my mother and I went out to a wonderful prime rib dinner. It was an extremely festive and fun occasion. When I received a call on the morning of December 23 that she had passed away I was appalled, shocked, and devastated. I immediately called my sister and brother-in-law who had just begun a driving trip to spend Christmas out of town - they turned around a returned immediately. Their reaction was much the same as mine. Latter in the day as we sat around talking we came to realize that there could not have been a better way for her to die. She was 91 at the time and although in good health some minor medical problem were beginning to develop. We were and are so grateful that she did not have to experience the agonizing death many people have to face. Even though writing this has put tears in my eyes there is absolutely nothing I would change about her death – after all it was all about her NOT me.

[+ SundayZip]

End-of-life health care directives are not foolproof, but they stack the deck in favor of the patient getting the EOL care that he or she wants. When it was clear that my father was nearing death, his health care directives made it much easier for my mother (and family) to tell the medical staff what to do. They removed the ventilator and let morphine and ativan in his IV drip keep him comfortable and peaceful until he stopped breathing. We were all thankful that he had completed healthcare directives and had the discussions with my mother when he was still lucid.

[adventurous old guy]

I don't think I'd like to watch this either, too many memories of my mother's death. She was smart and had filled out a living will years earlier, and there was no prolonged attempt at keeping her alive once it was clear she'd never get off the breathing tube or even regain consciousness. Mom's wishes were clear, I intend to make mine clear, and don't think I could handle watching people in worse situations.

 

End-of-life health care directives are not foolproof, but they stack the deck in favor of the patient getting the EOL care that he or she wants. When it was clear that my father was nearing death, his health care directives made it much easier for my mother (and family) to tell the medical staff what to do. They removed the ventilator and let morphine and ativan in his IV drip keep him comfortable and peaceful until he stopped breathing. We were all thankful that he had completed healthcare directives and had the discussions with my mother when he was still lucid.

 

My siblings and I have been through this journey too, twice actually -- both parents passing after extended cancer battles. Our major lesson learned is that one can't assume the decisions made and documented will be followed. Hospitals are complex places, with lots of opportunities for documented EOL decisions to fall between the cracks when shifts change and the nurse who knows and cares is succeeded by someone just punching the clock. Or when an unknown hospitalist writes orders for a patient he or she does not know. Or when the electronic medical record befuddles humans trying to find clinical notes in it. We had a very clear EOL decision, worked out through a series of conversations between my mother, her oncologist, and her kids. If she had a stroke, "let me go, I'm no good to anybody." If she had a heart attack, "bring me back because I'm not quite done yet." That was completely undone one afternoon by a blanket DNR order written by a hospitalist rounding when my brother and I had slipped away for coffee. Luckily my mom was alert enough to tell us about the doctor she did not know who came into her room, asked if she knew she was dying, and then had her sign something. When we consulted the attending oncologist, she explained that the hospitalist was a new doctor who she didn't know and that the new doc clearly didn't know her patients. Sounds weird, but there are over 2000 employees in that hospital, staffing it 24/7/52 now having crucial conversations with each other through an electronic medical record prone to complexity instead of face to face, human to human handoffs.

 

Bottom line, yes my partner and I have my EOL docs done, but I also will do everything I can to have round the clock extra eyes and ears with me should my time in the hospital come. And I pay it forward by helping organize or staff that kind of operation for family and friends now.

 

I also have to say that being present for big swaths of those end of life journeys are beautiful experiences in their own profoundly heartrending way. Getting ready for death was full of mystery for each of our parents. And the rhythm of the hospital, all those people interacting with you days, weekends, late at night, during awesomely personal, emotional life experiences -- it felt like we were living a story, a Robert Altman movie set in a hospital.

 

Years ago, but vivid in memory to this day. Like Nashville, LOL.

[gallahadesquire]

From my first year of medical school, at age 25, my mother made me promise that, when she felt her time had come, I'd give her the means to off herself. Well, I agreed wed figure something out.

 

When she had her terminal stroke, the doctors seemed a little disturbed when I said "Thank you for all you've done. Don't do anything else."

"That's what your step-father said."

"And he would be right. Thank you, but don't do anything else."

 

Morphine drip plus JUST a little morphine bolus, and she died. More or less the way she wanted. Those conversations 25 years earlier made the decision process very, very easy.

[+ newguy]

End-of-life health care directives are not foolproof, but they stack the deck in favor of the patient getting the EOL care that he or she wants. When it was clear that my father was nearing death, his health care directives made it much easier for my mother (and family) to tell the medical staff what to do. They removed the ventilator and let morphine and ativan in his IV drip keep him comfortable and peaceful until he stopped breathing. We were all thankful that he had completed healthcare directives and had the discussions with my mother when he was still lucid.

This was a very humane and thoughtful comment. Doesn't anyone in the USA use the Brompton Cocktail:?https://en.wikipedia.org/wiki/Brompton_cocktail

[+ OliverSaks]

In my experience, morphine plus Ativan tends to do the trick.

[TruthBTold]

Unfortunately it seems that many times these types of situations involve a functional family willing to rationally discuss many life and death issues separate and apart from their own issues. It seems hard to do that or get that.

[+ WilliamM]

It was not my decision, except in so far as exercising my mother's wishes as she requested, You situation was more straight forward. In your situation you had someone who was no longer capable of making a decision and you decided for her based on your thoughts about her wishes. In my situation, I had someone who could make a decision, so expressed that decision after prolonged conversation and then when the time came, I carried through her wishes, even though I did not agree with them.

 

I am not sure which is the decision of mine is the one with which you disagree, as the only decision I made was in deciding to carry out my mother's expressed and considered desires. That, it seems to me, is the purpose for the conversation about en of life care.

 

I did have a conversation with my mother about her wishes. Before I visited my mother in the hospital, her doctor called and expressed regret about sending her to the hospital because of pneumonia. Since she was 91 and deep into dementia, he believed it was time to let nature take its course. I agreed.

 

So my mother wishes were the same as her doctor's.

 

If her wishes had been to remain alive under all circumstances, I would have still gone with the doctor's advice about hospice care and a peaceful death.