* * Anonymous Doc

Saturday, June 19, 2010

I can't read or watch anything medical anymore without wanting to scream. I posted about the Grey's Anatomy season finale last month; this morning, someone forwarded me this New York Times article about a woman who watched her father suffer a long and unpleasant death.

And somehow she blames his pacemaker.

Read the article if you want, but I'll try to explain what's going on even if you skip the piece. Man has debilitating stroke, which the article leads the reader to believe caused vascular dementia. Quality of life seriously impacted. Man develops hernia, needs surgery. Surgeon reluctant to perform surgery without implanting pacemaker to address slow heartbeat. Pacemaker goes in, man has cascade of other medical problems over the next five years, and the situation gets more and more difficult and unpleasant until he finally dies, and daughter blames pacemaker for having unnaturally kept him alive. And blames the doctors for being unwilling to deactivate the pacemaker.

First, the doctors should have deactivated the pacemaker if the health care proxy was asking them to. She quotes a doctor saying he wouldn't do it because he was worried his heart would instantly stop and he would drop dead. Which makes no sense. The pacemaker was regulating the heartbeat, but it can't keep a dead heart beating. Shutting off the pacemaker might have hastened his death, it might not have. It is not a life support system. It wouldn't prevent an arrythmia. It's not a defibrillator.

Which leads to my second point. He was old, he had old-person illnesses. His macular degeneration, his falls, his dementia-- they weren't caused by the pacemaker, they weren't caused by his doctor, they happened because he was old and old people unfortunately get sick. I'm not saying that putting the pacemaker in to begin with was a perfect decision-- it wasn't. But at the point they implanted it, the article makes it seem like he was still functioning, albeit in a limited capacity, post-stroke, and with some degree of cognitive impairment. But people with dementia can live for many years, and the alternative to the surgery was a hastened death.

What did the daughter want from the doctors? It seemed like she just wanted her father to die. And while that's understandable-- he was suffering, the whole family was suffering-- and the situation was unfortunate, it's unfair to blame the doctors for not finding a way to kill him sooner. We don't know how illnesses will progress, and at what point a patient will cross the line from intervention being a benefit and enabling more years of life of enough quality to be worthwhile to intervention merely prolonging suffering. The system is set up to help people, not to kill them.

But what frustrated me most about the article is that the medicine makes no sense. I'm just guessing at half of this. Did he have vascular dementia, or did he have Alzheimer's, or did he have both? Did the doctor refuse to disable the pacemaker, or merely encourage against it? Did he have one stroke, two strokes, many strokes? She writes about the natural course of progression of disease-- what disease? what progression? He had many diseases. The pacemaker didn't cause them. If the New York Times is going to publish something like this, with all of these details, at least get the medicine right. Be clear, be accurate.

And why they're letting this writer trash the doctor--by name-- who put in the pacemaker, I have no idea. It's only her side of the story, and it's not clear at all that she's painting an accurate picture.

I feel like in the media, death-before-modern-medicine is romanticized, as if everyone died in his sleep, as if everyone had a peaceful and wonderful death back when we didn't have medicine. You know what? They didn't. People suffered. And in a lot of cases, they probably suffered much more than today. We have medication, to cure things, and to manage pain. We've eliminated so much of what killed people eighty years ago. We're not performing unanesthetized experimental surgery, we're enabling people to live longer lives, with more years of health. People suffered. You think cholera was a pleasant way to go? You think mass plagues were fun? How about infection and sepsis? Do people really think we have it worse off today, because of doctors?


  1. Wait, wait, WAIT. Her father died, which is a completely NATURAL process, and she's blaming the PACEMAKER?

    What the HELL, lady, humans aren't like toys, where you can just replace the battery -- when we wear out, sure, we can replace some parts (hips, knees, prosthetic limbs, kidneys, even entire organ systems), find workarounds for others (mobility devices, ventilators, heart-lung bypass), but there is no way to work around the fact that the "power" eventually fails.

    The "battery" WILL run out, you WILL die, and it will happen to each. and. every. one. of. us. in time.

    Christ, lady, just be glad your father had the life he had, and celebrate it in his memory.

  2. In America today, many people are remarkably isolated from the reality of dying.
    This story reminds me of when Oregon's Death with Dignity act was on the ballot and being debated. Some opponents were going on about how the drugs one takes to kill oneself might cause nausea, as if this was a ghastly and unheard of bit of pain and suffering for someone in the last stages of a terminal disease. (And, by the way, the extensive record keeping in the years since the law passed shows this hasn't been a problem.)
    I volunteered in a hospice for several years, and saw people in their last weeks, days and hours who were getting the best is palliative care. They dealt with way worse things than bit of nausea. I can only imagine what the people raising that as an issue thought they knew about dying.