Aug 15, 10 04:40AM
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A year ago, U.K. officials released convicted Lockerbie bomber Abdelbaset Ali Mohmet al-Megrahi to Libya on humanitarian grounds, based on a prediction that he had only three months to live. Karol Sikora, the British cancer expert on whose opinion the decision was based, recently owned up to his miscalculation to a London paper: “There was [...]
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Sign in nowAs a hospice nurse, I, too, am often called upon to prognosticate. If there is a doctor “handy”, I defer to him or her. Most of the time these requests come from family members of dying patients who want to know how long the dying process will take. I can’t remember ever being direct with a patient about a time line, and I have great empathy for physicians who must do this. I agree with Nicholas Christakis that there is a duty to prognosticate, and was surprised to learn about the trend in medical education away from including prognosis in the study of disease states.
Of course, in hospice care, we doctors and nurses have an advantage because it has all ready been acknowledged that the patient IS in fact going to die soon or is dying right now. Even then, we are asked ” when?”, and it is still a hard question to answer. Hope does spring eternal and in seemingly the most unlikely places. There is, for example the family of a 102 year old frail, somewhat demented and obviously suffering elder, who are anxious that every small crisis spells the end. And I have seen very sick and very very old people [90-105] live week after week and month after month and even year after year, on hospice care, subsisting on next to nothing except ensure and the ministrations of nursing aides. It is truly amazing. We find ourselves wrong often enough that we tend to hedge our answers at the next inquiry.
I have come to the conclusion that we just don’t die like we used to. It’s really hard to die in our present culture and medical environment. My experience particularly with the elderly, is that they get treated with procedures,IV’s, antibiotics and other medications, and they are pulled through the kinds of illnesses like pneumonia, strokes, MI’s and metabolic crises that used to kill people. It’s a new world of medical care and it’s here to stay. Prognosticating needs to evolve along with the medical advances and discoveries of the time.
Thank you, John Schumann, for developing this very fine website. I am enjoying the thoughts and ideas found here and will share this with my nursing and medical colleagues.
Denise, I truly appreciate your comments. Thanks for sharing your stories and observations.
-John S.
John,
This was simply an outstanding post, well-written and well-reasoned. I couldn’t agree more with your conclusion and would add only that I think the most important reason we physicians must learn to prognosticate better is to empower us to have the difficult conversations we must with people facing terminal illnesses to help them know what to expect. That, more than anything, it seems to me, is what people want and deserve.
Alex