Palliative Care and Me

A buddy of mine, actually, tuned me in to something. In today's Medical Care, when you are terminal, you get sent to Palliative Care ... PC for this thread. He told me he noticed that once there, it's only a few days and you're gone, in every case he knew of.

This got me noticing too, and I have to say, in every case I started to observe, the patient was gone in a few days. 10 days was getting close to the maximum, for what I have observed.

Please do take note that I do not, do *not*, doubt that all these people were terminal! ... and that further attempts to cure them were futile.

but in many cases, I observed a degree of hardiness left in the patient. Maybe that's not exactly the right word, but somebody who was still functioning a few days before, still upright and walking around, not bound to bed, not in a wheelchair. A brother-in-law who just went fishing; a golfer who sat at a bar with me that no one said was even sick, played and seemed in good health but was dead a month later in PC [reportedly a few days only]; a woman who may indeed have seemed on her last legs but only lasted 3-4 days in PC; Alex Trebek up and walking around "taped his final episode on October 29, 2020. Trebek died at his home in Los Angeles on November 8, 2020" [quoting wikipedia page]

As for Alan Mendelson, here is his last post at WoV, where he has a casual point to make. The sort of thing you might do if were unconcerned about dying, I have to say, but I admit you never know on these things ... the date, November 2nd. Did he go into PC? That I don't know.

https://wizardofvegas.com/forum/gambling/blackjack/37678-convincing-ploppies-to-let-you-bankroll-their-splits-doubles-what-could-i-have-done-better/11/#post869625

Certainly there can be unexpected sudden death. We all know or heard of people who dropped dead that no one thought was in bad health, maybe they even just had a checkup. So what am I getting at? I don't know, except it is bothering me that I haven't run into the exception. Is it that terminal people now are encouraged to go on with their normal lives, like Trebek, as much as possible, struggling through to the point that only a few days are left ... whereas years ago they would have had you stay in bed and not leave it? Or I have a terrible case of small sample size error afflicting me? Or what?!

It's usually because someone has decided to stop all further treatments to stay alive, like medications, blood transfusions, feeding schedules if there is a tube going into the stomach, IVs, surgery, additional oxygen, blood pressure medications and they just give medications like morphine as needed to keep someone comfortable.

I just remembered, a guy I played poker with was having undiagnosed 'not feeling well' ... soon after they know it's leukemia and about 3 weeks after the poker game he goes into PC , then dead in days

Quote: rxwine

It's usually because someone has decided to stop all further treatments to stay alive, like medications, blood transfusions, feeding schedules if there is a tube going into the stomach, IVs, surgery, additional oxygen, blood pressure medications and they just give medications like morphine as needed to keep someone comfortable.

True. But notice you are describing someone pretty darn sick, that is *not* showing a bit of normal life, not going to a casino, not playing poker, not gabbing at a bar, not going fishing ... etc. I'm troubled by those cases I'm seeing. Is it just me? Am I manufacturing what is not there? Was Alan being told he only had a few weeks and he didn't tell us?

Walking around doesn’t mean your health can’t turn on a dime. Heart attacks and strokes can leave you in pretty bad condition.

There were 10,064 assisted suicides in Canada in 2021 and they are increasing every year since being legalized in 2016. I would expect at least some of the cases you described were AS. I believe any adult has the right to have an AS if he no longer has the mental and/or physical strength to carry on with living.

A dirty little secret that I expect that SOOPOO can confirm is that when patients are truly at the end of life and were being given morphine to "make them comfortable" that the amount of morphine they were being given was slowly being increased to shorten their time in what is little more than a vegetative state. I also don't have any problem with that process. My Mom, Dad and Mother-in-law all had that happen at the end of life and I spent several days with each of them during the process even though they were non-responsive.

Another way is someone going into surgery and things going south for one reason or another. They could have looked fine prior to that.

Quote: odiousgambit

As for Alan Mendelson, here is his last post at WoV, where he has a casual point to make. The sort of thing you might do if were unconcerned about dying, I have to say, but I admit you never know on these things ... the date, November 2nd. Did he go into PC? That I don't know.

My father who passed away about two months ago went to his doctor on Monday for a normal checkup (he was 87). The doctor sent him for lab work so he went Monday afternoon for his blood draw. On Tuesday he dropped dead. On Wednesday we check the answering machine and the doctor got his blood test results and told him to go to the Emergency room. Sadly, we didn't get the message until the next day. Que sera sera.

Amazingly, at 56 years old that was the first person that I ever lost that was close to me.

There are quite extreme variations in the condition of patients when they enter ‘palliative care’. It can be someone near death with a tumor compressing their windpipe. It can be be an octogenarian with a ruptured sorta. But it can also be a generally healthy 60 year old with an inoperable brain tumor. The first two the patient may be dead in hours. The third May last many months.

A friends dad had an inoperable cancer. It caused continuous, but very slow, bleeding. Even in ‘palliative care, he was feeling very weak and went to the hospital, where he got a blood transfusion and felt better. But he continued to deteriorate, swelled up awfully. Next time he didn’t go for that transfusion and died peacefully at home.

There is a catchphrase used by palliative care physicians…. ‘Palliative care is NOT no care….’