Surprise Death

By Shawn Vuong


In the light of the current healthcare reform debates and all of the craziness that has come with it (the infamous 'death panel'), let us not forget what this debate is truly about, the patients.  


As Dr. Holm reminds us, eventually we will all come to our death.  The important thing is that we must let our loved ones pass away with a little dignity and pride.  To do this we must talk to our family members about their death wishes, as well as our own.  This is an important and often ignored piece of medicine that never gets the attention it deserves until it is too late.  
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By Richard P. Holm MD

The late physician poet John Stone wrote of Death… I have seen come on/ slowly as rust/ sand/ or suddenly as when/ someone leaving/ a room/ finds the doorknob/ come loose in his hand.

This is not a topic about which anyone likes to talk.  The poignant truth, however, is that all of us will die one day, so we should go there every once in a while.  Many say they would like to die quickly and unexpectedly.  Let me go at ninety, shot by a jealous lover.  Or more realistically, let it happen in the night during sleep, after a joyful day, as a very old person, still with all my faculties.

As a physician, I have seen death occur in many ways.  Certainly, no one wants to die slowly while suffering, or after a long period without the capacity to know what is going on.  In these cases I have grown to appreciate the hospice attitude of comfort care, instead of medically trying to prolong an un-enjoyable life.  Perhaps our ability to keep someone alive has gone past our ethical understanding about how to know when to allow a natural death.

But here we are talking sudden death.  The kind of end that is unexpected.  When we lose someone and we have to say “Why?”

I have often wondered what the ghosts of those who die so abruptly must think.  Is it, “That wasn’t so bad!” or “Wow, that caught me off guard!” or “I wish I could have told my family one more time that I love them.” Or “That was a better way to go than that long and drawn out suffering way!”

I have had too much opportunity watching people hear and react to words like, “We have found cancer, and your condition is terminal.”  We are simply not built as human beings to handle the hopeless sound of a phrase like that.

It is better to live our lives with hope for a reasonable future, but still knowing that at any moment this could be our last.  One friend told me that when it’s his time to go, “Surprise me.”

Take home message:
   1. Talk to your family about your own death wishes;
   2. Finish your business and say what you should say everyday.

Are South Dakota's Current Abortion Laws Hurting Doctors?

By Shawn Vuong

While many South Dakotans are glad we are done with "Initiative 11" Zita Lazzarini thinks South Dakota has already taken it too far.  Today in the NEJM, Lazzarini says that the current law that was passed in 2005 known as the "abortion script" threatens the physician-patient relationship.

At one level this type of law pushes our state's beliefs onto doctors and patients.  Also, the abortion script may actually be keeping doctors from giving scientifically based information to allow for an informed consent.  Lastly, Lazzarini says that if we let the states push it this far, what's next?  Who knows what other ethical dilemmas the state will try to push onto doctors & patients.  

If legislatures can mandate that physicians provide women with ideological, vague, intimidating, and false information about abortion, what is to stop them from intruding further into physician–patient discussions regarding end-of-life decisions, the use of future stem-cell–basedtherapeutics, the efficacy of birth control, or the role of condoms in preventing sexually transmitted infections?

How important is the doctor-patient relationship to you?  Whether you are pro-choice or pro-life should not make a difference in this issue.  Imagine that you are in the hospital with your loved ones, and the doctor was mandated to tell you and make you sign paperwork that the end-of-life decisions you and your loved ones are making are wrong.  

Alcoholism

By Richard P. Holm MD 

There is good science showing a glass or two of wine per night protects against heart disease. But what can be helpful to some, can be poison for others. 

One study found 53% of people in the US have a close relative who has a drinking problem. At last count 17.6 million in this country are alcoholic or alcohol abusive. Alcohol excess causing auto crashes, homicide and suicide, liver-heart-brain-kidney illness, and brain damage to the unborn, costs the US about 185 billion dollars per year, not to mention incalculable human suffering. 

"Alcoholic" means four things: craving, can't stop, withdrawal symptoms, and needing more and more to get high. This is different from "abuse", which means a pattern of drinking which results in failed work or school responsibilities, driving while drunk, legal problems or social and family problems. Although separate by definition, many alcoholics also experience alcohol abuse.

The CAGE questions help identify when there could be a problem: C stands for "cutting down", A for "annoyed" be criticism about drinking, G for feelings of "guilt", and E for the "eye-opener" in the morning to steady nerves. One yes is worrisome, and two means someone needs help. 

There is a myth that alcoholism is a sign of moral weakness, and to seek help is to admit some type of shameful act. In fact, alcoholism is a disease like diabetes or asthma, and not a sign of weakness or ethical deficiency. 

Why is it that alcohol will take hold of some people, and not let go until it's destroyed their lives or the lives of those around them? We dont know the answer to that question but we do know is that if there is a problem with alcohol, there is help to be had. You just need to ask for it.

Ethics & Alcohol

By Shawn Vuong

Today, Dr. Craig Uthe, a Family Practice phsyician in Sioux Falls, came in to talk to the medical students during their Introduction to Clinical Medicine class.  The topic for the day was Substance Abuse in General Practice.  We learned lots about the addiction process, and the tough road through recovery.  

Most interesting to me was the dilemma brought up near the end of the class.

Lets say there is a man named Mr. Jones.  Mr. Jones seems like he works non-stop, and today he finally has a day off to catch up on some things around the house.  He gets up early, fixes that dripping faucet that needed fixing, enjoys a wonderful lunch with his wife and children, and plays some ball outside with his kids in the afternoon.  Later that afternoon, he decides the grass is looking a little long.  Mr. Jones gets out the old lawn mower and starts cutting grass.  About half way through, he grabs an ice cold beer and drinks the whole thing before continuing to mow.  At that moment, he gets a call from work.  Its an emergency, and he needs to come in right away.  

Now lets say Mr. Jones is a maintenance man at the local hospital, and the power is cutting out in one wing of the little hospital.  Does the fact that he had a beer effect his work?  Should he be coming into work at all?

Now lets say Mr. Jones is actually Dr. Jones, and he is coming into the local hospital to deliver your baby.  Does the fact that he had one beer effect whether or not you want him to deliver your child?  Should he have been called in at all?