How we die

The death we want

Supreme Court Justice Thurgood Marshall reportedly said, “I expect to die at 110, shot by a jealous husband." Most of us expect a far more prosaic death and we want to die at home. That might be want we want but it’s far too often not what we get. What we get is a slow, wasting death in a cold, florescent-lit hospital room, often hooked up to machines and monitors, sometime unable to eat or talk.

We don’t want that, we recoil at the idea of that, but that’s what we get. Why?

Hold on to that question for a moment while I tell you about Joseph Gallo M.D., a professor at Johns Hopkins.  Back in the late 90s he started interviewing doctors who had been participating for years in the Johns Hopkins Precursors Study; he asked these aging medical men about death. Before we hear their answers, let’s do a bit of man-on-the-street sampling.

Scenario: you have an incurable brain disease which leaves you unable to recognize people or speak; in other words, you have severe dementia. In that situation, would you want the following done for you? Typical person-on-the-street answers were as follows:

CPR – “yes, sure”
Mechanical ventilation (breathing machine) – “yes, ok”
Dialysis – yes
Feeding tube – yes
Antibiotics – yes
IV Fluids - yes

Far and away most people say yes to all the above (and more).

Ask the doctors the same questions and their answers are shockingly different:

CPR - 90% say no
Ventilation or dialysis – almost 90% say no
Surgery – 80% say no
Feeding tube – 80 % no
IV hydration – 60% say no

Ask the docs about pain meds and 80% of them say “yes, relieve my pain.”

Why this huge difference? Because doctors know the truth. The rest of us have been lied to by popular culture. A 1996 study showed that 75% of people survived CPR intervention on television’s ER, Chicago Hope and Rescue 911. The actual number?

The ACTUAL number?

8%!

8% survive for at least a month.

And that’s a rosy exaggeration. In fact, a 2010 study looking at ninety-five thousand cases, 3% of patients who received CPR returned to a normal life. Another 3% ended up in a chronic vegetative state; the remaining 2% of that 8% fell somewhere between.

The other 92%?

Dead.

Doctors know this. They are therefore making informed judgments. The rest of us are flying blind, saying yes to almost everything hospitals offer – and charge us for.

In the strongest possible words I URGE you to listen to this Radio Lab piece. It’ll take twenty minutes of your time, but may be incredibly valuable to you at the end of your life.

How too many of us shuffle off this mortal coil