Lacking a coherent view of how people might live successfully all the way to their very end, we have allowed our fates to be controlled by the imperatives of medicine, technology, and strangers.

Dr. Atul Gawande, Being Mortal

[Editor’s note: Please read the amazing followup stories submitted by viewers here]

To anyone who cares for patients, or for those with loved ones who’ve faced the end of life, this statement rings tragic and true. Strip away the political posturing and nonsensical talk of death panels and the like, and we’re left with a stark truth: that we too often fail to have those difficult but crucial discussions about dying, and this failure leads to untold human suffering and billions in squandered resources. We are failing as caregivers, we are failing as family members, and we are failing as individuals—failing to simply have a conversation that ensures that we direct our own destiny. Plainly put, we need to talk about dying.

  • As patients, death and dying are often the last things we want to discuss and think about. We need to get over it. Who do you want making decisions for you at the most crucial juncture in your life? A set of strangers? Or do you want to control your own care? We need to think about and discuss the types of interventions we’d accept, and more importantly, what we’re willing to sacrifice in the process of reaching our goals of care. We then have to tell our loved ones and care team our wishes, and pick a surrogate to make decisions if we can’t. If we fail at this, we risk unnecessary suffering on a scale that is tough to imagine, while putting our families through a preventable ordeal of guilt and indecision. Here’s one set of resources to get you started.
  • As healthcare providers, we need to do better at starting these tough conversations, often over multiple visits, and preferably in the outpatient world while there’s relatively clear thinking and no imminent crisis. Having more time per patient, as in Turntable Health‘s relationship-based care model, doesn’t hurt either, but upcoming reimbursement changes should help incentivize these crucial discussions. We’ve all seen what happens if we fail at this.

Need help breaking the ice? Here’s Ain’t The Way To Die, based on the Eminem and Rihanna masterpiece Love The Way You Lie. It’s the first video we’ve made that is not funny—well, that is not funny on purpose, in any case. We initially planned to use blatant comedy to break down taboos around the process of dying, but some intense personal stories from our Facebook fans made it clear that this topic required an unprecedented level of gravity.

So Dr. Harry and I wrote lyrics that ultimately sprang from our own experiences caring for patients, young and old, at the end of their lives. Devin Moore blew us away by completely reimagining the instrumental track and laying down such insanely epic vocals that Rihanna herself might need to pull out her Um-b-rell-a. And medical peeps will recognize those tones at the end as actual ventilator sounds, triggering the appropriate PTSD response…

But the clincher? Storyworks productions. They were doing a documentary tentatively called “Wake Up” that featured ZDoggMD and his shadowy real-world alter ego, Dr. Zubin Damania. Hearing the audio track, they immediately offered to shoot the music video as part of the documentary! So now we have a true Hollywood-level production thanks to their amazing contributions.

There’s too many people to thank on this one, so please check the credits in the video. But well-deserved shout outs go to Dr. Michael Fratkin of Resolution Care for his inspiration and feedback, Variables of Light for some pinch-hit videography, and Ellen Goodman and The Conversation Project for helping to light the way.

And a special thanks to Medicare, for finally agreeing to reimburse physicians for conversations about end-of-life care. Tough break, Sarah Palin.

You only die once. Do it on your own terms.

—ZDoggMD

 

Get ZDoggMD to come speak and perform this song live. Let’s spread the message together!


 

Just gonna stand there and watch me burn
End of life and all my wishes go unheard
They just prolong me and don’t ask why
It’s not right because this ain’t the way to die, ain’t the way to die


Patient:


I can’t tell you what I really want
You can only guess what it feels like
And right now it’s a steel knife in my windpipe
I can’t breathe but ya still fight ‘cause ya can fight
Long as the wrong’s done right—protocol’s tight


High off of drugs, try to sedate
I’m like a pincushion, I hate it, the more I suffer
I suffocate
And right before I’m about to die, you resuscitate me
You think you’ve saved me, and I hate it, wait…


Let me go, I’m leaving you—no I ain’t
Tube is out, you put it right back, here we go again
It’s so insane, ’cause though you think it’s good, I’m so in pain
I’m more machine than man now, I’m Anakin


But no advanced directive, I feel so ashamed
And, crap, who’s that nurse? I don’t even know her name
You lay hands on me, to prolong my life again
I guess you must think that this is livin’…


Just gonna stand there and watch me burn
End of life and all my wishes go unheard
They just prolong me and don’t ask why
It’s my right to choose the way that I should die


Doctor:


You ever love somebody so much, you can barely see when you with ‘em
That they, lay sick and dying but you just don’t wanna let ‘em
Be at peace cause you miss ‘em already and they ain’t gone, beep beep, the ventilator alarms
I swore I’d never harm ‘em, never do nothing to hurt ‘em
Hippocratic oath “primum non nocere” now I’m forced just to torture ‘em
They push full code, no one knows what his wishes were
His sister heard him say once, “I don’t wanna be a vegetable”
But no one agrees in the family his caregiver Kate wants him comfort care but Aunt Claire lives so far away
That her guilt eats her like cancer so she answers, “Wait! I think he’ll wake”
Maam, you ain’t even in the state!
Palliate, relieve pain, get him home, explain
Critical care? Just hypocritical when it’s so insane
But they insist I shock his heart again so I persist
Guess that’s why they say that love is pain.


Just gonna stand there and watch me burn
End of life and all my wishes go unheard
They just prolong me and don’t ask why
It’s my right to choose the way that I should die, the way that I should die

  • Mark Ray

    Thank you from a nurse of 38 years.\n

  • Debbie Sutcliffe

    It amazes me, as a family doc, how many patients still refuse to discuss this with me, or their families. We gotta keep trying to break the silence….

    • Totally. But often as practitioners we could do a better job bringing up the tough stuff repeatedly (many of us don’t, either because of time, comfort level, concern about patient satisfaction scores, on and on). It’s a multifaceted problem. Thanks for your comment!

  • Kristen Annette Cash

    As an oncology/end of life nurse my whole career I want to thank you for this video!!! I’ve had all members of my family fill out an advanced directive. It’s a hard conversation to have but it’s better then leaving family to make hard decisions they will question the rest of their days. Thank you for everything you are doing!! Wish there were more doctors like you out there!!

  • Ashley, RN

    Thanks for creating a video like this. No one likes to discuss their death wishes, but reality is that we will all die eventually. One of the hardest parts of my job is having to watch a patient suffer bc their family keeps pushing and pushing regardless of what the patient wanted.

  • Evan Fusco

    This is your best and most powerful video yet ZDogg… great stuff and totally on pointe.

  • Linda Whobrey

    Thank you. I am a nurse and when my father when into have heart cath I tried to get him to sign a advanced Directive because we had talked about his wishes. I knew without one his wishes could not be honored. We asked for one but was to late because the Dr. just signed ordered for my dad to be admitted to ICU. Neatless to say he got an infection while in hospital and he ended up having countless surgeries and died on a vent. People really need to watch this. I am sharing.

    • OMG. Thanks for telling your Dad’s story Linda.

  • Victoria Kulli

    This is not living. It takes courage to tell your loved ones how you want a meaningful end, rather than prolong the agony. Everyone dies. Make it yours.

  • Cynthia Koar Easterling

    I’m a nurse. I’m a mom. I was a critical care patient. I went in for a cranial decompression. Routine but with risk. I have advocated for advanced directive my entire adult life. I have been designated on a few. Mine was not current and my IH did not help my thought process. I got everything ready for Christmas. Super special gifts for everyone and house decorated to the nines. December 17 would be the surgery and home by the 21st. No sweat. \nMy brain swelled post op like no ones business. On the 21st, instead of going home, I blew my graft. Obstructive hydrocephalus and a pseudomeningocele. They re intubated and for Christmas I got an externalized shunt. As an extra gift, a sub arachnoid bleed came with it. Two more weeks on a vent, whited out CTs, the trach and G tube talk with my family. They had know I didn’t want to be a vegetable but I never told them what that meant. \nI was lucky. I made it out and still have a quality life. It’s a heavy talk but you have to go there. It’s so much more than just a “no code”. This video hits so close to home. Thanks for exploring such a tough subject.

    • WOW. Thanks for sharing your story Cynthia!

    • David, MD

      But, you *did* make it. I’m an MD and my wife a PA. That story is miraculous… So where do you draw the line? By most Advance Directive guidelines, your care would have been withdrawn – and that would have been the wrong decision, because obviously you’re here. It’s not easy drawing up those criteria.

      • Spring Texan

        You say “that would have been the wrong decision, because obviously you’re here.” I disagree. If we keep going when there’s a small chance, although a few will benefit, many more will suffer. You have to go with the odds.\nA friend’s partner had brain surgery and neither she nor her partner wanted resuscitation, but she had left briefly after hours at the point some dire event happen, and the doctors, who HAD been informed beforehand, went right ahead and pulled out the stop. Her partner went into a nursing home and died two or three years later. The friend was loyal and took her home every weekend, but she was also very angry that they had treated her friend and left her living but so impaired, which neither one of them had wanted.\nSo I can’t agree at ALL that that would have been the wrong decision, even though it’s wonderful that she can be alive with a good quality of life now. And if you think that, I don’t want you for my doctor.

        • David, MD

          I am sorry that your friend’s partner suffered so, and also sorry that you are so angry on her behalf. I don’t know the specifics of their story enough to compare the two, but I *do* know that there is a big difference between an unexpected, terrifying complication and unanticipated outcome of a routine procedure, and either emergency surgery or a “last ditch effort.” Two major considerations are whether the person had the opportunity to make final plans and arrangements, including a living will/advance directive, and whether he/she and their family is psychologically/emotionally/spiritually prepared for death as a possible outcome. In Cynthia’s case above, she had interim improvement, then setback and decline, and finally, recovery. It is not all black-and-white, and much depends on progress over time and having patience. Life, albeit certainly meaningful life, is immeasurably precious, and any Surgeon or Critical Care Specialist will tell you they have seen more than their share of miracles. You (and everyone) deserves a doctor sensitive to the concept of futile care; you also deserve one (or more) who isn’t afraid to stretch and reach at every minute and hour with their heart and brain on your behalf for a meaningful recovery.

          • MidRoad

            I worked 15 years in the OR as circulating RN. And prior as RN on ped’s, ortho, med floors. The beliefs, the agreements to stop treatment, are not legally allowed when surgery is being done- I am so sorry for the outcome. But if one is in surgery they are treating as if for life- one cannot say, oh this is such a terrible complication we’ll just let them go die on the operating table if they are still having vital signs and other hopeful signs. Yes one can die in the OR, but that is after all has been tried, and unsuccessfully. Your friend’s outcome afterward of living in nursing home was possibly due to being younger? No loss of vital signs the entire years in the home? Life is so gray- had the partner not had surgery, would that have been the right thing to do? Human anatomy is frail and precious from what I have seen in the OR. It is also not cookie cutter the same in all unique human beings. To me it sounds like they tried their best for a young person, & something can happen out of their control, the Dr’s will make every attempt to save in the operating room. Unfortunately, with younger patients, yes they do have the ability to live a few years. And it is tragic. That to me is definitely where it becomes obvious life is not black or white, it is messy. I’ve experienced the pain of watching my BIL who is relatively young for 3 strokes (63), and in and out of rehab’s. He is reduced to living in W/C at home w/care givers he fortunately can do. But he knew w/the 2nd stroke looked in the mirror and said “Where’s name left out?” He’s survived for 8 yrs, and refused DNR as he paranoidaly feels it gives caregivers a reason “to not try as hard for me”.He’s still going, worst stroke during/after surgery; but his life is sitting and watching TV. PAIN. I’ve experienced the agony of fighting the dr’s and the RN in charge of my MIL who developed dementia yet knew it, had to fight to put her in her home, keep her there, accept the little falls that would never be tolerated in hospital. She was happier. The RN in charge did not recognize how to care for her when she changed in cardiac status at home- I found out the next day and rushed over calling the hospice nurse at the same time. That hospice nurse was The Boss! She granted Oxygen as she knew it would not prolong death, gave medications; I have such respect for them, and find them to be brave heroic nurses. I couldn’t do it! Life. It is messy and always so hard to let go – but as said before, I believe things are changing if only because our current govt is cutting funding, and these things as stands now are too expensive. Let people die at home! Put govt money there, not nursing homes. This would not mean a family member be responsible for the care, it means caregivers in the home. I send out support to those suffering these situations.

    • Spring Texan

      Great post and appreciate it. If you are willing to say, do you agree with David, MD, or with me, on the decisions made? Regardless, I am so happy for you and your family that you are doing well now; and cannot even imagine what you have been through.

  • Alicia Mccurley

    My father had lung cancer and went into surgery to have a lobectomy without an advanced directive. Complications following his surgery forced our family to make decisions that no one wants to be responsible to make. You’re damned if you do and damned if you dont in situations like this. In such a tragic time, the last thing you need is a divided family. There are always family members that want to wait longer and family members that want to end suffering. As much as making decisions about the end of your own life sucks, think about how much it compounds the pain of loss for the ones you leave behind. I don’t want my family to have to deal with guilt on top of loss. Thank you for this awsome video!

  • Diana Hershey

    I’ve been a hospice nurse for 18 years. All I can say is thank you and hope I meet you someday. This is a conversation I’ve had a thousand times. So traumatic to have this conversation at the End instead of before there is a crisis in the family. OMG I’m so tired.

  • DrbobUslander

    Great video, ZDogg! Very timely and catchy.\nNot sure when we spoke last, but for the past year and a half I’ve been doing full-time Palliative Care and Hospice, and working with patients and families every day to help make them as comfortable as possible and guide them to make the best possible decisions about their care. It’s incredibly gratifying work.\n\nMy mom died from lung cancer last year and my dad just died from lung cancer last week. \nIt’s been a tough 13 months. \n\nBut they both ended their lives in their own homes, surrounded by loving family members, on their own terms. It was my gift to be able to provide my parents with guidance and support at the end of their lives, and they both fully understood the various options open to them and the likely benefits and risks of those options. This is what is needed so desperately- honest conversations that evaluate all the options and provide people the freedom to make decisions from a place of love and understanding instead of a place of fear and confusion.\n\nI hope our paths cross again soon, my friend.

    • Bob, good to hear from you and so sorry for your losses. But it sounds like things went as well as they could, and congrats on seeing the light with palliative!

    • Spring Texan

      My parents also both died at home, precisely because they were firm about NOT pulling out all the stops. And though death is still difficult, it was certainly better than their being subjected to all this stuff.

  • brianahier

    BRAVO!!!

  • Hal Grotke

    I had to quit my hospitalist job because most days I went home feeling guilty about keeping people alive. I think I was better at and more proactive than most of my hospitalist colleagues about having that discussion with families but it is really hard for people to grasp fully in that moment.

    • I often contemplated running away and becoming a palliative care doc.

      • Betsy Clark

        You’d make a great one. As a hospice chaplain I work with the amazing Dr. Brian who “gets” this stuff like no other. And yet there are so many docs who still view referring their patients to us as “giving up.” So much education needed on so many levels. I’m shouting it from the rooftops and sharing your video everywhere I can. Thanks so much for all you do.

      • We’d love to have you, homie!

      • Hannah Wham

        You should! Come to New Zealand and work with us! We are an awesome bunch of experienced palliative care RNs! Awesome parody and we love your humor filled ones too. Especially the confrontation at the moment!

      • Alexandra Rosson

        You are always more then welcome to come to Fairbanks Alaska and be one anytime! Those conversations are hard ones and puts us all in an uncomfortable spot! What many docs don’t realize is that more people wish docs had more of a frank discussion!

      • aimee

        I wouldn’t call that running away by any means. Yes we need all physicians to be capable and proactive of initiating the difficult conversations but until that happens, palliative care teams are our bridge and attempt at informed consent and need to continue to grow exponentially. They are the ones puting things in english, sitting with families until there are no more questions, clarifying with 5 consulting physicians on what the realistic expectations are on recovery and asking people/ patients what an acceptable life looks like for them. \nDo we need medical school to include a palliative care section and help teach more communication skills on difficult topics or is palliative care a specialty that certain people have a passion and skill for and should be kept separate? Perhaps a combination? \nThank you for your video…. I really appreciate it and it helps spread awareness on a very needed topic. I wish there was a way to get out to the non medical world what real compressions and a difficult intubation look like. I hope medicare now paying for primary providers to have these conversations helps increase them. \nYou would be a wonderful palliative care physician. \n\n\n

      • MidRoad

        No! More dr’s as you are needed at that juncture! I know how rushed it is, how difficult move on move on. I worked as circulating RN in the OR 15 yrs after time spent in ped’s, ortho, and med floors. I became unable to continue due to having had 3 DVT’s in my left leg, and miss my career so terribly. I miss being able to see the little things that matter, and speaking up for my patients. I saw the frailty and uniqueness of all human’s anatomy, it is not all the same, well except that Operation Game. I’ve also experienced the pain of 2 family members ((in-laws) not accepting their future demise even after heinous events. One is my BIL who at 63 has had 3 strokes. ED did not tell him after a bike fall about his elevated and unrelenting high BP while in there- he looks kinda homeless but is ASD & engineer. Bad bad decision. 2nd stroke, he did not get his medical clearance, & urology dr went ahead w/surgery for kidney stones. BAD stroke from that, surgeon took too long, didn’t recognize was time to stop and re-think. HOW people look, isn’t always an indicator of how much MONEY they have. But, I live in FL, sewage center of medical. I cried real true tears at this video. Is it released as a video commercially? If not it should be. How I miss my OR circulating days, people say your patient is asleep- I beg to differ. I was there holding their hand as they went to sleep, or if having awake procedure. I was looking at everything on their chart. I was watching the team and the patient simultaneously- safety. I was there when they woke up right next to the anesthesiologist. Just as when they went to sleep. I haven’t seen it mentioned, but I do believe all living wills, intents, etc. are not legally recognized while the family member is IN the OR, after all, a decision has been made to go there for the best attempts, and unless our patient utterly failed with vital signs, coding,etc, no, patients are not allowed to die on an operating table. Life is so messy. So messy, and unpredictable. For me, it has been a difficult difficult thing to learn- to let go, and move in different ways. Life. Living. Is gray. NOT black or white. Thanks for all you are doing!

        • MidRoad

          May also add- hospice nurses are (old vernacular) Da Bomb!!!! We had one for my MIL, they have the courage and bravery to do what is right in the midst of chaos usually. I honor and revere them.

      • nomadnurse

        There’s no such thing as running away. When you are a healer/healthcare worker, you are for life. It’s a calling, and we are committed. I’ve been a critical care nurse for 18 years. My concentration has been with heart transplant, VAD, ECMO, and total artificial heart patients waiting for transplants. (That ain’t the way to die.) We heal the ill, we hold the hands of the dying. I’ve had this conversation a thousand times, and STILL I see some of the most painful endings because the topic elicits such discomfort and conflict. Can I stand another 18? I don’t know. It’s tough work. But I do know that if I ever leave, I will stay in the healthcare world. I don’t know anything else. I don’t want to know anything else. It’s what we do, it’s what we love. I think palliative care is one of the most noble areas. We look to them for guidance when we have nobody else to look to. I love the messages you are sending, funny or serious. If you ever contemplate expanding your ideas north to Oregon (where the Death With Dignity Act is in effect), or for any other reason (what you have done for Las Vegas is amazing), I would support that and be honored to be a part of it. If not, I will continue to support your mission and ideas from afar.

  • Amy Camille Denton

    Thank you. Forwarded to all who are interested (mostly healthcare providers). See this time and time again and most recently in my own family.

  • Krissy Miller

    Seen too much of this as an ECF nurse. You hit this one.

  • Mandy

    From a 15 year RRT-ACCS working in critical care this was spot on. Awesome video.

    • Mandy

      Btw, love the ventilator at the end!

      • mommynator

        I call those ventilators the “Close Encounters of a Third Kind” ventilators.

  • Meredith Gould

    Extraordinarily important contribution to the growing and still desperately needed resources to begin/continue conversations about EOL. I’ve “managed” EOL wishes and care for family and friends, plus had my own medical encounter of the “gee, you were almost dead” kind. As a result, I’m fiercely passionate about the need to create ways to have these conversations. Oh that discussing death would become normative and safe. (FWIW, I’m posting this to the Health & Spirituality (#hlthsp) group on FB and will be tweeting a link with that hashtag.)

  • Tammy Brooks Patterson

    Thank You! I am a nurse in a ltc facility and we urge families do a physicians order for life sustaining treatment if they do not have advanced directives. It takes the burden off the family when end of life comes.

  • Tanya Beaven

    OMG, watching this video just a few days short of my brothers death 19 years ago brings it all back as if it was yesterday. I remember talking to his Neurologist just hours after his craniotomy, telling him that my brother was not here with me, and just 3 hrs later giving them the order to remove him from life support. 38 is to young to die, but my brothers needs needed to be met, not mine nor our parents. \n

    • Wow, Tanya, thanks for sharing your story.

  • Peggy Shepherd

    Thank you so much. A very important and needed discussion! As a Hospice Social Worker getting hospice consults from the ER are always the hardest. So glad you made this video. It is about what we can do for someone not what we can do to them…

  • Luissette Matos

    As a hospice nurse and community educator I cannot stress enough the importance of having this conversation. People don’t realize that most of the individuals we have seen in the news due to disputes over end of life conversations were young, ex Terri Shaivo, or Bobbi Kristina Brown. Hopefully with the Advance Care planning metric in HEDIS and the new CMS Advance Care Planning Billing code for 1Q16 we can encourage these physicians to have the conversation early!! Thanks I will definitely share this in my Five wishes/Advance Directive presentations!! Awesome Job Doc!!!

  • NB

    ZDogg, I love your stuff, but I have very mixed feelings about this one. \n\nFirst and foremost, I absolutely agree that talking to family when you’re young and healthy is IMPERATIVE so that your true needs/wishes can be carried out. My POA, advanced directive, etc. is all signed and ready.\n\nWhat I don’t like about this video is the premise it makes that anyone with the possibility of being at end of life actually does want to die. This isn’t true. Many people want to keep fighting. I know many people who were told by there ICU docs that they should ‘pull the plug’. One of these people was a practicing physician who had an anoxic brain injury but made a full recovery and is back at work treating patients. Because someone codes once, or even twice, does not mean there will be no quality of life thereafter. \n\n\n\nFor those without a advanced directive, this may be eye opening in the sense that it will get them to get one. I just don’t like the presumption that it’s better to just “Let me go…”

    • SkibuniRN

      I don’t feel as though the video expressed that sentiment at all. In my opinion, it very clearly expressed the fact that we need to have these difficult end of life care discussions with our loved ones while they are able to tell us their wishes… and then the patients wishes should be followed. If one wants to have heroic measures taken, find that out, document it in the appropriate way, and FOLLOW it. But too many times in my experience in the ICU, family either doesn’t know, or they know and don’t want to follow an informal, unclear directive for their own reasons. Or, as happens so so many times, they can’t emotionally make that choice, which is totally understandable. I’ve seen amazing recoveries, and I’ve also seen pts kept ‘alive’ beyond the point of reason. To me, this video addresses the inevitability of death, and that we do our loved ones a great service by having the conversation and understanding clearly what THEY want. On both sides of it.

  • Connie

    This message is so very important to get across to people before it’s too late. I am an oncology nurse practitioner and work with patients with life threatening cancers such as pancreatic. Too often we are guilty of delaying this conversation because we can’t face our own mortality and because patients and families don’t want to give up and are holding on to the remote possibility of a cure. Thanks for this thought provoking video. \n\n

  • ccorbettrn

    As a nurse and as a family member who had the privelidge of being with a loved one as it was time to go. It was the most powerful and right thing I have ever been part of in my life. My son is in his 3rd year of med school and I have shared this with him.

  • Lillian Pickering

    Thank you for this video! And the consequent opportunity to rant for a bit…\nI’ve been a dialysis nurse for 44 years, and have been distressed countless times watching the inevitable misery unfold; nobody wants to say “S/he is elderly, and elderly people suffer greatly on dialysis – – it’s not an easy life, it only prolongs the suffering. And at least one study showed that those elderly who chose no dialysis at Stage IV/V kidney disease survived longer with fewer admissions and complications than a matched cohort which did choose dialysis.” Nobody wants to be “Dr. Death”, which is what some patients called our one brave MD who did try to tell the truth to his patients (who then shunned him). Of course there are the very rare fit and vibrant 90-somethings who manage to live a year or two on dialysis before the cumulative complications kill them, but most elderly patients who start maintenance dialysis treatments are headed for the revolving door of their chosen medical center ED and thence to the funeral home. I understand the reluctance to bring up the subject, as it is often met with hot irrational anger by family members who really don’t know what their loved ones are going to have to endure to “continue to live”. Patients themselves, fearful of dying, ask for us to “do everything you can”. And many of us healthcare professionals are uncomfortable with the subject personally, making it even easier to brush under the rug. Yet another contributing factor is the question of whose job is it to share the grim news with patients and family? Compassionate nurses are willing to do it, I know, but they are not permitted to do so by the system, thus leaving the distasteful job to untrained (in how to have this type of crucial conversation) physicians. What a broken system we have! And I am sure I have left out other factors that contribute to this sorrowful situation. But, to begin to solve these problems, I think it is very important to ask “who benefits?”, for it is there that the most resistance to change will be found. Our culture, which continues to revere modern medicine as being capable of any and all miracles, needs re-education and transformation. And as a society, we need to grapple FOR REAL with the question of fair and wise usage of scarce and costly resources (do I need to add: WITHOUT the influence of Big Money making all the decisions?). \nHey guys, if my heart stops, please just leave it that way. I’m going Home.

    • Spring Texan

      Love your post. Thank you!

  • Judy

    This is great. Thanks. I’m an Oncology NP. I call myself the closer. I’m usually the one to have the talk…..maybe it’s time to stop…..

  • Cyndi Haynes

    Thank you. \nI started hospice care as an unlicencensed volunteer in 1998- I saw my first “good death” in 2001. RN since 06 and blah and blah… THIS IS NEEDED. \nKeep the work up, this is huge. \n\nIf you can ever do one on suicide… Yea, we need one, as I’m sure you know.\n

  • Melodie K.

    I thank God that I had that discussion with my mother many times before she was diagnosed with end stage cancer. I had the opportunity to look her in the eye and tell her that it was time to make that tough call that we had always talked about. She hugged me. thanked me, told me she loved me, and said that she knew that I would do the right thing for her-make sure she was comfortable. As a PA with 20 years experience, I know that was my final gift from my mom. If I can have that discussion with her, I can have it with anyone. Thanks for this wonderful message along with all of your others.

  • Dennis

    Hola ZDogg! This was cross posted on @kevinmd: Rap on ZDogg! I especially loved the plea you placed in the credits for having these conversations. Laying the ground work for a goals of care conversation takes empathic curiosity. As Osler has exhorted us as physicians, “It is much more important to know what sort of patient has a disease, than what sort disease a patient has.” Beyond a reasonable competence in clinical sciences, what makes a physician “good” vs “average”? I agree with the author of this most excellent A Piece of My Mind @JAMA (http://jama.jamanetwork.com/article.aspx?articleid=1734708&resultClick=3) “As an average physician in-training, I had empathy, but the mark of a good physician is the manner of conveying that empathy.” A good start can be made by asking these two questions once the ground work for rapport has been laid. “What are you hoping we can do for you?”. This question leads to a clearer understanding of the patient perspective and insight. This should prompt a discussion of needed knowledge of the medical context, relative to the patients perception and insight. At some point thereafter, this should be asked (best placed toward the end of an interview) “When you think about what lies ahead, what are your greatest worries or fears?”. Be prepared to get right to the heart of patient identified goals. This is what the “Good” physician is truly curious about. Who is this person, and what is most important for them? As Francis Peabody said in his classic article “The secret of the care of the patient is in caring for the patient” It’s a necessary, patient centered way to avoid an ICU burn.

    • Spring Texan

      Great questions posed in an open ended and tactful way. That’s what I want in a doctor when it comes to the crunch!

  • Pat Larkin

    Thanks so much for this video! As a long time nurse, I agree that we need to discuss end of life while our patients and families are healthy. We also need to do much more to prepare our nurses and physicians for end of life. My mom died 3 years ago, complications of C dif. She had a POLST, very specifically filled out and on her chart. When she started in to respiratory failure and I was on my way back to the hospital, she was placed on BiPAP, even though she specifically listed she did not want intubation/CPAP/BiPAP and it had been discussed. Once I arrived back to the hospital (1 hour later), this issue was again discussed and her wishes for “comfort care” were honored. I found some of the nurses and physicians comfortable with end of life and some not. \nI still at times struggle with her dying of hospital acquired C dif and also that her initial POLST wishes were not followed.

    • Spring Texan

      This is what worries me the most, that so often it does not matter, one’s specifications are disregarded. For this reason I have a bracelet that says ‘No CPR, no respirator, no vasopressors.’ Have only been in a hospital once and since it was a rather ordinary surgery didn’t figure I better wear it that it would freak them out, but the minute I felt death was a possibility I am hoping that might be more persuasive, that I have taken the trouble to make up a bracelet in advance. I keep one in my car glove compartment in case of a car wreck . . . but I still fear that yes with its being the default, this stuff could happen to me.\nI saw a vet give my dog CPR when dying (without asking me), I thought that was horrible (and yet it was far more minimal and briefer than what they do to people).

      • Pat Larkin

        Most important thing is to make sure that your family or other designated medical power of attorney understands your wishes and you believe they will be able to follow through. As a long time ICU nurse, I can tell you that even if you let the hospital staff know your wishes, they may look to that person if you are unable to make a decision.\nMy medical friends and I at times joke about having our personal medical decisions tattooed on our chests….

        • Spring Texan

          Thanks, I do have a sister who is my medical POA, and yes she is the sort who will follow through.\n\nMy sister says that when she would tell people she wouldn’t do all that they would always say oh yes you would if it was YOUR mother, but when our mother was dying the whole family was united in not wanting aggressive treatment, including my mother herself. So I know that, unlike some people, she really WILL follow through.

      • aimee

        Why do we treat our animals more “humainly” than we do people? Vets are usually better at saying, your pet is suffering And we will have the same outcomes now or in days, weeks but we have the option to make them comfortable now.

  • josh gates

    My dad passed last year after a short term illness, his last six weeks were spent in the hospital and the last three of those he was unconsciousness. He was ready to leave, we were not ready to let him go. Our selfishness, our sorrow, our love didn’t want to let go. He should have left sooner, but we could not release his hand to sent him on.

    • Josh, thanks for telling this story. You clearly loved your father very much.

  • Steve

    That was amazing- thank you for that- I’m an EM doc who just the other day had to start that same end of life conversation with a patient’s family while they were still in the ED. I am hoping it will lead to making the right choices in her care. We need to talk about these issues now and we need to all have the courage as healthcare providers to have these talks and be honest with patients and their families. Keep doing what you do ZDogg- like Mel Herbert likes to say- “What you do matters”\n\n-Steve Carroll

  • Lisa Allen

    painful video to watch for me, brought back memories of my Dad’s death 22 years ago. Thank you for this video from a geriatric CENA of over 30 years.

  • Becki Brown Baker

    I have been a nurse for 24 years and ha e seen just about every travesty that medicine can jeap on a human being. Having early Advance Care Planning conversations could have preventedmany of those. In medicine and nursing, I believe that we fail in our obligation to help and heal when we fail to have “hard conversations” that truly reflect CARE. Advance Care Planning is our job. It is our honor and privilege to help our patients transition as smoothly as possible. That is part of caring.

  • LLB

    By now I don’t think anyone hasn’t heard of Brittany Maynard,\n the twenty-nine-year-old woman who will most likely be ending her life \non November 1, 2014, with a legal prescription drug, before cancer takes\n her. Brittany’s case has special meaning for me, because almost a year \nago to the day, my husband, author Robert E. Bailey, passed away from \nthat same cancer.\n\n \n\nGlioblastoma is fortunately rare; about 22,000 people are diagnosed with this each year. But the tumor is a terror. On Glioblastoma Support Group, our Facebook support group of about 3000 people,\n maybe 1/3 of the patients have a tumor so aggressive or in such a bad \nlocation that they survive less than a year. The rest of us, with very \nfew exceptions, have lost our loved ones within two years. We’ve had \ndebates over there since Brittany’s original video\n was posted, the same as everywhere else on the net, but a lot of the \nrancor and religious pronouncements and posturing is missing. In our \ncommunity, where all of us have this tumor or are caring for someone who\n does, we all understand. \n\n The more I read from outraged Christians or from people nowhere near this stage of their illness… http://robertebaileyauthor.com/cgi-bin/blog/view_post/967450

  • Carol Christensen Kurtz

    Wow, that is beyond incredible and so powerful! Congratulations on this one, I hope the message is heard and that eventually we can all make the choice for ourselves and our loved ones that we make for our pets.

  • Bojan Korda

    Wow, great video on such a difficult topic. Hopefully will get some to think on it…\n\nAs an MD, I find this an extremely difficult conversation to have with the family of patients, heck, even my own family. The problem I find is that no-one can accurately quantify levels of intensive care, and on top of that its difficult to explain what happens in an ICU to lay persons. I’m not sure if anyone knows of any online resources out there that can be used to explain what happens to you in an ICU, an ICU code, the sort of procedures you must be prepared to endure, and the risk benefit stats – information that is presented for the non health professional? I feel this would be incredibly helpful…

    • Alexandra Rosson

      It is definitely a hard conversation to have. A softer way to put it is in the context of overall goals. It is easier to say that cpr doesn’t meet the overall goal of staying alive longer because quite frankly it wont in 99% of cases. CPR doesn’t cure cancer or CHF or COPD or any other chronic disease. Taking meds as prescribes, quitting smoking, etc may help but the bigger question is, how do you want to live the rest of your life because quite honestly, the choice is not whether we live or die (we have no control over that) but what do we do with the life we have left?

    • Stacy

      There is a book called “Hard Choices for Loving People” that is intended to help non-medical people think about the implications of various life-prolonging therapies. 🙂

  • wow wow wow. thank you.this is a message I am committed about sharing.

  • Tina Marie

    My dad died of brain cancer almost 4 years ago and it was his decision to be taken off the oxygen. We supported him fully and stayed by his side until the end. I am in the process of making my POA and living will and have already asked my brother to see to my medical wishes. Thank you for this powerful video!

  • Cathy Naghitorabi

    Some people here have been on the receiving end of these interventions. I’m lucky to not have been. But once at the dentist, after the novocaine shot, I realized I felt as if I were scared. I knew in my head that I wasn’t, but my heart was pounding and it felt like fear. I wonder, since then, what it feels like to have those massive amounts of code drugs flooding through the body, and I hope every time I give them that the patient is beyond awareness.

  • Tatiana Falk

    My dad’s neurological issues slowly deprived him of the ability to swallow without aspirating. Even though he had a clear advanced directive and POLST stating “NO artificial feeding”, one of his doctors continued to push for a feeding tube. If Mom hadn’t pushed back twice as hard on Dad’s behalf, he might have given in — but with her advocating as his caregiver, he lived out his days the way he wanted to. He died at home, sitting in his favorite chair. The only interventions at the end were oxygen and medications from hospice.\nAs a nurse, I see more than enough bad deaths to know how blessed we were that his death was a good one. It couldn’t have happened without those tough conversations about his wishes AND without Mom’s determination that his wishes be respected.

    • Thanks for sharing this story, we need to hear more about model examples of “good” deaths.

    • Spring Texan

      It’s wonderful that your mother protected him, terrible that that was necessary. Makes me worry as a single person, though I have an advance directive and a medical power of attorney in place. A wonderful book on the realities of what happens that I am reading now is . . . And a Time to Die: How American Hospitals Shape the End of Life, but Sharon R. Kaufman. She closely observed what happens in hospitals.\nShe’s very clear about how reimbursement and medical bureaucracy force both patients and practitioners to have only a very limited menu of choices. The person who would like to stay in the hospital to die but NOT be forced to endure a lot of “treatment” . . . nope, can’t do that, have to move them to a nursing home or somewhere and stress them at the end of life. The person who would want to be helped out of their misery . . . no, we can’t do that either (she recounts someone like that who spent days bravely facing death, refusing food, and dying because the other choice, which he much wanted, was of course not available to him or the doctors). We can have all the discussions we want and yes they do help make things less worse, but the structures of the hospital and our culture persist and limit how much things can possibly be improved — which scares the heck out of me now that I’m an old woman.

  • davidakramer

    I am an emergency physician with early onset Alzheimer’s disease (retired, of course). I directed emergency medicine residency programs for 25 years. You have initiated an important discussion. While I am doing quite well in the early stages of Alzheimer’s, at some point the situation will likely be grim. \nThe subject of death with dignity and an individual’s right to choose when to die is very important to me and the millions around the world living with dementia. We face an interesting conundrum. Even in states with physician-assisted suicide, the terms are very restrictive. Those of us with Alzheimer’s simply cannot know when we will have six months to live. We must still have the capacity to make the decision but don’t want to do so while we are still enjoying life. I am not depressed. I simply consider quality of life to be much more important than quantity of life. \nI don’t want to be a burden on my wife or the health care system. But this comment isn’t about me. It’s about many of us who simply want to be able to determine our own destiny. We simply want to have the option to choose. \nYou can see more about me on my Living Well with Alzheimer’s Facebook page. https://www.facebook.com/LivingWellwithAlzheimers?ref=hl \nThanks for raising this crucial issue!

    • David, thanks for telling this story.

    • Spring Texan

      Yes. The point you raise is SO important. Without better rules, if you have something like Alzheimer’s or ALS, you still may be out of luck. And it is such a comfort to have that choice whether exercised or not.

  • Sheri Hawkins Schmidt

    Thank you for making this video. Made me cry and I have the chills. Been a mdic for 13 years, with 8 of those being in the ER. The moral aspect of our job often goes unacknowledged, which is so hard for me. Thank you for bringing attention to it!

  • Sherry Richards

    Hit it out of the park this time. Congrats! From a social worker and therapist for 20 years.

  • mommynator

    I personally watched this scenario unfold when my father collapsed on the subway on the way to work one day. He had a massive stroke. Of course, he was rushed to Lenox Hill Hospital where they hooked him up, tubed him up and wired him every which way. When he sort of came to and realized what had happened to him, he tore everything off because he did NOT want to have his life prolonged through these means.\n\n\nAt the time, I was not a nurse and we were pretty ignorant about lots of things. There was a plan to remove the blood from his brain, but his heart was so weak by that time, surgery would have killed him. Then his kidneys started failing. Then his extremities weren’t being perfused and he would have had to have had his hand amputated, and maybe a foot or both.\n\n\nWe KNEW that he would not want any of this and we asked them not to use extreme measures like shocking, but we found out later that they had repeatedly resuscitated him. He finally managed to really die, beyond what they could do to him.\n\n\nHe died in 1981, before advanced directives and living wills were well known, and even if enacted, were heeded.\n\n\nI’ve made it my mission, as a nurse, to tell everyone that they need to decide what they do and don’t want done. I don’t judge their choices, but help them make those choices as we run through the list of possible therapies and treatments that are possible in extreme circumstances. I also make sure to tell young folks they need to make some decisions, which they can change as their life circumstances change.\n\n\nThanks for making this more accessible to folks whose eyes glaze over.

    • Thanks for sharing the story of your Dad…

  • Sarahpc

    I oversee palliative care for the largest nonprofit health system in the country. We struggle daily with families and other physicians saying their patient is “not ready” for palliative care despite the fact that it can be delivered at any stage of any illness and not just at the end of life. Upstream PC and advanced care planning (ACP) are vitally needed and thankfully CMS, the NIH, the IOM, and several Congressmen are realizing this. ACP should be done early and often–I think 18 year-olds should have them. The most famous ethics cases around the issue were with youngish females (Cruzan, Quinlan, Schiavo). Had these women had ADs we wouldn’t even know their names, whether they wanted continued life support or not should have been their decisions. Unfortunately lack of understanding persists. Representative Steve King is going to introduce a bill that would prohibit Medicare from covering ACP. This is not a bipartisan issue!! We can all get behind allowing people to make decisions for themselves and sharing those decisions and the reasoning behind them with their loved ones before it is too late, just like you said! Thank you Zdoggmd et al. for this important video. I usually love your funny ones but am so glad you did this!!

  • Sherry

    Our son was 13 years old, about to go through full body radiation on top of overwhelming chemotherapy in preparation for a bone marrow transplant – a last ditch effort to cure his relapsed AML. We had a serious conversation that day, in the office of the radiation oncologist, who had bravely brought up all the grave concerns that come with this kind of treatment. Solemnly, maturely and with remarkable self possession, Joseph, my son, spoke plainly on a subject nobody his age should even be aware is an issue. He told us he did not want to be kept alive on a ventilator if there was little hope for meaningful recovery. Meaningful recovery for him meant the ability to go to school, to have a girlfriend, to look to the future with hope of an independent life. A mere four months later, we had to make the decision no parent should have to make and silenced the machines keeping the shell of our son alive. Knowing his wishes some days is the greatest source o comfort I have. That was 8.5 years ago now. I started back to school four months after his death and now work on a critical care unit as an RN. So many people deny that death comes and do not want to have to make these decisions, but doing so may be the final gift of peace in your passing for your family. If a 13-year-old can face this and discuss it, so can you. Do it. Do it right away.

    • I’m not crying, it’s just been raining…directly into my eyes. Sherry, thank you for sharing this story, your son sounds like he was an amazing soul. As a father, I can’t fathom your loss, and as a doctor, all your words resonate as truth.

      • Sherry

        It is my privilege to work with physicians like you. I love my career and I cherish the lessons my son’s brief life taught me. Thank you for acknowledging his story. 🙂

        • Lisa Loiselle

          Sheri, it’s our experiences, good or bad, that shape us and coming from your coworker, you are one of the most compassionate nurse and human being I have had the pleasure of working with 🙂

    • mommynator

      Words fail. For what it’s worth, ** hug **

    • Veronique

      As a critical care physician, I was thoroughly moved by your story.\nI am so sorry for what happened to your son and your family, but I am sure you’re an extraordinary RN, with a unique wisdom that comes with such sorrow.\nThank you for sharing.

    • Linda Burke-Galloway

      Thanks for sharing your powerful testimony!!

    • Heather Boog Jarvis

      Thank you Sheri for sharing your story and the importance of making your wishes known. It is truly one of the main coping mechanisms…. knowing you did exactly what he wanted .

    • DannaSteve Matheny

      I am in my first semester of nursing school- (BSN) and want to specialize in hospice/ palliative care. I admire you for going back to school, I cannot imagine where you got the courage from. I have three sons of my own and my heart and prayers go out to you. No 13 year old should have to think about death. 🙁

    • Robin Zamayar

      You and your son were very brave. Thank you for sharing and thank you for joining me in the noble profession of nursing. You bring to your patients and family a world of experience that cannot be taught in school.

  • Anna Carrillo Kelly

    From a mom, I love my children and when my son 14 was diagnosed with leukemia, with tumor on spinal cord causing paralyzing legs they Doctors said he needs this and that, but when my son began having headaches they pumped him full of pain medication now bring in unable to eat and still giving chemotherapy, now he’s unable to use the bathroom (both) so they dump 3000 ml. Golightly in him. Doctor’s said your son is lazy really? His body is riddled with clots because the “nurses” not checking, so me the Mom force him up and now he had a seizure and DVT. Now he is in a coma, Doctors he will be a vegetable unplug him! What? So I punched the doctor and said, NO! I told my son to fight inside and I’ll fight outside. We prayed with the the priest on the 20th of his coma, and the doctor said you should really arrange his funeral! I said if you come near me you can arrange your, you see this doctor had lost 6 kids in 26 days and I was not going to let my son be his 7th! On the 23rd I said son tell me or help me know what you want and he squeezed my hand and I know I did the right thing. Doctors and nurses you know there’s more to this story to much, But an hour later my son woke up and WAS NOT A Vegetable! He has just turned 23.

  • So grateful that this conversation is exploding out of the shadows on the strength of art, passion, and the courage of doctors-rappers-fathers-husbands-friends like ZDogg. This system of healthcare belongs to all of us and if we relinquish control to the institutions that are driven by economic incentives rather than the needs of people like you and me, and all of those we love, we will will get what we pay for….more done to us rather than for us! See what the future of palliative care looks like at http://www.ResolutionCare.com

  • Ginger Olsen

    As a nurse I saw too many vegetables that we fed and watered but I also saw the miracles that we returned to life. I personally arrested when I was 21and am grateful that I was resuscitated. I’ve had a full life since. When “dead” I felt a great void and then nothing. I awakened the next morning to my father sitting next to me and then I slept another 24 hours and returned to school as though nothing had happened. What did happen was an awareness and acceptance that every day was precious.I have now lived 78 years with that daily belief. I have directed that as long as there is belief that I can have my thinking intact without pain or fear, resuscitate me. If my world is to be medically directed, let’s me go gently or help me along the way out. I have been involved in codes, “slow codes” and assisted deaths. I have refused to participate in slow codes. Death requires thoughtful participation from caregivers, family and, the dying one himself.

  • This video is powerful with an important message. We need to have meaningful conversations and we need to plan for life changing events. The experience of my mother’s sudden death inspired me to help adults, at any age, plan for the inevitable at http://www.LastingMatters.com

  • Bunny

    Great video! I worked in ICU for a short stent….most of my background ER. This is SPOT on. My heart always went out to the family members sleeping in the most uncomfortable chairs in the ICU waiting room, while they grieved, stressed over there sick loved one connected to tubes in every orifice of their very tired body’s. Long term ventilators…no quality to life… Too selfish to say…”let her/him go” … just let them go. Its ago to let them go. I know its a mother, father, child… its hard…letting go..but…they desserve more! Thank you.

  • Kelly Anondoc

    The Internet hates me and my first comment didn’t go through. Anyway; thanks for this from a hospice doctor. I get referrals FAR too late for most patients to get the full benefits of our services. We can do so much more for families and patients if we got them earlier in their course. There have been several recent articles about how healthcare providers choose to die and how different it is from what we do to our patients (less aggressive and usually ineffective treatments -opting instead for more quality of life vs quantity). So thanks again for spreading the word. We’d be happy to take you on the hospice/PC team if you ever want to cross over. We have a huge shortage and you seem to “get it.” 🙂

    • Spring Texan

      Absolutely. I don’t really understand this “hospice for only a few days” thing unless a very sudden condition occurred. What a help it can be to get pain under control and to help with presence and support much much earlier.

  • eolnavigator

    Thanks for this very honest and relevant video. We will be discussing it on #hpm chat tonight (7/29/15). Please join us if you can! Everyone is welcome to participate. Just wanted to say that telling family (or a proxy, or anyone really) what your choices in death are…… is a GIFT. Many people don’t realize the gift until they are in the moment, when they are very clearly able to tell the healthcare team what the dying person wanted, because they were told! Takes a huge burden off, even in the difficulty of the situation.

    • Sorry I couldn’t contribute more, had kiddie duty with wife out of town! #DrMrMomDogg

      • eolnavigator

        Lots of demands on your time! #zpups are #1 priority top dawgs! We know you love #hpm too. We’ll snag you some other time.

  • Gloria Whitcomb

    Thanks Docs…. there are not enough people in the US who could see this i fear. As a respiratory therapist, we are often the last person in the room withdrawing devices. I’ve done this on neonates, peds, parents, teens, the rich, the poor and the homeless; Death does not discriminate. It’s a serious responsibility. As a family member, I’ve been the decision maker for my mom’s death and a brother’s. As a cancer survivor…. i had to educate my young sons & my brother that “Yes… i would die, because everyone does” and it would be on my terms as much as i could control. Fortunately, my cancer is gone with a mighty battle that did not approach death for me. I so applaud you for trying a new way to educate…. lets get it in every med school, nursing school & RT school in the USA.

    • RT on the front lines. Thanks for your perspective.

  • Daniel Mendelson

    Thanks Z! As a veteran Palliative Care doctor I am so appreciative of you bringing good natured attention to this issue. End of life care and decision making are much easier for a patient and family if there is an advanced directive and prior discussion. Help me be the best doctor I can for you and your family- do a directive today!

  • laura denman

    Wow, this was wonderful, inspiring and brought back so many memories of my mother’s death 8 years ago. She died of Alzheimer’s. We (her 7 children) were very lucky: she was an RN, and the director of a nursing home for many years, so we were we fully aware of her wishes NOT to be kept alive artificially. Before she was unable to communicate, we had had numerous conversations about how to “let her go” when the time came. And, luckily, her care providers at the wonderful VA in Napa, Ca., were completely on board with her plans and ours. In the end, she had 5 of her 7 children surrounding her and singing her favorite songs as she took her last breath. As a nurse-midwife, I have had the privilege of holding many babies as they take their first breath and greet the world; being able to hold my mother as she took her last breath, in such a peaceful way, was no less of an amazing privilege.

  • Nikki Williford-Khan

    America is the best place to live, the worst place to die. All I want is Ativan and morphine on my way out…. R.N. for 10 yrs. Love your video.

  • Jody

    Thank you. I actually gave a friend health care proxy because I was so afraid my brother wouldn’t let go and I know she knows my wishes and would follow them. I am very vocal and clear about my wishes so nobody would have any questions as to my wishes.

    • Spring Texan

      Me too, but unfortunately although it helps toward that end, in today’s system that does not guarantee your or my wishes will be honored.

  • Erika

    Some of my background…ever since I could remember I have wanted to be a doctor, I idolized them and the medical field. While doing a BS in science, I noticed that I had all the requirements of an ADN program, and knowing medical school stats, I decided to do a minor in nursing. It forever changed me! As an RN I started at a LTAC (long term acute care) and was there for about a year. I couldn’t do it anymore! I wish regular people saw what we (healthcare workers) see. I have seen “living” bodies rot and decompose! It is disturbing!…it is so disturbing that it’s best to go through the motions sometimes and not think about the moral aspect. As long as I’m receiving a pay check and doing my job “per policy” then everyone is happy! In an effort to see a different side of medicine, I transferred to an ICU, I am sad to say that it was a lot of the same. Patients with failing kidneys, hearts, livers, vent dependent, that are dead in a bed, yet the physicians order 1000 labs in the morning, CT, 2400 new medicines, “trach and peg”, central line, flexi-seal, foley, etc…when there is absolutely no way that their condition is going to improve….It will not change the outcome!!! We put the patient on display for the families, with nice sheets, a gown, and dressings to cover all the gaping holes, when the reality is that they have someone probing and poking 24/7…One day, I want to practice the kind of medicine that is measurable by patient’s quality outcome and not by the “success” of the procedure and if that means hospice, then so be it! Quality over being dehumanized any day!

    • Spring Texan

      My mother’s wonderful hospice nurse (she was on hospice for 6 months because my family believes in signing up for hospice as soon as possible) had been an ICU nurse before and the things she saw were what motivated her to go into hospice. I am so grateful and appreciative and she made such a difference.

    • Spring Texan

      Sharon Kaufman’s wonderful book, . . . And a Time to Die, has a lot of observations of ICUs and one chapter about LTACs. She emphasizes how hospitals shape dying.\n\n It’s fine to recommend having conversations, but much more needs to be changed, because the “choices” patients have are only those on the menu. Yes, the default is to provide aggressive care. If the default were changed to be more neutral, a lot of suffering could be avoided and the burden of “conversations”/”decision-making” not placed on families.\n\nAs well, although we have the choice to “let patients die” without feeding or respirator, but we have no choice to hasten death even if a fully conscious patient requests it, making dying very prolonged and difficult. Not all the conversations in the world will fix so many bad deaths until cultural/institutional changes happen.\n\nSimilarly, with reimbursement realities and so forth, we do not have the choice to let patients who want to do so remain in the hospital and die WITHOUT aggressive medical treatment. Instead, they must be shuttled off to a nursing home or something which is an additional stress and burden at a terrible time. It’s so much more than a matter of individual advance directives or patient advocacy.\n\nDon’t get me wrong, having the conversations still helps some, but it’s not all about the individual but about our societal “menu”.

  • Jenny Ward

    I was a critical care nurse for 10 years and have now been in ambulatory care for 18. My organization’s advance directives info packet has nothing about the importance of organ and/or tissue donation. This is another very important conversation to have!

    • Spring Texan

      You know, it may be important for society, but it is not important to the individual and is not either something that everyone wants to do. For me, the distasteful aspect of having my organs on “life support” and not letting everything die quicker and the possibility that brain-dead or not there is some perception means I would not be willing to donate any organ that could not be taken from a non-breathing, non-heart-beating cadaver. (Once that happens, no problem.)

  • Bart Windrum

    Hah! Can’t help but link you to my Never Say Die Rap. It’s from 7:39-10:00 mins in my TEDx talk at https://www.youtube.com/watch?v=_emItC-9ves . Enjoy!

    • Bwa hahahaha nice.

    • Spring Texan

      Really liked the grid of dying outcomes!!! Made sense.

  • Tony Trimble

    Thank you for being bold enough to address this issue. As an ER nurse, it rings so very true for our professional lives on a daily basis. However, there is a very personal side to my opinion also. My best friend and mother entrusted me with responsibility for their ‘end of life’ wishes. It was a painful decision to do the right thing for them in the final moment; however, it was their decision which I supported and enacted with love.\nThank you.

  • Wendell Cooke

    Oh wow, this was incredible. Amazingly well done. I have just finished a 3-min documentary on voluntary euthanasia over here in New Zealand. Not that this needs an antidote, just another take is all 🙂 https://vimeo.com/132291523

    • Spring Texan

      Thanks. Agree this is an option that needs to be “on the menu”. It is not good enough to only give me the “option” of “dying naturally” when say a feeding tube is detached, it takes too long.

  • Mary Spaulding

    I have worked EMS and ER for the last 14 years. One of the biggest tragedies I have seen repeatedly is family not honoring a patient’s end of life choices. When grandma comes into the ER from the nursing home, suddenly nobody can live without her and we must do everything to save her, completely revoking her advanced directive. Only to end up sending her back to the nursing home after a two week hospital stay and treatment for hospital acquired pneumonia. Many family members have mocked me because at the age of 35, I have completely planned my entire end of life care including the funeral. None of my family are medical and don’t understand what the long term effects are of “saving” someone, all they would see is a loved one. I know they would not be able to make the tough choices. My advice is to sign paperwork stating your wishes and make sure each of your adult children have a copy and whoever else will honor your wishes. Thank you for this tough video! I hope it opens some conversation doors!

  • robin oaks

    I am an oncology/ med serg nurse. I see this all the time. the family sees it from their point of view and we see it as “cant they see they are dying?” as an oncology nurse we see some patients for months while they are getting their chemo, its hard to not get attached to them. I have watched my patients go from a healthy young person to a small fighting person. the family’s have watched too but some don’t want to give up. I have seen them as young as 18 to 96. we have to counsel the family about the signs of the dying process but they still don’t want to give up. sometimes we don’t have the doctors on our side to see that all we are drawing out the pain and suffering for that patient. I know it is out of love and the fear of life without their loved one, but I know in my heart they are still with me as they are their family.

  • Brittany Hayes

    The father of my children. My high school love was in a horrible accident in 2010. A 75 lb shield off the blocks of a drilling rig came loose and fell 40 ft on him while he was bent over making a connection. His internal damage was extensive. Both lungs collapsed, ruptured kidney and spleen, punctured liver, shattered L4 and L5 and spinal cord damage. When I received the news they told me they were estimating about him having about 2 hours left because all the bleeding inside. I was 2 hours away from the facility that he flown to. 2 weeks intubated, in a medical induced coma. The unfortunate part of this is we were never legally married. His family whom haven’t seen him in years showed up to call ALL the shots. Thanks for the care by Dr’s and nurses he was later moved to a rehab facility and recovered almost 100%!!!!! This past November he suffered another accident. This time a motorcycle, no helmet and a cement culvert in a ditch. We were separated but non the less still raising a family together! This time he was 5 hours away. Coded twice, brain dead and his family STILL calling the shots because he had no “adult” children. My children lost their father November 8, 2014. I feel he suffered for 14 hours because of selfish acts made by the family that only had something to do with him when tragedy strikes. My children’s father was taken from them a second time when his family took him 6 hours away to lay him to rest. I have a 1o year old and 6 year old and I have made it clear to my family that my children are to make EVERY decision if something happens to me. They’ve been through enough and my family has seen us all suffer with the outcome of this event. WRITE IT DOWN! PUT IT IN LEGAL FORM! Because guess what? These things don’t happen to people you hear about. They DO happen to people you love dearly at the least expected time!

    • Brittany, I’m so sorry for your loss and your childrens’ loss. Thank you for telling this story!

  • Lorrie Wilson

    Critical Care and Emergency Care Nurse for over 20 years…mostly in ICU…just had this conversation about how we talk to patients and families this week about End of Life with our hospital chaplain….I get to respond to all the emergencies in the hospital…many times without a doctor. The conversation SHOULD not be happening during the emergency, but that’s when I meet most of the patients outside of the ICU…I NEVER ask a family if they “want everything done”…because most do not know what that means. I tell them the truth and ask what would the patient want at his or her end of life…I am very specific about what we could do to this person or give the option of “allowing him or her a natural death, making them as comfortable as possible”……Just because we can, does not mean that we should!!! Thanks for making this video..I have shared it on FB with all my friends and family and encourage all to have that difficult conversation way before a crisis….you never know when your last day is….AND we are not getting out of this life alive!!!

  • Joan Light

    “Death is part of living”…… LIVE your life they way you wish…DIE the way you wish. I have been a nurse for 35yrs and am a strong advocate for end of life wishes. It makes those tough decisions in difficult times somewhat easier. Families should find peace in honoring their loved ones final wishes. Death assigns no date to you when you are born…. your wishes should be known to a loved one as soon as you know what you DO and DO NOT want. Talking is all it takes.

  • Phil Cheatle

    My end of life wish is for a medically assisted suicide, following professional counselling, while I am still mentally competent, at a time of my choosing. Unfortunately this is illegal in many countries. In UK the medical bodies are not in favour of a change in the law. Why should I be forced to go to Switzerland to have the death I want? 82% of the UK population support some form of assisted dying why wont medics and politicians listen to the people?

    • Spring Texan

      Amen!

      • Phil Cheatle

        In the UK papers today – a story of a 75yr old retired paliative car nurse who chose to end her life in Switzerland because she’d seen enough of the plight of the very elderly to know she didn’t want to experience it.\n\nhttp://www.telegraph.co.uk/news/health/11778859/Healthy-retired-nurse-ends-her-life-because-old-age-is-awful.html\n\nThe Society for Old Age Rational Suicide supports her choice and campaigns for a change in the law in the UK so that people who make the same rational choice as her when they feel that their life is complete do not have to go to Switzerland. .http://www.soars.org.uk/

  • Doreen

    The truth is advanced directive or not. You still can be held onto by the people that love you. \nI’m a nurse and seen it happen more often than not. \nI made the decision to have the talk with my children. \nThey know my wishes. I pray they have the courage to carry them out. \nLOVE YOUR LOVED ONES ENOUGH TO LET THEM GO.

  • cindy patten

    Thanks for starting this conversation! I still have mixed feelings about how I handled my parents end of life decisions. Both parents had always talked of how they never wanted to be on “life support”, an ill defined concept in TN. I sat with my Father for hours and every 3-5 minutes of that time I was reminding him to breathe because the levels were dropping and buzzers reminding. I suppose they could not “do” anything else for him based on what my mother had told them about his choices. I had been told at that point that his prognosis was grim but not hopeless. I just couldn’t see him struggle anymore and it seemed cruel. I asked them to put him on a vent and they did. \n He was never able to come off the vent and eventually died. Some still believe my decision to put him on the vent hastened his death. I saw the pictures of his heart with what looked like a forest of bacteria growing over it. I knew he was dying regardless but the confusion over what life support means both legally and to laypersons remains sketchy. A clear and direct conversation saves agony all around. So how do you start this conversation with your loved ones? Thanks to this video I know how with mine!

    • Thanks for telling this story Cindy!

  • May Susana

    Zzdog, i think you are a genius, seriously. Ever since I first saw your video on KevinMd i have been hooked. I even looked up zmom and zdad. So great!! You are lucky to have these parents, but the video you just release about dying makes you a hero right up there with Atul Gawande speaking out on this topic. As a doctor who tries, sometimes falling on a deaf ear, to explain that some medical procedures are just not worth it, i really appreciate your contribution.\nSusana May, MD\nKey Largo, FL 33037\nSusanamay@bellsouth.net

    • I’ll let ZDadd and ZMomm know they’ve got a fan! Thanks for the love.

  • Alexandra Rosson

    This should be the new hospice and palliative care anthem! I love all of your videos as I get a good laugh out of all of them but as a hospice and palliative care nurse this hits close to home with my job!\nThanks for the great video!

  • Angela Baumeister

    Thanks. Can’t say more cuz I’m crying. You are always on point, keep it up.

  • Linda Kolmar

    Way back in 1973 (when I was a mere child of 18), I had to rush my father to the hospital with severe abdominal pain. Turned out he had a AAA; it ruptured in the ER. They rushed him to Surgery. After about 3 hours, the Vascular Surgeon came out. Since I was the next of kin (my mom had died one year earlier), he talked to me. He told me that Dad’s heart had stopped twice on the table, but that they had brought him back. Remember, we are talking 42 years ago; advanced directives weren’t around then. I’ll never forget that the surgeon said “Listen, we can keep bringing him back, but I want to tell you what it will be like if he survives.” The surgeon then went on to describe in great detail the damage that had been done when the aorta ruptured (part of the colon & 1 kidney destroyed, lack of blood flow to both legs that may require bilateral amputations, etc). He then said “What do you want me to do if his heart stops again?” To me there was no question. My dad, a retired Army sergeant, had been physically active all his life. He continued to work full time after his retirement and was still working full time at the time (even though he was 65); I picked him up from his work that day. The idea of being dependent on others and possibly in a wheelchair would have made him totally miserable. Besides, he had not really been happy since my mother had died. After looking at my godfather (who was also Dad’s best friend) for confirmation, I was able to say “Let him go.” He died about an hour later.\nI have been a physician assistant for the past 23 years. I now realize how progressive and “ahead of his time” that vascular surgeon was. For a surgeon to offer such a choice in 1973 was unheard of. I have always wished I could thank him. Even though I still miss my dad, I have never regretted my decision; I know in my heart it is what he would have wanted.\n Both my husband & I have living wills; we have also discussed our wishes with our children. I have worked with a lot of residents in my career as a PA. I have found that they simply have not been trained to honestly discuss these issues with patients. Many inn my hospital just, during the admission process, just ask “what do you want us to do of your heart stops?” They do not tell them what a code is really like (It ain’t like TV folks) and what the chances of survivability with all processes intact are. I did tell an inpatient who was being treated for lung cancer that once; he still wanted to be a full code. The next AM, my beeper went crazy as I was walking in. “Come see Mr. Smith right away.” I went in. Turns out his roommate had coded (with an unsuccessful result) the night before; Mr. Smith had a front row seat to the whole thing. He said “you weren’t kidding were you? I don’t want to go through that!”

  • Matthew Holt

    Great vid ZdoggMD Anyone looking at this who wants a conversation guide ot that conversation should check out EngageWithGrace.org

  • Sheryl M

    Eminem and Rhianna both deserve to die slow and excrutiating deaths.

    • MidRoad

      I’m curious. Why ever for? You wish for 2 human beings to die “slow and excruciating deaths”, so you’ve obviously given this much thought. Why them?

  • Marti Haykin, MD

    Thank you SO MUCH ZDogg! I am a neurologist, and I have to have end of life discussions with families every day. I consider it my responsibility to discuss code status with my patients and their families. Some families become very hostile and angry when I bring this up — but they NEED to know that I am only trying to save their loved ones from pointless suffering.\nMy mother-in-law died of ALS. She was the kindest person I have ever known. She gave us all the tremendous gift of telling us that she wanted no tubes at all: no feeding tubes and no intubation. She lost the ability to talk and to swallow in her last days, but with her last fragment of strength, she signed her own DNR form. I am forever grateful to her.\nCPR/Intubation/”life support”: these are supposed to be a bridge for people who are expected to get better. They are all too frequently used as a bridge to nowhere. I encourage EVERYONE, young or old, to discuss this difficult topic with their families.

    • I like that phrase, “bridge to nowhere” in this context. Thanks for weighing in!

  • Lizzy Miles

    LOVE this. I work in hospice and we frequently have the issue of late referrals to hospice. When patients and families come to me, my initial visit is often listening to an extensive retelling of every bad hospital experience they had leading up to the referral. Thematically, patients did not feel in control of their own medical care and/or they felt uninformed. This video is so important because it is a fun way to talk about a serious topic. Perhaps people who see this will share it and use it to spark conversations about what they want. Great job ZdoggMD!

  • medave

    Nice job, Dogg. Don’t usually go for rappist stuff myself (musically, I’m a dinosaur) but your message is spot-on.\nAs for my tale – both good & bad. In 2004, I had myself put on my mom’s legal paperwork (at her request, along with the rest of the family) as alternate on the advanced healthcare directive, and primary for DPOA for Asset management. Exactly one month later my mom had an apparent heart attack; got her to the hospital and found out that what she DID have wasn’t an MI – she had a dissecting aorta w/associated aneurysm. Emergency surgery didn’t go well (the RN hitting on the EMT’s instead of tending to my mother was just the beginning…) and she ended up with an anoxic brain injury due to being on bypass for just a bit too long. Month of rehab, 3 1/2 years of battling with care givers (mid-level dementia & an anoxic brain injury makes for interesting times), a screwup on the part of the drug manufacturer resulting in an OD on digoxin led to…a near-fatal ischemic stroke in March of ’08. More rehab, battling to keep her in a nursing home (they don’t like the MediCal pay rates) and…a second ischemic CVA in November ’08. Which is where my sister and I had to make the call…and we opted to let her go. The decision was actually pretty easy to make – living with ourselves afterwards, that’s a different matter.\nBad as the above may sound – I try very, very hard not to think about how much worse it might have been had we not had the proper legal paperwork in place. And, a cautionary note for healthcare folks – it’s not always obvious to lay people that when they are asked “who’s the POA” they’re being asked for the primary person on the health care directive. Better to be a bit more explicit – I ended up on the hot seat way more than I should have because the distinction was never made clear to me.\nGood news – I start nursing school in just over 2 weeks; reinforcements are on the way!\n\n—– Dave

  • Coleen Skinner Rev.

    This is such a powerful video… I have been working on getting the conversation going in our community and this is a powerful statement. You have brought youth into the discussion which is something that has been lacking in the conversation.. I am running a death cafe and I am a non denominational rev. working with grief and loss. I am trying to get the youth of our community to understand the importance of this topic.. Thank you so much for making this video to help reach those who may not be listening.. Bravo

  • Please don’t ask me to do everything. I spent so many nights in the hospital, “saving” lives that weren’t meant to be saved. I could feel the anguish of keeping someone in a body that no longer functioned. I also had many, many conversations with patients and families about not pursuing futile care. Even as a junior resident, I was the one family members felt they could talk to if they didn’t want to keep going. In practice, doing nothing was always a possibility with me, with a frank discussion of what that could mean. I think people are much more willing to talk about this than most medical personnel appreciate, but they get easily dragged along on the futile care train.\n\n\n\nWatching this hurt me, because I no longer practice. I wonder who is having those discussions with patients now. Thank you for presenting this to the public in such a frank and meaningful way.

  • Janie Harvey Garner

    I am a critical care nurse. My background is in ICU, ER, and cardiology. As a young nurse, I saw so much futility and pain at end of life that I started making the ‘DNR tattoo across my chest’ joke. Four and a half years ago, my 17 year old son was killed by the distracted driver of a 9-ton tow truck. The ER Nurse that called me naturally wouldn’t tell me that he was dead. However, having made ‘that’ phone call many times, I knew he was, or that it was hopeless. I repeated over and over as I drove to the hospital, “Please let him be completely alive or completely dead.” I saw the pain on so many faces as they made the decision to terminally wean; I thought the pain of withdrawing care from my son would kill me. He was actually already gone by the time I reached the hospital.

    • Janie…the loss of a child is always inconceivable to me. Thanks for telling your son’s story.

  • Janie Harvey Garner

    My end-of-life story #2: My Father-in-law was a decorated Vietnam Vet with a host of medical problems. He recovered from adenocarcinoma after a LL lobectomy in 2009. He made me his medical POA, because he was afraid that his kids would keep him alive, and that I would make a more informed decision. (damn him) When his cancer came back in mid 2011 he ignored all of the signs, and refused to see a doctor, because he knew. He finally went to be evaluated in February 2012. He had lung CA with mets, and a malignant pleural effusion. He opted for pleurodesis and had the 1 in a million allergic reaction to the talc and arrested on the telemetry floor. At that point, we had not signed a DNR. They got him back, and he opted for a pleurex drain. Pathology came back with a diagnosis of lymphangitic carcinomatosis. We immediately signed a DNR and took him home directly from the ICU by ambulance. I was his primary caregiver, and never even emptied the drain. Oxygen, morphine, ativan intensol, and love were the only things he needed. He died in three days, at home.

    • Thanks for sharing this story, Janie.

  • Merilynne Rush

    I’m a nurse in training for an palliative care specialty. This is really important. This wonderful video and the whole project will help spread awareness of the need to plan ahead. Do it! Start the conversation. It’s a part of life.

  • Wendy

    I got this sent to me today by an ICU nurse and am blown away. I am a clinical social worker who works in the ICUs of a huge university hospital. My role is to work with families whose loved one is likely to die during the hospitalization. In the 9 years I have been in this role, I have seen enormous suffering and families who are desperately hoping for miracles that medicine cannot achieve. While advance directives are good and everyone should do one, they can be ripped apart. MUCH more important is the conversation…TALK TALK TALK to your family about what you would or would not want, take that burden off them when faced with end-of-life decisions where you cannot participate. Thanks so much to Eminem and Rihanna for doing this, can’t say I’ve been much of a follower or fan of either of them, but this is totally awesome!

  • From my parent’s neighbor:\n\nDear Zubin,\n\nIn 1990, at the age of 70, my father, a resident of Sun City West, AZ, died of a metastasized melanoma in his liver, a “secondary” cancer that had originated as a choroidal nevus melanoma, very rare.\n\nThree years before my father’s death, when they’d found the cancerous nevus in my father’s right eye, they enucleated it. At the time, I asked the surgeon, “Is there any chance that any rogue cancer cells, even just a few, might have escaped into his bloodstream during surgery?” and his answer was, “Definitely not—no chance!” Uh huh, suuuure, Einstein. \n\nTwo-and-a-half years later, while conducting his community choir in concert—during his career, he’d been a singer (tenor) on ABC radio and TV, a member of the Robert Shaw Chorale, a choral conductor, and college music professor—he almost collapsed from a sudden, searing pain in his liver area. Always the professional trooper, he’d stood back up on the podium—his favorite spot in life!—and finished the performance. The show must go on! \n\nThe next day, the biopsy of his swollen liver confirmed that the melanoma cells they extracted were, in fact, ocular in origin. So clearly, during and just after the eye operation 30 months earlier, rogue cells did escape into his bloodstream and his liver had done its “filtering” job quite well—too well. \n\nHis doctor and the oncologist told him there was a tiny chance—“five percent”, in their words—that their then-state-of-the-art chemotherapy might help him, or at least “prolong his life…a little”. I remember that moment, as he lay there, shrugging his shoulders and saying, “I guess I don’t have a choice.” \n\nUncharacteristically for me at that moment, I kept my mouth shut, although I wanted to scream at him, “OF COURSE you have a choice! Tell these assholes to fuck off, give you a great big bottle of morphine, and let you go home to die in peace and comfort! You and I will play your favorite music and talk about the old days in New York City radio and the dawn of television. You’ll love it. And, we’ll get to know each other better!”\n\nInstead, I bit my tongue, because I was sure over the next few months as he “slid” downhill, he would have constantly gone on and on about regretting his decision to forego the toxic chemicals, a decision that I had recommended—“Oh damn, maybe I should have tried it…”, etc. To this day, I resent those docs holding out that silly little chemo straw for him to grasp in desperation. Why didn’t those doctors level with him? WHO recovers from a secondary liver cancer of that magnitude? Did they fear a postmortem lawsuit from my brother and me? Probably. “Cover your ass and only then treat the patient.”\n\nOther MDs friends, believers in complementary medicine who later reviewed his case, told me that, despite the advanced state of his liver tumor(s), with aggressive nutritional support plus serious pain control, he could have continued in relative comfort for perhaps another three or four months, if not longer, which I know he would have wanted. Instead, he was gone in six weeks in a blizzard of chemo-induced blinding pain and intense misery.\n\nSo, as I maintained my silence, the ghouls started their nightmarish, month-long, chemo course on the poor man. Since chemo is—duh—a poison and since the liver is our main defense against poisoning and since his liver was 90% compromised…gee whiz, what do you think the outcome of this brilliant medical decision might be? What a huge surprise: of course, he immediately got sicker and sicker as his liver and already compromised immune system failed even further in the face of the toxic onslaught. Ah, but ever the optimists—and, probably, ever in fear of lawsuits—the oncologists pressed on with their full-court-press of “approved” chemo modalities. Hey, one size fits all, right?\n\nAs they continued to dose him, the pain grew to what the the chief oncologist called “unimaginable levels”. I respected her, not for her medical abilities, but for her extreme empathy for his plight. She really did feel for him by the time morphine was utterly failing to even slightly reduce the pain. \n\nFinally, she stopped the chemo and, in a quiet moment in the hallway outside my father’s room, looked at me square in the eye, and very slowly and carefully said in words I’ll never forget, “As you know, your father has been unconscious for some time, but what you don’t know is that he is in unimaginable pain, far worse than any torturer could ever inflict on a victim. This should not continue. Legally and ethically accepted procedures for cancer patients allow me to administer N ccs [I forget the dose] of morphine intravenously. We have not administered that much until now because, given the condition of his liver, an ‘allowable’ morphine dose would kill him. He is absolutely terminal with only a couple of miserable days left to live, and probably more like just a few hours. The ‘allowed’ dosage will probably make his last few moments comfortable, but it will kill him. [pause] May I administer N ccs of morphine to your father right now?”\n\nI looked at her square in the eye and managed to croak out the two words, “DO it!” I then wordlessly turned and walked away. She immediately gave my father the morphine at full dose and he was “gone” in an hour. \n\nWho says we don’t have appropriate euthanasia in America, as in this case? I never did get a chance to thank her for her courage, putting empathy for her patient above any legal or phoney-baloney “ethical” fears. She really did go out on a limb for my father—an action that, today, has been made even more dangerous legally thanks to the twisted, backward, “right to life” madness pushed mainly by the Christian Right that pollutes any rational, end-of-life discourse.\n\nThen again, I wish the oncologist had intervened much earlier with a strong recommendation to my father to stop the “treatment”, go home with his morphine, and take himself out of the game, encouraging him to take charge of his own destiny, instead of leaving it in the hands of “the gods in white coats”. I think he probably would have listened to her. \n\nWhen my time comes, I hope I have the courage to tell them, “Get the hell away from me with your surgery, your radiation, and your chemo. Gimme dat damned groove juice and lemme go home to die!” \n\nLet’s see: in Medieval times, to treat cancer, they cut (today’s surgery), burned with hot irons (today’s radiation), and poisoned with small doses of toxic chemicals (today’s chemotherapy). Gee, we’ve come a long way in cancer treatment, haven’t we?!\n\nThanks for listening. Please let me know your reaction to my story. \n\nAlso, thank you for all of your hard work, not only at your innovative clinic, but also with your amazing videos! Break a leg!!

    • Anna Cross

      Doctor Damania, your neighbor is advocating for “physician-assisted suicide.” \n\n\n\nThe excerpted text, copied at the bottom of my comment, illustrates the reason why people like myself are 100% against legal assisted suicide and euthanasia: the decision was NOT this patient’s but his daughter’s. Our argument is not religious.\n\nPAS (physician-assisted suicide) advocates argue that an individual patient’s autonomy and “choice” is justification for legalizing PAS. Whose choice?\n\nI’m from California. I’ve read SB 128 to legalize PAS. And I lived in \nOregon when their PAS law was passed (I voted against it). It’s very, \nvery dangerous. \n\nThe Dutch ethicist Theo Boer has said about legal euthanasia in The Netherlands, “We were wrong, terribly wrong.” I’ve reviewed the 2014 Oregon DWD Report. Intractable pain is not the reason given by Oregonians who use the PAS law there; instead the top three reasons were “loss of dignity,” “loss of autonomy,” and “can’t do things I want to do.” http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf\n\n\nExcerpt from the Comment, “From my parent’s neighbor:”\n\n\n’ We have not administered that much until now because, given the \ncondition of his liver, an ‘allowable’ morphine dose would kill him. He \nis absolutely terminal with only a couple of miserable days left to \nlive, and probably more like just a few hours. The ‘allowed’ dosage will\n probably make his last few moments comfortable, but it will kill him. \n[pause] May I administer N ccs of morphine to your father right now?” I\n looked at her square in the eye and managed to croak out the two words,\n “DO it!” I then wordlessly turned and walked away. She immediately gave\n my father the morphine at full dose and he was “gone” in an hour. \n\n’Who says we don’t have appropriate EUTHANASIA in America, as in this \ncase? I never did get a chance to thank her for her courage, putting \nempathy for her patient above any legal or phoney-baloney “ethical” \nfears. She really did go out on a limb for my father—an action that, \ntoday, has been made even more dangerous legally thanks to the twisted, \nbackward, “right to life” madness pushed mainly by the Christian Right \nthat pollutes any rational, end-of-life discourse.’

    • Teresa Brown

      Your story reminds me of a couple of patients I saw when I was working in outpatient oncology and in hospice.\n\n\nThere were times that I felt like what we were doing was immoral. Unfortunately, some patients (and family members) hear the doctor saying “We can treat your cancer with ‘x’,” and interpret it to mean the doctor is saying s/he can cure the cancer. You can treat someone right into the ground, but that’s not curing him/her.\n\n\nMy grandmother had metastatic bladder cancer. Even when she was lying comatose in a hospital bed, her surgeon and oncologist were saying they could do this/that.\n\n\n

  • Robin Wronski

    Incredible job! I’ve been a critical care nurse for 21+ years. This topic is one of the most discussed when asked “what is something that frustrates you about your work?”. I will be sharing this video with the hope that anyone that views it takes your message seriously and discusses the topic with their loved ones. Thank you for covering an often overlooked aspect of care.

  • Kim Osmond-Tomosky

    All I know is my mom doesn want to be put in the ground…and she said a tree house would be nice…bt a really nice tree house. My step dad does NOT want to burned to ashes…He was a AMAZING FDNY captain and since he had some of the world trade center hit him and so many..MANY…fallen brothers. I will respect this forever. My dad…I don’t know.? I want to be cremated and just show nice pics and family pics with me. And lots of awesome music and a party! Preferable Pink Floyd and Foo Fighters. I hope there will be a bon fire. That scent is amazing…

    • Kim Osmond-Tomosky

      I also worked in the hospital for over 20 years. I’ve seen parents say their last good-bye. Heard grown men wail in pain of knowing a loved one die. Police officers trying to keep it together as their brother has fallen and we try to work and do everything we can do……….his shooter is in the room next . Police got a shot off before lying on the stretcher in front of me. I helped him too.Thats what we do.

  • Denise

    I found this site through the Tucson, AZ All Souls Procession website link. I’m so glad I did. My beautiful daughter died in May, 2014 from colorectal cancer. She was 39. She was a beautiful soul who blogged throughout her treatments at alinamo@wordpress.com. She made her journey through cancer hell easy on her hubby & family with her candor. Her hospice nurse told us we gave her “a good death”. She died at home in her bed with only those around her she wanted to be there. The day before she died we had even discussed her funeral wishes. I get some measure of comfort in knowing we honored her wishes, but all these months later her death is very difficult for me. I think it always will be. Thanks Dr. Damania.

    • Denise, welcome, and I’m so sorry for your loss. Thank you for sharing your daughter’s story with us.

  • Rose

    Working in a Level 1 trauma ICU for 12 years and now in a cardiac intensive care unit, death has been and is a constant companion in my work life. Death is in fact a constant companion in all our lives because it is the culmination of every life. Failure to include this final ending to our lives in each of our health care decisions is living in a fantasy world. We are born, we live, we die…….that is the story. We have to own our death as much as we own how we live our life. Choose your ending and let the people in your life know what you have chosen. Die like you lived……..on your own terms.

  • Louise

    Thank you so much for making this video. As a unit nurse, I take care of people near death or dying on a weekly basis, but lately I have been struggling a great deal with this issue. A certain situation has left me emotionally and mentally drained at work. I have found myself feeling like I am prolonging suffering rather than healing. The greatest gift of selflessness a family can give is mercy. We enjoy your goofiness and in a high stress environment, our odd sense of humor is what gets us through. Plus, I love making our hospitalist smile with your videos????

    • Thanks Louise for what you do!

      • Louise

        I’m showing this to my colleagues at work tomorrow, and the nurse educator. We have classes on ballon pumps, infection control, etc., but what about this topic. We should be educated on this topic as well. How can we expect our families to talk about it when we barely address the important issue, as a profession. I’m hopeful we can make a difference!

  • Tony

    In 2007, my Dad was at the end of his fight with ALS. We didn’t know what he wanted until a few hours before he passed. He couldn’t speak, so he wrote,”Burn me” on a piece of paper. Man, that was tough. He had three years to plan for this, but he ignored it and went on with his life as best he could. I’m not mad at him. He did what he thought was best for him. We tried to have the conversation for three years, but he wasn’t interested. I wish he would have made it easier for Mom though. I don’t intend to go out that way. I want to have the conversation. I just need to find an MD willing to take the time. I’m sure it’s not something you can do in 5 minutes while you’re in getting a Z pack for your cold.

  • Tony

    That was not what I posted.

  • Teresa Brown

    Several years ago, I finally stopped farting around and got my advance directives and POLST completed. Six months later, I was lying on a gurney in a cold Emergecy Department, trying to wrap my mind around the words the ED physician had just said: ovarian cancer. How ironic: the nurse who worked in oncology becomes a cancer statistic.\n\nMy best friend in nursing school used to have this saying,”It’s always darkest before it goes completely black.” That’s pretty much how you could describe the past four years. If something could go wrong, it did. I used to think that I understood the expression, “There are worse things in life than dying,” but I didn’t truly get it until it was me in that hospital bed.\n\nI hope that when my time comes, I’ll have doctors and nurses who respect my wishes. I’ve found out the hard way that some docs (and nurses) have no respect for those carefully planned directives.

    • Teresa, thanks for sharing your story, I’m so sorry it’s been so hard! I think there are a lot of docs who are very uncomfortable not doing everything (and there are complex reasons for this, none of them excusable), and that needs to change via education (especially starting in medical school) and possibly through severe public humiliation which I’m happy to provide 😉 Best of luck.

      • Teresa Brown

        If you ever want to come to the Philly area and provide some of that public humiliation, I’m sure we’d be glad to have you. Yo!

  • Joanne McLain

    My mother lived with myelofibrosis for several decades–gradually worsening bone pain. We started the end of life discussion when I was fifteen and continued it throughout the years. It was heartrending, but it brought us together in a way nothing else ever would have. Each time she went to the hospital (mastectomy, hysterectomy, splenectomy…) she would ask me if I thought she was ready yet for Dr. Kevorkian. She held on through the various opiates and blood transfusions until my son and then my daughter was born. Then she decided to stop taking her blood transfusions. It took a few months, but the end was clear. Hospice nurses are amazing people–I will never forget the comfort they provided. Because we had been able to discuss her wishes, her end was truly beautiful. I was able to sing to her the old songs that she had sung to me when I was a child, knowing I was helping her walk down a path that was her choice. She was at peace. For her memorial service, we played the song she had chosen when I was fifteen: Joy to the World (by Three Dog Night). Joy to you and me…

    • Thanks for sharing this story Joanne!

  • Anthony Braun

    Being an ER nurse I’ve seen all these frustrating scenarios you describe in the video. It eats us up all the wasted resources and pain and discomfort we are causing get these patients because they haven’t had this discussion. And too many times they have advanced directives but the family POA comes in an pulls it saying they now want everything done to save “grandma “. Totally unfair to the patient.\n\non a different note about dying, I have also had the opportunity to be able to see my grandfathers as they were in the process if dying. Both had prolonged death experiences: one Alzheimer’s and one kidney failure. The family knew what was coming and we were coming to terms with it. In my last conversation with each of them, I gave them permission to die, telling them that it was OK and we were ok. We would watch out for each grandma and we would remember them always. Both of them had one more visit from their spouse and died less than 24 hours after I had that conversation with them. You never know what is going on in a dying person’s mind but I firmly believe they can hear more than they let on and sometime they need to be told it’s ok.\n\nZDogg keep up the good work.\n\nAnthony\n

  • Fonda D. Holland

    This is truly a touchy subject for most, one that most will avoid until it’s to late. I love your approach to this topic. I went through it with my grandmother while she was in the hospital and I was glad I was there to let her know it was ok to leave, that she didn’t have to worry about us any longer, that she was free to go be with my grandfather on the other side. She passed away like 4 hours later peacefully in her sleep. We had discussed the do not resuscitate option many times since my grandfather’s passing, so it was easier (so to speak) to tell the doctors her wishes. It’s not something you should put off. Have the talk!

  • Tempskya

    I have been a nurse for 22 years, and my family and I had to let my dad go Home last week. If nursing has taught me anything at all, it is that we often learn from and are blessed by the things and people we let go of even more than from the battles we fight. I was very fortunate to be guided in my dad’s final hours by 2 wonderful intensivists that I have known for 10 and 22 years.\nAs a OR liaison nurse I heard [in my opinion] thousands of selfish excuses of family members. It all boiled down to one statement, “What am I going to do without my ____?” This is not the way anyone should be thinking regarding someone they claim to love. If you love someone, you do not prolong their misery. In the end it is as simple as that. Perhaps your loved one’s last miracle is that they died in peace, without suffering and without a lot of pain. \n –My 2 cents from someone who knows the pain of loss, and who also knows the other side of the knife. [I have 15 t-shirts to prove it.] \nThank you, ZDogg, for bringing this video out and starting a lot of conversations that need to happen before it is too late. I hope and pray that the families of those who want and need to go Home have the courage to do what is right for their loved one.

    • Thanks for sharing your story!

      • Tempskya

        Thank you again. My dad had only a short time on pressors and was there for less than 48 hours. I will be sharing your videos far and wide because there is a lot to be taught and often the serious note doesn’t work. In addition to other problems, my dad had metastatic skin cancer, so I am thankful for your take on that topic as well.

  • M1aintnothang!

    One year ago I woke up in the ICU after an opioid overdose. Although unintentional, as I was taking my medicine as prescribed, I did suffer respritory distress and eventually anoxia. Luckily, my girlfriend called the paramedics and I was rushed to the hospital in time to save my life. Yet, I did die on the table in the ED and would spend the next two weeks intubated and in a medically induced coma. Over this time I endured multiple-system failure, multiple rounds of dialysis, and more central-line medications than I can possibly imagine. Extraordinary measures barely describes my previous situation. \n\nIt is from the grace of God, my extraordinary care team, and, most likely, my amazing family that I am here to experience life! Coming from a medical family, I was lucky to be immersed early in the need for an Advanced Directive, even at the age of 29. It scares me that many, if not most patients, have no such directive or even discussion with their loved ones! I never expected to be in this situation and nobody ever does. Currently as a medical student, I am amazed by how many patients and their families lack such necessary instructions. I urge everyone to please spend the time to inform your loved ones of your wishes. It will ensure your proper treatment and piece of mind for your family during an incredibly difficult time!

    • Epic story, thanks for sharing!

  • Sherry Harvel

    Thank you for such a powerful video. I died of a widow maker heart attack 6-17-2011 i am well into quality of life issues, have been … for a while i regretted telling that surgeon to resuscitate me i actually at one point in CCU refused any more treatment. I am here actually it changed my spirit for the better. my medical team repeatedly has the talk with me. They know how far i am willing to go and prolong but hey my heart is stable now nothing a little lung transplant won’t help. yes it is important we have a surrogate at the very least. You did a good job!!

  • Joanna E.Hill

    Love your message we all need advanced directives…a hospice nurse.

  • Mandy Burr

    My daughter was born with hypoplastic left heart syndrome but was not diagnosed until 18 days. When I took her to the ER I thought she had a cold. They immediately took her away from me and never gave her back. What followed was more than 6 weeks of pure torture. She crashed several times and the worst was on Christmas eve. They put her on ECMO and then the next day she clotted both cannulas on the ECMO machine. She somehow survived. I immediately signed a DNR for her. The next day I ammended it to if she crashed when I was not there they could do CPR until I arrived. (I was about 4 minutes away) When she crashed again I was not in the room. Luckily I was just down the hall. I set a timer on my phone for 4 minutes because time was standing still. I told myself that if they didn’t have her back by then I would tell them to stop. I made it 2 minutes and 46 seconds. I just couldn’t allow them to hurt her anymore. I entered the room and demanded they stop and hand me my baby. I was able to hold her when she took her last breath. Life is about quality not quantity. I had 18 days with her at home while she did normal baby things. That is 18 days more than most heart babies have and for that I am thankful.

    • Thanks for sharing your story Mandy…

  • Heather Boog Jarvis

    Hi….RN here, 10years ER / trauma experience. It’s was my life ! On my Mother’s deathbed she asked me to change my field and spend more time with my children. In this rebirth of my life I found Hospice Nursing….. it is my passion because I know how YOU DONT WANT TO DIE ! Thank you for expressing your thoughts in a way that will reach the younger generation :)\nHeather Jarvis RN, BSN

  • Carol Javens

    I am a hospice nurse manager. So often, we see patients who receive messages from health professionals that offer false hope and encourage choices that increase suffering. It takes time to have the conversation about prognosis, and we in healthcare need to do a better job as a whole in assisting families and patients understand what is happening so they can make informed choices. There is often little we can do having a patient on hospice for 18 hours, but we do what we can so the last hours are as comfortable as possible. Thank you for putting this video together, and keep up the great work!

  • Stephanie Rankin

    I am so grateful that you all made this video, not only is it catchy but it opens the eyes of a younger generation and sometimes an older generation to have that tough conversation with their family members about what they would want in the case that they can’t make decisions. I unfortunately work in a state that allows a family member to revoke a DNR/DNI regardless if the Patient signed it when they were coherent. For me I am personally dealing with my grandfather currently dying of cancer and he wants to be placed on palliative care. My family is having a hard time with the adjustment but for me working in an ICU, I understand where he’s coming from, but it doesn’t help to try to explain to my family. But anyways once again I am very grateful for the video and I will share it in get the story out!

  • PerrineAnderson

    thank you

  • Robin Zamayar

    Excellent job as always. You touch on a very sensitive and controversial topic. As an ER Nurse, my heart breaks to let a patient die, but to put them through the tortures of a code during the last few moments of their life when you know your efforts are futile just satisfy the guilty feelings of the family is not right. ADVANCED DIRECTIVES EVERYONE!! Get them in place!\nR.ROEMER, RN

  • Sara Brown

    I just found this a few days ago, and I still keep watching (and fighting the tears) it over and over. I’ve been an ICU (SICU) nurse for 12 years. We tend to have a young population, being surgical/trauma ICU. So often it makes sense to pull all the stops, do everything you possibly can. I’m talking, young person, trauma, doesn’t look good, but treatment works…..DNR PROPERLY reversed. I also, in the course of moving back home to wonderful san diego, did some travel nursing. One 3 month assignment was a medical ICU. Admitted a patient from the ER. She came in, perfectly clear, knowing up from down, left from right, etc. Said “do not resuscitate me”, signed the paper work. Paper work was put into her chart. Patient decompensated. Certain doctor decided he didn’t like her DNR paperwork. Called the family, who said “no, she never had that before”. So they rescinded the DNR………granted, at the time the DNR was rescinded, the patient did NOT have the capacity to make a decision about DNR, BUT at the time she made herself DNR, she DID!!!! However, obviously, she had never spoken to her family about it. Doctor said “she didn’t have the capacity to decide that”, and she was tortured for a week before finally passing. I only had her that first night, very pleasant lady, and she even made sure I knew that if anything happened, she wasn’t to be resuscitated. She said it was something she should have done a long time before, but had never gotten around to. She was happy she finally did, knowing that she wouldn’t be subjected to things that, at her age, wouldn’t do any good………a do gooder doctor (no offense to all doctors, this was just one, and granted it was a catholic hospital) thought he knew better than the patient what her wishes were, AFTER she was able to make her wishes clear……………..this is a conversation that needs to be had, and I’ve made sure I’ve had the conversation with my family, know what they want. I have my advanced directive done……..but so many people DON’T have the conversation. And with those that do, some don’t respect their wishes (and this is another topic, maybe you can address, so many loved ones do NOT respect the wishes of the patient, even when in writing, i have some examples, names excluded, certain details that could identify them excluded, if you like)

  • Larry Shoup Jr

    I just graduated with my BSN and we had to take a Critical Care class. I loved my day rotation in the ER. But I could not do CCU unless it was a cardiovascular unit. Here is why…\n\nI had a patient who was intubated for 5 days and I was going to write my paper on this patient, and my jaw just dropped to the ground when I read that “The Family said they were told they had 21 days to decide to keep patient on ventilator.” It broke my heart because people don’t realize what this does to your mind, body and soul. I know it is a difficult thing to explain to the family of loved ones, but they need to know what the body is going through so they can make an informed decision when there is no advanced directive in place. I told my wife that if there ever comes a time where I cannot breath on my own or pump my blood on my own, just don’t bother. Let me go. It’s in writing too.\n\nPeople need to know. I look forward to your documentary.

  • Sophia Argon

    Thoughtful piece . my company yesterday used https://goo.gl/VxhLxg to access pdf . It’s phenominal effortless to try and it’s affordable – I am guessing they offer a 7 day promotion ongoing

  • KIARA BRICKHOUSE

    Good article, Thanks!