Issues in Geriatric Medicine 1: End-of-Life Discussion

This is an excerpt on "End-of-Life Discussion" from the movie, Issues in Geriatric Medicine. Produced by the University of Georgia's Dr. Leonard W. Poon, video by Alan Stecker of ASV Productions, and filmed at Mercer University's School of Medicine.
You can find other clips from this movie on our youtube channel or you can visit the Georgia Geriatric Education website (www.training.geron.uga.edu). There you can also find other helpful videos and learning modules on various issues in gerontology and geriatrics.
Our Important Links
Institute of Gerontology at the University of Georgia: www.publichealth.uga.edu/geron
Georgia Geriatric Education Center (Resources and training about best practices in the aging field): training.geron.uga.edu
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UGA Gerontology KZbin Channel: / ugagerontology
UGA Gerontology Vimeo Channel: vimeo.com/channels/ugagerontology
Elder Cohousing & Other Intentional Communities: www.geron.uga.edu/eic/elderint...

[@peggyperson9629]

I feel so sorry for this woman..she seems so kind and sweet. God bless this doctor. God bless her and her son

[@Paranormalin416]

As a medical professional for the last 20 some odd years of my life, you will actually be amazed at just how many patients absolutely fine with the idea of dying. You would assume most people would not want to talk about it, or even entertain the idea, and that is true in some cases, but I have to say for the most part, once a patient reaches the stage the patient in this video has, they are well aware that their time is limited, and as a result, they tend to calm down, knowing that their time is finite, and become much happier, because they know for the first time what is going to happen and when it’s going to happen. It’s very rare that my patients remain in denial, because their bodies are telling them it’s time to go, most of them are in so much pain and discomfort, they actually look upon death as a release, a way out of the pain, and it doesn’t matter how old the person is. I have found this to be true and people as young as 20, or as old as 100, and everything else in between. Once they give you that opening, once they are comfortable talking about it, you would be absolutely amazed at how open they can be, speaking of their own death as it’s the most natural thing in the world, which it is, but the average person would never want to talk about it. It’s only until they reach a particular stage in their illness that they finally come out of denial and except the reality, and in most cases, whatever time they have left, are inevitably very happy times for them, because they want to create as many positive happy memories as they possibly can, and I found they don’t really worry too much about their health at that point, because they know there’s nothing they can do about it, so most of them just make the best of the situation at hand, and try to enjoy what’s left of their life. Just last week I had a Lady that had only months left to live after undergoing countless rounds of chemotherapy and radiation to treat stage for breast cancer, which had metastasized throughout her entire body. Without exaggeration, she walked out of my office after a very intense conversation, with the biggest smile, and immediately called her travel agent, and booked a trip of a lifetime, and spent three months travelling the world, using up every last penny of her savings to do it. She had no family to leave the money too, and she had worked so hard her entire life, she told me that for once and she is going to enjoy that money because she knew she could not take it with her, and frankly she had an absolutely wonderful end of life experience. After she came back from her three months abroad, within two weeks she went from strong and vigorous, to the graveyard. Her mind allowed her body to enjoy those last few months of life The best way she knew how. It’s for that very reason that end of life discussions are so incredibly important to discuss, so people can make all their final arrangements, so they can say goodbye to all the people they love, so they can ensure all of their wishes are carried out, and so they can enjoy their life with absolutely no worries whatsoever. I know it sounds strange to the average person, but having been in that situation myself, thanks to intestinal cancer and Crohn’s disease, there was a time I was told I was not going to live more than six months, and knowing how much time I have left allowed me to let go of all the worry, and allowed me to do all the things I always wanted to do. I had no idea that the cancer was going to mysteriously vanish, but that’s exactly what happened. Nobody could explain it, not even me, I didn’t do anything to fight the inevitable, the only thing I did was allow myself to finally calm down and relax, to take away all the stress I have been under, terrified as I thought this disease as aggressively as I possibly could. It is a subject of great personal interest to me, because I know exactly how my patients feel, but also because I can’t explain why I am still alive and cancer free, when by all rights I should have been dead years ago. I’m not complaining, in fact I am absolutely thrilled to death that I was given a second chance. At the time I was working as a registered nurse, but I always wanted to be a doctor, after I came back from my final journeys in life expecting to die, like discovering that I was going to live, I am mediately in rolled into medical school, and graduated first as a family practitioner, and then after many many years of hard work and dedication, I decided to become a gastroenterologist, who specializes in patients with all the various forms of bowel diseases, who are also fighting cancer at the same time. My colleagues tell me I have a unique insight, that’s something of an understatement, but I understand my patience better than anybody else possibly could, and while I can’t perform miracles, and I do lose many of my patients to the disease, I can at least let them know of my own personal experiences, and once I tell them that, everything suddenly changes, and all their fears are transmuted to joy, their anxiety disappears, and they, for the most part, do what I and many other people have done, and made the most of the time that they had left. Some, like myself, mysteriously recovered fully, and it’s that in particular that I am so fascinated by, as I’ve dedicated my life to understanding how and why it happens. Obviously I am a man of science, but in my personal life I am also a deeply spiritual man of faith, and without hesitation, I will fully admit that a part of me believes it’s a combination between the two things that kept me alive, and it kept countless others alive. Sometimes, when science and logic completely fails us, we have to be open to things we normally wouldn’t believe in. It’s a difficult line to walk on, as I must remain a medical professional, adhering just standard medical practices, but I will always and forever set a side a very small part to allow myself to consider other options that science cannot explain. I suppose it makes me somewhat of a hypocrite, but I’m OK with that, because after having gone through it myself, I have no explanation, nor do any of my former doctors and my current colleagues. I have all the scientific data to show them, that proves that by all rights, without a shadow of a doubt, I was going to die for certain, Yep for reasons that nobody can explain, the cancer that had spread throughout my entire body, had literally vanished, over a period of six months. I too decided to set aside my inhibitions and just make the most of the time I had left and travelled the world by cruise ship, airplane, car, cycling, you name it I did it, all the while still feeling the pain, having no idea that my body was healing itself, but not being on any type of special diet, or taking any experimental or unusual medications/therapies. I finally came to the point where I stopped asking why, and just excepted it, and literally thank God every single day of my life ever since that day, for allowing me to go this far in life, to the point where I can now help other people who went through the exact same thing that I did, so I can do so with so much more compassion than most other doctors. Not to disrespect my colleagues, but when you’ve been through it yourself, you tend to come at it from a completely different angle, then most other doctors do, and for whatever reason it seems to help my patience greatly. As a matter of fact I have the highest survival rate out of all the specialists in the city, yet I don’t do anything different then my colleagues do, with the exception of telling them about my story. The power of suggestion perhaps? Nobody will know for sure, ever, I just remain thankful, I live my life to the fullest.

[@earnold1896]

Great testimony of your healing. Are you saved and born again? If not, some born again person must have prayed for your recovery or else God decided the outcome, anyway. I have to go for a colonoscopy when they send me the appointment date. I'm a woman. I have digestive issues and stomach problems. (I suspect Crohns too and my brother has it as well). I'm greatful though to be breathing. I don't relish the colonoscopy procedure ha. My sister died of oesophagal cancer. She was up there in years though. Mind you even those of 90 seem young to me too as life is so short. (She wasn't 90). Yes you would have insight and empathy having gone through issues yourself. It's great when people know God exists. Thanks for your interesting read.

[@Paranormalin416]

@@earnold1896 born again, and you’re very welcome, I’m so happy my words are able to reach out and help…that’s what it’s all about for me. I still believe I was meant to endure it so I could share it, to help others facing it. God bless, and I know the colonoscopy will be just fine…it’s not exactly fun, but with modern medicine, you feel very little, keep me posted if you can, hugs and prayers!🙏🙏🙏🙏

[@lynettesanchez9315]

it isn't your time god had something better for you turn to Jesus he is our dr when drs can't help us anymore

[@jordanwardan7588]

holy sh I wasnt expecting my entire screen to fill up when I clicked Read more, your comment legit jumpscared me

[@nota7660]

Heart breaking, prayers for this sad lady

[@edball4906]

AS A MEDICAL PROFESSIONAL FOR LAST 20 SOME ODD YEARS OF MY LIFE WILL ACTUALLY BE AMAZED AT JUST HOW

[@karencrecco2922]

I love this doctor. He is kind, yet direct.

[@leongasperment3343]

At one point people should have the option to go peacefully not in hospice . Other countries are starting to do this They should be asked would you like to go now? And if they say yes there should ways to help them. We have more compassion for animals then humans that needs to change

[@elbacar4838]

Totally. We need to start making this process more to the point and less running around.

[@donnathomson4048]

Hospice helped us n Mom at the end. Because of Hospices helped Mom was able to pass at home.

[@rossmoli8567]

in other country doesn't exist hospice they just go home or street no one offer them any care

[@ignolator]

I appreciate your video. This is going to help with some difficult conversations and help people make decisions and support their choices. Thank you for this.

[@bertacafferty1555]

I really wish I had a doctor like this one. I want to know options and I want the truth.

[@michellebrown8393]

I love this doctor his bedside manner is wonderful ❤

[@TeeNicole10]

YES GREAT BEDSIDE MANNER IS THE BEST💙

[@leeann2226]

This Dr has a dreadful Bedside manner

[@PastaMakerCordy-qy4uz]

This is a wonder doctor. Bless him.

[@ventilator98]

I'd like to know stuff that was obviously NOT discussed. I want to know more medical perspective. So let's say an elderly gentleman is dying in ICU. He's not on a ventilator. He's not on advanced therapies such as ECMO, IABP. He's on a pulse oximeter, ECG monitor, and the ECG monitor incorperates Respiratory Monitoring. Let's say, this patient is an elderly gentleman dying due to Sepsis. His Vasopressors were removed a couple of hours ago. His family is there, by his side. The alarms have been turned down to a low volume. The pulse beep has been turned off. What are the most common end of life rhythms you would see in such a case? Like how often will yo see tachycardia go into V-Tach, then V-Fib to Asystole? What are some other rhythms, you might see in this patient, near death? Do you always see the agonal rhythm, right before Asystole? And does the Agonal come between V-Tach, and V-Fib, or does it come before the V-Tach? I want to know some common rhythms, you might see in these end of life cases.

[@anneoconnor8741]

64 and extremely healthy, but I know how quickly things can change. I have told my children that if I have a heart attack or stroke or whatever, do heroic measures for a month to give me a chance to come back.I love my life. But when it is your time, that is it

[@judithkstephens8564]

I like this doc

[@applejellypucci]

This doctor has a wonderful bedside manner.

[@IwasBlueb4]

You think so ? I find him cold and matter of fact....

[@hal013]

Evy Courtney I’d rather have a doctor that doesn’t beat around the bush. He’s matter of fact, but in this case its a good thing, and he also seems to have boundaries. What I mean is, its important for a patient to know their prognosis but he drew the line at discussing whether or not she wanted to be resuscitated. Its a discussion for another time. Other doctors would likely keep drilling question after question whether a patient was in the correct state of mind or not.

[@suziq5958]

WHAT?? Cold hearted and condescending. It’s a really good thing he was NOT caring for my Mother as she was passing.

[@johndelcher5251]

What a kind man -we all need a doctor like him -very compastionit -

[@IwasBlueb4]

Kind ? Compassionate ?

[@1950francesca]

I don't agree. He struck me as very cold and detached.

[@assessmenttreatment8445]

It’s a lonely world when your spouse and friends die off…

[@lynettesanchez9315]

🙏💫

[@IwasBlueb4]

I like this lady....so sad/….she seems so young for her age.....I don't think someone needs to know a year or two b4 they die, that they are going to die..... unless they insist in knowing...but this isn't the case

[@PastaMakerCordy-qy4uz]

More people need to be comfortable talking about death.

[@sarasmile6071]

It is definitely not set up for continuity. I believe we really lost a lot of ground in that respect when we introduced the Hospitalist system.

[@lindamiller5489]

How about giving her oxygen 🤔

[@leeann2226]

This doctor comes across as cold and hard ! As if shes old and doesn't matter..This women is just another number...Dr Remember one day you to will be treated by a Dr

[@Noname-jm3fq]

Exactly correct, the time hasn’t come as yet for the doctor.

[@apanbortae]

Such an unemphatic approach. Dont use this MD as an exemple how to talk to patients...

[@Legittoquit1]

The doctor is mean

[@suziq5958]

Damn… I hope to GOD that I never get you as a Doctor. You have horrid bedside manner and speak very condescending to this patient. Actually kind of pisses mr off that you even had the nerve to put this on KZbin. Shame on you sir.

[@Queen_banana1983]

Why