“The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life” – new book

This recent New York Times article is about a new book “The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life,” by Ira Byock, MD.  The author of the short review says:  “What makes Dr. Byock’s book particularly valuable is the chance to eavesdrop on the doctors we’re often quick to blame. He tells what it’s like on the other end of the stethoscope.”  The reviewer is “most appreciative of [Dr. Byock’s] front-line insights into the way medicine operates at the end of life.”

One take-away from this book must be that we all need to have advance directives or we may suffer the fate described of the family matriarch in the ICU whose niece objects to stopping all treatment as “letting her die [when] only God can take a life.”  Apparently most Americans do not have advance directives.

Here’s a link to the full article:

newoldage.blogs.nytimes.com/2012/03/20/the-caregivers-bookshelf-dying-by-degrees

The New Old Age Blog: Caring and Coping
The Caregiver’s Bookshelf: Dying by Degrees
The New York Times
By Paula Span
March 20, 2012, 4:25 PM

Various calculators for estimating prognosis for seniors

The ePrognosis website at UCSF (eprognosis.ucsf.edu) has various calculators for determining the prognosis of seniors.  See:

www.eprognosis.org/p/calculators.html

There are four top-level categories, based upon where the patient is — living in the community, living in a nursing home, hospitalized, or outpatients with advanced cancer.

This website is designed for physicians so that they can determine the prognosis and learn communication skills for discussing the prognosis with families.

MDs know limits of treatment and the need to plan

Some of us were talking at last night’s caregiver support group meeting about whether MDs, in general, seem in favor of or opposed to feeding tubes, and whether MDs will honestly answer a family’s question as to their advice as to what they’d do if their family member lost the ability to swallow.

There’s an article in last Saturday’s Wall Street Journal (wsj.com) about one person’s view of these matters.  The author, a retired physician, believes that doctors tend to choose less treatment at the end of life for themselves, and are reluctant to impose their “views on the vulnerable” when families ask “what would you do?”

Here’s an interesting statistic about CPR from the article:  “A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life.”

Here’s a link to the article:  (there may be a charge to view the full article)

online.wsj.com/article/SB10001424052970203918304577243321242833962.html

Life & Culture
Why Doctors Die Differently
Careers in medicine have taught them the limits of treatment and the need to plan for the end
By Ken Murray
Wall Street Journal
February 25, 2012

It’s worth reading.

“Let Go” (poem)

Someone on one of the online Lewy Body Dementia support groups shared
this poem. The poem’s author is unknown. The poem is included in
Jolene Brackey’s lovely book Creating Moments of Joy. It describes
the healthy choice of letting go for the right reasons. Perhaps this
will resonate with many of you.

Robin

————————-

Let Go

To let go does not mean to stop caring;
It means I can’t do it for someone else.
To let go is not to cut myself off;
It’s the realization that I can’t control another.
To let go is to admit powerlessness,
Which means the outcome is not in my hands.
To let go is not to try to change or blame another;
It’s to make the most of myself.
To let go is not to “care for,” but to “care about.”
To let go is not to judge,
But to allow another to be a human being.
To let go is not to deny, but to accept.
To let go is not to nag, scold, or argue,
But instead to search out my own shortcomings and correct them.
To let go is not to regret the past,
but to grow and live for the future.
To let go is to fear less and love more.

25 Documents You Need Before You Die

At a recent local atypical parkinsonism caregiver-only support group meeting, we talked about the importance of adult children knowing about their parents’ finances (especially where to find the necessary documents) and final wishes.

At the meeting, I mentioned a helpful article from the Wall Street Journal on this topic; I thought I’d share that resource more widely.

The article, titled “The 25 Documents You Need Before You Die,” instructs us to gather our important documents in one file box and tell family members where the file box is.  This way family members don’t have to go hunting for these documents.  The article notes that getting organized in this way provides huge piece of mind to parents and adult children.

The WSJ article suggests that one adult child work with one parent on this task.  In one example, it took an entire year for a daughter and mother to go through all of the papers and visit all of the banks and brokerages to ensure the daughter was listed on the mother’s accounts.

The article notes the importance of having an original will and original trust documents in the file box.  One expert says:  If your family can’t find the original trust documents, you are “basically setting your estate up for litigation.”

Here’s a link to the WSJ article on the 25 documents:

online.wsj.com/article/SB10001424052702303627104576410234039258092.html

Weekend Investor
The 25 Documents You Need Before You Die
Wall Street Journal
By Saabira Chaudhuri
July 2, 2011

You may have to subscribe (or pay) to read the full article.

Beneath my name below, I’ve listed some of the documents you need to have.

One final note:  It may be hard for a wife, who has never had responsibility for finances and legal documents, to ask her husband, now diagnosed with a neurodegenerative disorder, about these 25 documents.  That’s why I think adult children can naturally champion this endeavor because, in the end, the adult children will get stuck with the task.

Robin

————————————–

The documents include:

  • Will
  • Living trust
  • A “letter of instruction”
  • Durable financial power-of-attorney form
  • Proof of ownership for housing, land, cemetery plots, vehicles, stock certificates, savings bonds, any partnership agreements
  • List of brokerage and escrow mortgage accounts
  • List of loans you have made to others
  • List of debts you owe
  • Most recent three years of tax returns
  • List of all bank accounts and online log-in information
  • List of any safe-deposit boxes you own
  • Durable health-care power-of-attorney form
  • Living will.  (The durable health-care power-of-attorney form and the living will constitute “advance directives.”)
  • Copies of life-insurance policies with name of carrier, policy number, and agent associated with the policy.
  • List of pensions, annuities, individual retirement accounts and 401(k)s
  • Marriage license
  • Divorce judgment or decree, or stipulation agreement.  Include the distribution sheet listing bank-account numbers