When Does Life Really End? Dr. Sunita Puri On The Problem With CPR And the Denial Of Death
Jul 26, 2023
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Dr. Sunita Puri, palliative care physician and author, discusses the impact of medical advancements on end-of-life care. She explores the complexities and misconceptions around CPR and the need for better communication about prognosis. Ageism, socioeconomic class, and racial biases in medical decisions are highlighted. The lack of conversation training in medical education and the shortage of palliative care professionals are also discussed.
Palliative care should be provided alongside curative treatments from the time of a serious diagnosis, emphasizing the importance of managing symptoms and making informed decisions about treatment.
CPR is not always effective in saving lives, emphasizing the need for honest discussions about CPR and end-of-life care, and the importance of advocating for preferences and accessing palliative care when appropriate.
Younger patients with terminal illnesses often experience ageism in end-of-life conversations, highlighting the need for healthcare providers to treat them with honesty and support in making informed decisions about their care.
Deep dives
The Purpose of Palliative Care and Hospice
The podcast episode explores the role of palliative care in addressing physical, emotional, and spiritual suffering of people with serious illnesses. Palliative care involves treating symptoms, such as pain, and having conversations about patients' goals, priorities, and treatment preferences. The podcast emphasizes that palliative care should be provided alongside curative treatments from the time of a serious diagnosis. The distinction between palliative care and hospice is explained, with hospice being a form of palliative care specifically designed for people with a terminal diagnosis. The importance of involving palliative care early in the patient's journey is highlighted, as it can benefit both the patients and their families in terms of managing symptoms and making informed decisions about treatment.
The Complexities of CPR
The podcast delves into the misconceptions surrounding CPR (cardiopulmonary resuscitation), highlighting that CPR is not always effective in saving lives as it is often portrayed in television shows. The podcast explains the process of CPR, which aims to reverse death by keeping blood flowing to the brain to minimize neurological damage. It presents the actual survival rates of CPR in hospital settings and outside of hospitals, clarifying that survival does not guarantee a full recovery. The podcast explores the importance of having honest discussions about CPR and end-of-life care, as well as the need for patients and families to advocate for their preferences and access palliative care when appropriate.
Ageism in End-of-Life Conversations
The podcast episode highlights the presence of ageism in end-of-life conversations, particularly in how physicians and healthcare professionals approach younger patients with terminal illnesses. It discusses the tendency to withhold discussions about prognosis and end-of-life care from younger patients based on assumptions about their readiness or ability to handle the information. The podcast emphasizes the importance of treating younger patients with the same level of honesty and support in making informed decisions about their care as older patients. It calls for healthcare providers to challenge their biases and engage in open conversations about end-of-life issues with patients of all ages.
The Origins of CPR and its Evolution
CPR originated as a way to treat people who had been electrocuted. In the past, various techniques were attempted, including bloodletting and blowing tobacco smoke into the person's mouth or anus. The development of CPR as we know it today began in the 60s and 70s, during a time of medical inventions and a belief that previously unfixable conditions could be treated. Initially, CPR was intended for people with sudden and potentially reversible problems, such as those who had been electrocuted or drowned. Over time, the distinction between reversible and irreversible causes for cardiac arrest blurred, resulting in CPR being applied in all cases, regardless of the underlying condition.
The Lack of End-of-Life Discussions and Palliative Care
There is a crucial lack of end-of-life discussions and palliative care in modern medicine. Many doctors fail to have honest conversations with patients about the significance of their conditions and the potential outcomes of treatments. The current medical education system also lacks adequate training in communication skills and palliative care. As a result, patients often receive unnecessary and even futile interventions. Factors such as a person's socioeconomic status and race can further impact access to timely and appropriate care. The shortage of palliative care specialists exacerbates these inequalities, emphasizing the need for primary palliative care skills to be incorporated into general medical training.
In the latest installment of her unofficial series about death and dying, Meghan talks with writer and palliative care physician Dr. Sunita Puri. Sunita is the author of That Good Night, Life and Medicine in the Eleventh Hour and has written about end-of-life issues in The New York Times, The Atlantic, Slate, and elsewhere. In this conversation, Sunita discusses the ways that medical advancements can cloud the vision of doctors and patients alike when it comes to being realistic –and even humane –about how we die. She describes how terminally ill patients can get treated differently–and often receive different information–depending on a variety of factors, including their age. Sunita also discusses her forthcoming New Yorker article about the complexities and misconceptions around CPR, a practice that turns out to be not nearly as effective as many people think. CPR’s origins also contain some fascinating trivia. For instance, did you know that the expression “blowing smoke up your ass” is said to come from an 18th-century life-saving procedure involving bellows and tobacco smoke?
For paying Substack subscribers, Sunita stays overtime to share personal thoughts about the struggle to overcome a hyper-critical inner voice, whether doctors’ inner voices are extra critical, and why it’s so hard to get into medical school even though there seems to be a shortage of doctors. To hear that portion, visit meghandaum.substack.com and join the listener community.
Guest Bio:
Dr. Sunita Puri is currently the Program Director of the Hospice and Palliative Medicine fellowship at the University of Massachusetts, where she is also an Associate Professor of Clinical Medicine. She completed medical school and residency training in internal medicine at the University of California San Francisco followed by a fellowship in Hospice and Palliative Medicine at Stanford. She is the author of That Good Night: Life and Medicine in the Eleventh Hour, a critically acclaimed literary memoir examining her journey to the practice of palliative medicine, and her quest to help patients and families redefine what it means to live and die well in the face of serious illness.
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