I recently heard one of the smartest ideas about how to help make end of life decisions better. This was from a June 17, 2013 Diane Rehm Show on NPR where she interviewed two physicians from Harvard, Angelo Volandes and Aretha Delight Davis. They have created short videos that can be used by physicians to help show patients what it means, for example, to receive CPR when you are 85 and frail or what certain goals of care mean or what it’s like to live with advanced dementia. Instead of relying on every physician to be skilled at having advanced directive conversations, these videos give clinicians an important tool at the bedside to show patients what their choices mean. Visit the Advance Care Planning webpage to see samples of the videos and see segment of Diane Rehm Show below.
But conversely you’ve said that there’s a war on death in this country. Dr. Davis?
Yes. I believe there’s a war on death. As a physician, I am trained to do whatever is necessary to prolong your life. That is true irrespective of whether you are healthy as a patient, or if you’re a patient with advanced disease. That’s the guiding principle, and I will do that until and unless you tell me not too. Now, if you’re a patient with and advanced disease, and you are informed about the risks and the benefits of these interventions, and that’s how you would like for me to proceed, great. I have my marching orders. I know what I need to do.
But if you aren’t, and if you have not translated your values, your wishes, the core of who you are into some sort of medical plan, unfortunately what I will do is often times provide marginal benefit, cause great suffering to you and your family, and frankly, only postpone your death.
So Dr. Volandes, how did the idea of these videos come to you, and how did you proceed?
Sure. The story behind the videos began about a decade ago this month in fact. I was a first-day intern in residency, and I was admitting to the hospital one of the University professors of English. She had widely metastatic cancer. So I did my history, I did my physical, and then I got to that point in the conversation that all doctors have a tough time with, talking about goals of care, CPR, breathing machines.
So she looked at me and she said, Angelo, what would you do if you were in my shoes. What would I do? I was a first-day intern. Just yesterday I was a medical student, and today I’m Volandes. I had read and studied these things, goals of care, CPR, and breathing machines, but I didn’t have much experience with it. So I told the professor, well, professor, I think it’s important that we have a forest from the trees perspective, that we think about the risks and benefits for each of these interventions, but that we come to an understanding of where you are on your journey with this disease.
And then she gave me that blank look that probably all my patients gave me that first day of internship, and so I asked her naively, I said, professor would you mind taking a walk with me down to the intensive care unit so I can show you some of these things? Of course she obliged. We didn’t walk down to the ICU, I put her in a wheelchair and rolled her down to the ICU where she got to see a breathing machine. She got to see a patient on a vent. The professor was able to get a sense of the place, to hear the beeps and buzzes, to see the colorful monitors, to feel the rhythm of the ICU.
Well, as fate would have it, I obviously didn’t plan on this, but there was a code blue that was called in the ICU while we were there, and that’s when a very nervous intern thought he was going to get fired on his first day on the job. So I took the professor out of the ICU, but not before she caught of few glimpses of CPR. When we went back to her room, she looked at me and she said, words, words, words. Angelo, I understood every single word that you said before, goals of care, CPR, comfort care. I am after all a professor of English. But I had no idea that’s the sort of thing you were talking about.