Tag: death

How to Overcome the Fear of Aging

How to Overcome the Fear of Aging

Aging, like sickness and death, is part and parcel of life. Everyone who is born must eventually age and die. This is the natural cycle of life. However, not everyone ages in the same way. Some age gracefully. Others age with fear.

Fear is Optional

If you are fearful of aging, you should know that this fear is not inevitable. It is there only because of your own past experiences, your own beliefs and your own attitude towards it. In the end, it is a matter of choice. Aging is inevitable but fear of aging is not. Aging of this body is a physical phenomenon. That is why it is inevitable. Fear, on the other hand, is a mental phenomenon. It is optional.

Identify Your Fears

If you are fearful of aging, you should try to be more specific and identify what it is that you are really fearful of. Generally, those who fear aging are actually fearful of sickness and death. Those who believe that they can age with a healthy and functioning body have little fear of aging. Those who think of the possibility of sickness and death as they age become fearful.

Having identify our specific fears, it then becomes possible to do something about it.

Fear of Sickness

If it is sickness, then we can start to live a healthy lifestyle. It is never too late to start a habit of living healthily. If you smoke, stop smoking. If you drink alcohol, and especially if you drink heavily, then tone it down. Drink less. Scientific studies have actually shown that a small amount of alcohol is good for your physical health but too much is harmful. Sleep early and wake up early. Sleep well. Exercise regularly. Eat healthily. Drink lots of water. Practice yoga or tai chi. Learn to meditate. All these improve the quality of your life, making you healthier mentally, emotionally and physically.

Fear of Death

If your fear is death, then once again you have to be specific. Is it the process of dying that you are afraid of, or is it death itself? If it is the process of dying, then the real fear for most people is actually the fear of a painful dying process. If that is the case, we have good news for you. Science and medicine today have reached a point where we can almost always minimise pain in the dying process. In most cases, we can even totally eradicate pain. However, even without medicine, pain can still be managed well. Physical pain may be inevitable but mental suffering is optional.

The question then is how do we free ourselves from mental suffering in the presence of physical pain? The answer to that is a strong mind. We can train our mind to be strong and resilient. It is a skill, and like all skills, it takes practice. The most common and popular mind training is meditation. So, learn to meditate, and learn it well. Gain mastery over your own mind. Then you will have little to be fearful of.

Fear of the Unknown

Lastly, if it is death itself that you are afraid of, then it is most likely because death is a big unknown. What happens to us after death? This is a spiritual question, and you will need a spiritual answer. It all comes down to your belief system. So, when you talk about death, and especially when you want a solution to this type of fear about death, then you must re-visit your spirituality, and the very nature of who you are.

Are you simply this body or are you more than just this physical body? When you die, is there a part of you that continues on? This is your quest. It is a journey that none can take for you. Only you can do this for yourself.

Dying is a happier experience than most people imagine

Dying is a happier experience than most people imagine

Dying is a more positive experience than most people imagine, psychologists have claimed.

A recent YouGov survey found 68 per cent of people in Britain fear death – but according to the authors of new study, dying is “less sad and terrifying – and happier – than you think”.

Researchers at the University of North Carolina analysed blogs written by terminally ill patients and last words of prisoners on death row.

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How one death saved seven lives

How one death saved seven lives

A seven-year-old boy’s heart has finally stopped beating 22 years after he was shot dead.

Nicholas Green, from the US, was killed during a holiday in southern Italy in 1994 when attackers mistook his family’s rental car for one involved in a jewellery heist.

His brave parents opted to donate their son’s organs and his heart, corneas, kidneys, liver and pancreas were given to seven people in desperate need – changing their lives forever.

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Fear of talking about dying ‘leading to thousands of traumatic hospital deaths’

Fear of talking about dying ‘leading to thousands of traumatic hospital deaths’

Thousands of cancer patients would prefer to die at home but are forced to suffer “traumatic” deaths in hospital, according to Macmillan.

Taboos around talking about death are fuelling a “crisis of communication” in the UK that prevents people from planning their final days, warned the organisation in a new report.

Research by the charity found that while 38 per cent of people who die from cancer die in hospital, just one per cent would choose to do so, with 64 per cent saying they wanted to die at home.

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How Doctors Want to Die

How Doctors Want to Die

Dr. Kendra Fleagle Gorlitsky recalls the anguish she used to feel performing CPR on elderly, terminally ill patients.

“I felt like I was beating up people at the end of their life,” she says.

It looks nothing like what people see on TV. In real life, ribs often break and few survive the ordeal.

Gorlitsky now teaches medicine at the University of Southern California and says these early clinical experiences have stayed with her.

“I would be doing the CPR with tears coming down sometimes, and saying, ‘I’m sorry, I’m sorry, goodbye.’ Because I knew it very likely was not going to be successful. It just seemed a terrible way to end someone’s life.”

Gorlitsky wants something different for herself and for her loved ones. And most other doctors do too: A Stanford University study shows almost 90 percent of doctors would forgo resuscitation and aggressive treatment if facing a terminal illness.

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Bringing the Dead back to Life

Bringing the Dead back to Life

A radical procedure that involves replacing a patient’s blood with cold salt water could retrieve people from the brink of death, says David Robson.

Rhee isn’t exaggerating. With Samuel Tisherman, at the University of Maryland, College Park, he has shown that it’s possible to keep bodies in ‘suspended animation’ for hours at a time. The procedure, so far tested on animals, is about as radical as any medical procedure comes: it involves draining the body of its blood and cooling it more than 20C below normal body temperature.

Once the injury is fixed, blood is pumped once again through the veins, and the body is slowly warmed back up. “As the blood is pumped in, the body turns pink right away,” says Rhee. At a certain temperature, the heart flickers into life of its own accord. “It’s quite curious, at 30C the heart will beat once, as if out of nowhere, then again – then as it gets even warmer it picks up all by itself.” Astonishingly, the animals in their experiments show very few ill-effects once they’ve woken up. “They’d be groggy for a little bit but back to normal the day after,” says Tisherman.

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Processed meat links to early death

Processed meat links to early death

Sausages, ham, bacon and other processed meats appear to increase the risk of dying young, a study of half a million people across Europe suggests.

It concluded diets high in processed meats were linked to cardiovascular disease, cancer and early deaths.

The researchers, writing in the journal BMC Medicine, said salt and chemicals used to preserve the meat may damage health.

The British Heart Foundation suggested opting for leaner cuts of meat.

The study followed people from 10 European countries for nearly 13 years on average.

Lifestyle factors

It showed people who ate a lot of processed meat were also more likely to smoke, be obese and have other behaviours known to damage health.

However, the researchers said even after those risk factors were accounted for, processed meat still damaged health.

One in every 17 people followed in the study died. However, those eating more than 160g of processed meat a day – roughly two sausages and a slice of bacon – were 44% more likely to die over a typical follow-up time of 12.7 years than those eating about 20g.

In total, nearly 10,000 people died from cancer and 5,500 from heart problems.

Prof Sabine Rohrmann, from the University of Zurich, told the BBC: “High meat consumption, especially processed meat, is associated with a less healthy lifestyle.

“But after adjusting for smoking, obesity and other confounders we think there is a risk of eating processed meat.

“Stopping smoking is more important than cutting meat, but I would recommend people reduce their meat intake.”

Health benefits

She said if everyone in the study consumed no more than 20g of processed meat a day then 3% of the premature deaths could have been prevented.

The UK government recommends eating no more than 70g of red or processed meat – two slices of bacon – a day.

A spokesperson said: “People who eat a lot of red and processed meat should consider cutting down.”

However a little bit of meat, even processed meat, had health benefits in the study.

Ursula Arens from the British Dietetic Association told BBC Radio 4’s Today programme that putting fresh meat through a mincer did not make it processed meat.

“Something has been done to it to extend its shelf life, or to change its taste, or to make it more palatable in some way… and this could be a traditional process like curing or salting.”

She said even good quality ham or sausages were still classed as processed meat, while homemade burgers using fresh meat were not.

“For most people there’s no need to cut back on fresh, red meat. For people who have very high intake of red meat – eat lots of red meat every day – there is the recommendation that they should moderate their intake,” she added.

Ms Arens also confirmed that the study’s finding that processed meat was linked to heart disease was new.

Mr Roger Leicester, a consultant surgeon and a member of the Meat Advisory Panel, said: “I would agree people should eat small quantities of processed meat.”

However, he said there needed to be a focus on how meat was processed: “We need to know what the preservatives are, what the salt content is, what the meat content is…meat is actually an essential part of our diet.”

Growing Evidence

Dr Rachel Thompson, from the World Cancer Research Fund, said: “This research adds to the body of scientific evidence highlighting the health risks of eating processed meat.

“Our research, published in 2007 and subsequently confirmed in 2011, shows strong evidence that eating processed meat, such as bacon, ham, hot dogs, salami and some sausages, increases the risk of getting bowel cancer.”

The organisation said there would be 4,000 fewer cases of bowel cancer if people had less than 10g a day.

“This is why World Cancer Research Fund recommends people avoid processed meat,” said Dr Thompson.

Tracy Parker, a heart health dietitian with the British Heart Foundation, said the research suggested processed meat might be linked to an increased risk of early death, but those who ate more of it in the study also made “other unhealthy lifestyle choices”.

“They were found to eat less fruit and vegetables and were more likely to smoke, which may have had an impact on results.

“Red meat can still be enjoyed as part of a balanced diet.

“Opting for leaner cuts and using healthier cooking methods such as grilling will help to keep your heart healthy.

“If you eat lots of processed meat, try to vary your diet with other protein choices such as chicken, fish, beans or lentils.”

Source: BBC Health

How Doctors Die

How Doctors Die

This article was written by KEN MURRAY, MD

erYears ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).

Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.

To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent. “How can anyone do that to their family members?” they’ll ask. I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.

How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.

To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not.

The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.

But of course it’s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.

Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman’s terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.

Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.

It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.

Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack’s worst nightmare. When I arrived at the hospital and took over Jack’s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.

Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of overtreatment.

But doctors still don’t over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.

Several years ago, my older cousin Torch (born at home by the light of a flashlight—or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.

This post was originally published at Zócalo Public Square, a non-profit ideas exchange that blends live events and humanities journalism.

Stress can truly kill

Stress can truly kill

Emotional distress, also known as psychological distress, can increase the risk of death in the general population. Anecdotal evidence has shown that distress leads to a myriad of health disorders. [Psychol Med 1995;25(5):1073-86, Ann Epidemiol 2004;14:467-72]

Emotional distress, a term referring to the signs and symptoms of depression and anxiety, has been linked to an increased risk of premature mortality, cardiovascular disease, susceptibility to infection and, potentially, all cancers. [Psychol Med 1995;25(5):1073-86, Ann Epidemiol 2004;14:467-72]

Signs and symptoms of depression can include fatigue and lack of energy; and feelings of hopelessness, helplessness and worthlessness. Signs of anxiety include the feeling of ‘butterflies’ in the stomach, pounding heart, startling easily, muscle tension, and overwhelming feelings of panic and fear.

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Why we should talk more about death

Why we should talk more about death

In this week’s Scrubbing Up opinion column, Prof Mayur Lakhani chair of the Dying Matters Coalition, urges doctors to be more open and frank about preparing patients and their families for the end of life.

Imagine a situation where most people with a common condition are undiagnosed and where opportunities are repeatedly missed to identify the problem and to offer good care.

What is this condition? It’s dying.

Each year, an estimated 92,000 people in England are believed to need end of life care but not receive it.

As a practising GP I have seen distressed relatives after a patient has died in hospital.

Often they have not had a chance to see their relative before they died and were unaware of the seriousness of the condition, despite repeated admissions with deteriorating conditions.

Many such patients are never formally identified as at risk of dying and not assessed for end of life care.

One relative said something that haunts me to this day: “I wish the doctors had told me that my mother was dying.”

As a result too many people still die in distress with uncontrolled symptoms, or have futile interventions when this will not make any difference.

All of us, including doctors, must do more to talk about dying.

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