This morning, CNN published a story surrounding the death of the hilarious Joan Rivers, who died at New York’s Mount Sinai Hospital on Thursday after undergoing elective throat surgery at Yorkville Endoscopy. Joan Rivers was laid to rest today with a star-studded funeral in New York City.
Though I have my own thoughts on the subject, we may never know what exactly led to Joan’s ultimate and unfortunate demise, as the medical examiner’s autopsy was “inconclusive”. But beyond the loss of a powerful and history making female celebrity, Joan’s death brings up two incredibly important points to me as a health care provider.
The first is that we as physicians, particularly those of us who perform procedures, have become the victims of our own success to a certain extent. We often remark that patients are undergoing a “routine” or “elective” procedure – I have often remarked that a patient is “just having a hernia repair”. But as the CNN article points out, calling a surgery “routine” or “elective” doesn’t mean it is simple or risk-free. Every procedure we do has risks, whether planned in advance (elective) or emergency surgery. Even the most mundane procedures carry risks.
A good friend of mine who also happens to be a resident physician posted the following on Facebook, and I couldn’t agree more. As a nation and as a medical profession, we’ve collectively done a terrible job at discussing end of life decisions and goals of care. Melissa Rivers should be commended for following her mother’s wishes.
Since every recent national tragedy results in us needing to have a national conversation (on guns, mental health, race), can we please take Joan Rivers’ death and have a national conversation on goals of care?
Many of us residents have dealt with hundreds of situations like Joan, and from what the news says (I was not involved in any way in Joan’s care), Joan lost her pulse, and CPR/ACLS kept her alive, but she never regained her mental status. Her goals were pretty clear, as she said them on national TV: if she couldn’t be functional (doing stand-up comedy, using her brain), she didn’t want to be kept alive. And it seems her daughter Melissa respected what Joan wanted, didn’t fight to keep her alive – trach’d and peg’d and living in a nursing home for months or longer in a chronically critically ill state with decubitus ulcers and line infections just because she couldn’t let go. They decided to no longer keep Joan’s body alive with life support, as it’s what Joan had said she wanted.
So please, talk to your parents and grandparents about what they want in case of tragedy. Have clear goals. Respect what your family would have wanted. Make a reasonable decision. *gets off soapbox*