Most People Would Prefer to Die at Home. So Why Are We Still Dying in Hospitals?
Too many people continue to die in hospitals, often in pain and hooked up to machines, when they'd much prefer to die at home in peace surrounded by family and friends. Dr. Angelo Volandes' new book helps guide families to understanding end-of-life scenarios and to take control over their fates.
Dr. Angelo Volandes is a practicing internal medicine physician in the Massachusetts General Hospital Department of Medicine and a junior faculty member at Harvard Medical School. He is a Harvard College and Yale Medical School graduate, as well as the co-founder of Advance Care Planning Decisions (ACP), a nonprofit organization devoted to empowering patients, along with their families, to participate in their own health care.
Dr. Volandes continues his work of exploring the role of visual media in medical decision making, and is lending his expertise to efforts surrounding Advance Care Planning (ACP), the process by which patients plan for future medical care under circumstances of impaired decision-making. One of his research questions is determining whether, as part of the ACP process, patients can realistically imagine future health states which include difficult and uncomfortable hypothetical scenarios.
His latest book is titled The Conversation: A Revolutionary Plan for End-of-Life Care.
Angelo Volandes: As a doctor, there have been many experiences that encouraged me and inspired me to write this book. Too often in health care, when we ask our patients where do they want to die, they tell us at home surrounded by their families and loved ones. But the fact is most Americans are still dying in our hospitals, often tethered to machines and in a good deal of pain and suffering. The book addresses the conversation, which is that discussion that patients and families and doctors need to have before they become seriously ill.
There are many reasons for that disconnect between people saying they want to die at home but ending up dying in our hospitals. First and foremost, although we expect our doctors to be master communicators, the fact is we don't really train them on how to communicate to patients. Look, I finished medical school, residency, and even became a young junior attending and I had to show competency in how to run a code, how to perform CPR, how to perform a lumbar puncture, but not a single person actually certified that I could actually talk to a patient and a family about care at the end of life. I think that's a huge problem in our health care system, in our education system that accounts for this disconnect, this misalignment between the type of medical care patients want and the type of medical care they end up getting in our health care system today.
I think there are a lot of things in medicine that have led to this state of affairs. First is look, we live in one of the greatest places in the world where science has conquered a lot when it comes to disease. And so I think the expectation is the next new thing in health sciences, the next new cure. We live in a society that has a denial of aging and a denial of death. I think that's a large reason why doctors are uncomfortable about talking about this, but also we as a society don't like to talk about death and dying at all.
I think a lot of people ask me what should I as a non-doctor know about you the doctor when it comes to this topic? And I would say that look, even though I'm a doctor, I struggle with this as well. And so I look forward to when my patient or my family member tells me, "Hey look, I'd like to talk about this. It's an important part of a good life, a good death as well. And so I'm open to talking to you about what's important to me if I become seriously ill and in need of medical care." I think if more patients started the conversation with their doctors, we'd have a much better patient/doctor relationship. I think doctors need to know that it's okay to broach this inherently difficult subject matter.
Too many people continue to die in hospitals, often in pain and hooked up to machines, when they'd much prefer to die at home in peace surrounded by family and friends. Dr. Angelo Volandes of Massachusetts General Hospital describes this fact as the inspiration for his new book, The Conversation: A Revolutionary Plan for End-of-Life Care. The conversation at the heart of the book is the discussion every family needs to have before serious illness rears its head. In the process of teaching how to have this discussion, Dr. Volandes explores the faults of the medical system at large and offers solutions for major fixes.
It's just the current cycle that involves opiates, but methamphetamine, cocaine, and others have caused the trajectory of overdoses to head the same direction
- It appears that overdoses are increasing exponentially, no matter the drug itself
- If the study bears out, it means that even reducing opiates will not slow the trajectory.
- The causes of these trends remain obscure, but near the end of the write-up about the study, a hint might be apparent
Through computationally intensive computer simulations, researchers have discovered that "nuclear pasta," found in the crusts of neutron stars, is the strongest material in the universe.
- The strongest material in the universe may be the whimsically named "nuclear pasta."
- You can find this substance in the crust of neutron stars.
- This amazing material is super-dense, and is 10 billion times harder to break than steel.
Superman is known as the "Man of Steel" for his strength and indestructibility. But the discovery of a new material that's 10 billion times harder to break than steel begs the question—is it time for a new superhero known as "Nuclear Pasta"? That's the name of the substance that a team of researchers thinks is the strongest known material in the universe.
Unlike humans, when stars reach a certain age, they do not just wither and die, but they explode, collapsing into a mass of neurons. The resulting space entity, known as a neutron star, is incredibly dense. So much so that previous research showed that the surface of a such a star would feature amazingly strong material. The new research, which involved the largest-ever computer simulations of a neutron star's crust, proposes that "nuclear pasta," the material just under the surface, is actually stronger.
The competition between forces from protons and neutrons inside a neutron star create super-dense shapes that look like long cylinders or flat planes, referred to as "spaghetti" and "lasagna," respectively. That's also where we get the overall name of nuclear pasta.
Caplan & Horowitz/arXiv
Diagrams illustrating the different types of so-called nuclear pasta.
The researchers' computer simulations needed 2 million hours of processor time before completion, which would be, according to a press release from McGill University, "the equivalent of 250 years on a laptop with a single good GPU." Fortunately, the researchers had access to a supercomputer, although it still took a couple of years. The scientists' simulations consisted of stretching and deforming the nuclear pasta to see how it behaved and what it would take to break it.
While they were able to discover just how strong nuclear pasta seems to be, no one is holding their breath that we'll be sending out missions to mine this substance any time soon. Instead, the discovery has other significant applications.
One of the study's co-authors, Matthew Caplan, a postdoctoral research fellow at McGill University, said the neutron stars would be "a hundred trillion times denser than anything on earth." Understanding what's inside them would be valuable for astronomers because now only the outer layer of such starts can be observed.
"A lot of interesting physics is going on here under extreme conditions and so understanding the physical properties of a neutron star is a way for scientists to test their theories and models," Caplan added. "With this result, many problems need to be revisited. How large a mountain can you build on a neutron star before the crust breaks and it collapses? What will it look like? And most importantly, how can astronomers observe it?"
Another possibility worth studying is that, due to its instability, nuclear pasta might generate gravitational waves. It may be possible to observe them at some point here on Earth by utilizing very sensitive equipment.
The team of scientists also included A. S. Schneider from California Institute of Technology and C. J. Horowitz from Indiana University.
Check out the study "The elasticity of nuclear pasta," published in Physical Review Letters.
Scientists think constructing a miles-long wall along an ice shelf in Antarctica could help protect the world's largest glacier from melting.
- Rising ocean levels are a serious threat to coastal regions around the globe.
- Scientists have proposed large-scale geoengineering projects that would prevent ice shelves from melting.
- The most successful solution proposed would be a miles-long, incredibly tall underwater wall at the edge of the ice shelves.
The world's oceans will rise significantly over the next century if the massive ice shelves connected to Antarctica begin to fail as a result of global warming.
To prevent or hold off such a catastrophe, a team of scientists recently proposed a radical plan: build underwater walls that would either support the ice or protect it from warm waters.
In a paper published in The Cryosphere, Michael Wolovick and John Moore from Princeton and the Beijing Normal University, respectively, outlined several "targeted geoengineering" solutions that could help prevent the melting of western Antarctica's Florida-sized Thwaites Glacier, whose melting waters are projected to be the largest source of sea-level rise in the foreseeable future.
An "unthinkable" engineering project
"If [glacial geoengineering] works there then we would expect it to work on less challenging glaciers as well," the authors wrote in the study.
One approach involves using sand or gravel to build artificial mounds on the seafloor that would help support the glacier and hopefully allow it to regrow. In another strategy, an underwater wall would be built to prevent warm waters from eating away at the glacier's base.
The most effective design, according to the team's computer simulations, would be a miles-long and very tall wall, or "artificial sill," that serves as a "continuous barrier" across the length of the glacier, providing it both physical support and protection from warm waters. Although the study authors suggested this option is currently beyond any engineering feat humans have attempted, it was shown to be the most effective solution in preventing the glacier from collapsing.
Source: Wolovick et al.
An example of the proposed geoengineering project. By blocking off the warm water that would otherwise eat away at the glacier's base, further sea level rise might be preventable.
But other, more feasible options could also be effective. For example, building a smaller wall that blocks about 50% of warm water from reaching the glacier would have about a 70% chance of preventing a runaway collapse, while constructing a series of isolated, 1,000-foot-tall columns on the seafloor as supports had about a 30% chance of success.
Still, the authors note that the frigid waters of the Antarctica present unprecedently challenging conditions for such an ambitious geoengineering project. They were also sure to caution that their encouraging results shouldn't be seen as reasons to neglect other measures that would cut global emissions or otherwise combat climate change.
"There are dishonest elements of society that will try to use our research to argue against the necessity of emissions' reductions. Our research does not in any way support that interpretation," they wrote.
"The more carbon we emit, the less likely it becomes that the ice sheets will survive in the long term at anything close to their present volume."
A 2015 report from the National Academies of Sciences, Engineering, and Medicine illustrates the potentially devastating effects of ice-shelf melting in western Antarctica.
"As the oceans and atmosphere warm, melting of ice shelves in key areas around the edges of the Antarctic ice sheet could trigger a runaway collapse process known as Marine Ice Sheet Instability. If this were to occur, the collapse of the West Antarctic Ice Sheet (WAIS) could potentially contribute 2 to 4 meters (6.5 to 13 feet) of global sea level rise within just a few centuries."
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