The Downsides of Dying in a Hospital
Ira Byock, MD was the Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire and is currently Professor of Anesthesiology and Community & Family Medicine at Dartmouth Medical School.
Dr. Byock has authored numerous articles on the ethics and practice of hospice, palliative and end-of-life care. His first book, Dying Well, (1997) has become a standard in the field. His most recent book, The Four Things That Matter Most, (2004) is used as a counseling tool widely by palliative care and hospice programs, as well as within pastoral care.
Dr. Byock has been a consistent advocate for the voice and rights of dying patients and their families. He has been the recipient of the National Hospice Organization’s Person of the Year (1995), the National Coalition of Cancer Survivorship’s Natalie Davis Spingarn Writers Award (2000), the American College of CHEST Physicians Roger Bone Memorial Lecture Award (2003) and the Outstanding Colleague Award (2008) of the National Association of Catholic Chaplains.
Question: What are the downsides of dying in a hospital?
Ira Byock: Well, the medical model that, I began to talk about this problem-based model is really restricted, it’s very powerful and it helps us, but it only takes us so far. The fundamental nature of dying is not medical, it’s personal. And so dying cannot be encompassed by a set of medical problems, and a set of diagnosis and treatments. So while we can remain disease focused for as long as it makes sense, we also have to attend to the personal aspects of dying. People, you lose and dying in the hospital many times is you lose that personal time. Your space is not your own, people walk in and out, you don’t have this privacy or intimacy with family.
Beyond that though we – staying within that medical model, everybody who walks in your room or interacts with you or talking to you about medical problems, they will continue to conscript your attentions to the lab test and the scans and the next treatments and the drugs and your vital signs and all of that, instead of attending to the personal.
They actually conscript your time and energy for the medical. The best end of life care that I know of through modeled by hospice programs and the best palliative care programs still does all the medical stuff, but its subordinated to the personal, its – in hospice care we make appointments to see you and your family not the other way around, we’re coming to your home, we are explicitly acknowledging the importance of interactions of your privacy and intimacy.
And beyond that we’re even offering some help, some guidance that maybe of value to you in this area of human interaction, I would call life completion and life closure, which again in a problem-based medical model doesn’t even exist, it’s not there. Quality of life and quality of life completion really exists in a developmental model that really honors the breadth of human life for the person and family but not in a problem-based model. So even the very best of problem-based medicine, and including attention to symptoms and the like, tends not to see those personal experiences of completing one’s affairs, physical and legal and project-related affairs but also they are personal affairs, they are relationships, they are explorations of their own meaning and significance of their own life. Their relationship to something larger than themselves, that stuff that’s not abstract for people who know that, that their life is measured in weeks or days, it’s very tangible.
Recorded on: March 21, 2008
The downsides of dying in a hospital.
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A trio of intriguing galaxy clusters<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQzNDA0OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTkzNzUyOH0.0IRzkzvKsmPEHV-v1dqM1JIPhgE2W-UHx0COuB0qQnA/img.jpg?width=980" id="d69be" class="rm-shortcode" data-rm-shortcode-id="2d2664d9174369e0a06540cb3a3a9079" data-rm-shortcode-name="rebelmouse-image" />
The three galaxy clusters imaged for the study
Mapping dark matter<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="d904b585c806752f261e1215014691a6"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/fO0jO_a9uLA?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>The assumption has been that the greater the lensing effect, the higher the concentration of dark matter.</p><p>As scientists analyzed the clusters' large-scale lensing — the massive arc and elongation visual effects produced by dark matter — they noticed areas of smaller-scale lensing within that larger distortion. The scientists interpret these as concentrations of dark matter within individual galaxies inside the clusters.</p><p>The researchers used spectrographic data from the VLT to determine the mass of these smaller lenses. <a href="https://www.oas.inaf.it/en/user/pietro.bergamini/" target="_blank" rel="noopener noreferrer">Pietro Bergamini</a> of the INAF-Observatory of Astrophysics and Space Science in Bologna, Italy explains, "The speed of the stars gave us an estimate of each individual galaxy's mass, including the amount of dark matter." The leader of the spectrographic aspect of the study was <a href="http://docente.unife.it/docenti-en/piero.rosati1/curriculum?set_language=en" target="_blank">Piero Rosati</a> of the Università degli Studi di Ferrara, Italy who recalls, "the data from Hubble and the VLT provided excellent synergy. We were able to associate the galaxies with each cluster and estimate their distances." </p><p>This work allowed the team to develop a thoroughly calibrated, high-resolution map of dark matter concentrations throughout the three clusters.</p>
But the models say...<p>However, when the researchers compared their map to the concentrations of dark matter computer models predicted for galaxies bearing the same general characteristics, something was <em>way</em> off. Some small-scale areas of the map had 10 times the amount of lensing — and presumably 10 times the amount of dark matter — than the model predicted.</p><p>"The results of these analyses further demonstrate how observations and numerical simulations go hand in hand," notes one team member, <a href="https://nena12276.wixsite.com/elenarasia" target="_blank">Elena Rasia</a> of the INAF-Astronomical Observatory of Trieste, Italy. Another, <a href="http://adlibitum.oats.inaf.it/borgani/" target="_blank" rel="noopener noreferrer">Stefano Borgani</a> of the Università degli Studi di Trieste, Italy, adds that "with advanced cosmological simulations, we can match the quality of observations analyzed in our paper, permitting detailed comparisons like never before."</p><p>"We have done a lot of testing of the data in this study," Meneghetti says, "and we are sure that this mismatch indicates that some physical ingredient is missing either from the simulations or from our understanding of the nature of dark matter." <a href="https://physics.yale.edu/people/priyamvada-natarajan" target="_blank">Priyamvada Natarajan</a> of Yale University in Connecticut agrees: "There's a feature of the real Universe that we are simply not capturing in our current theoretical models."</p><p>Given that any theory in science lasts only until a better one comes along, Natarajan views the discrepancy as an opportunity, saying, "this could signal a gap in our current understanding of the nature of dark matter and its properties, as these exquisite data have permitted us to probe the detailed distribution of dark matter on the smallest scales."</p><p>At this point, it's unclear exactly what the conflict signifies. Do these smaller areas have unexpectedly high concentrations of dark matter? Or can dark matter, under certain currently unknown conditions, produce a tenfold increase in lensing beyond what we've been expecting, breaking the assumption that more lensing means more dark matter?</p><p>Obviously, the scientific community has barely begun to understand this mystery.</p>
Astronomers spot an object heading into Earth orbit.
Minimoons<p>Scientists have confirmed just two prior minimoons. One was <a href="https://en.wikipedia.org/wiki/2006_RH120" target="_blank">2006 RH120</a>, which orbited us from September 2006 to June 2007. The other was <a href="https://en.wikipedia.org/wiki/2020_CD3" target="_blank">2020 CD3</a>, which got stuck in the 2015–2016 timeframe, and is believed to gotten away in May 2020.</p><p>2020 SO, the new kid on the block, is expected to arrive in October 2020 and pop out of orbit in May 2021.</p><div id="37962" class="rm-shortcode" data-rm-shortcode-id="f4c0fc8a2cba6536ea4cd960ebed3e6e"><blockquote class="twitter-tweet twitter-custom-tweet" data-twitter-tweet-id="1307729521869611008" data-partner="rebelmouse"><div style="margin:1em 0">Asteroid 2020 SO may get captured by Earth from Oct 2020 - May 2021. Current nominal trajectory shows shows capture… https://t.co/F5utxRvN6Z</div> — Tony Dunn (@Tony Dunn)<a href="https://twitter.com/tony873004/statuses/1307729521869611008">1600621989.0</a></blockquote></div>
Identifying 2020 SO<p>The first clue 2020 SO isn't your ordinary asteroid is its exceptionally low velocity. It's traveling much more slowly that a typical asteroid — their <a href="https://www.lpi.usra.edu/exploration/training/illustrations/craterMechanics/" target="_blank">average rate of travel</a> <a href="https://www.lpi.usra.edu/exploration/training/illustrations/craterMechanics/" target="_blank" rel="noopener noreferrer"></a>is 18 kilometers (58,000 feet) per second. Even <a href="https://en.wikipedia.org/wiki/Moon_rock" target="_blank">moon rocks</a> sent careening into Earth orbit by impacts on the lunar surface outpace pokey 2020 SO.</p><p>For another thing, 2020 SO has an orbital path very similar to Earth's, lasting about one Earth year. It's also just slightly less circular than our own orbit, from which it's barely tilted off-axis.</p><p>So, what is it? <a href="https://cneos.jpl.nasa.gov/ca/" target="_blank">NASA estimates</a> that the object has dimensions very reminiscent of a discarded Centaur rocket stage from the <a href="https://en.wikipedia.org/wiki/Surveyor_2" target="_blank" rel="noopener noreferrer">Surveyor 2 mission</a> that landed an unmanned craft on the moon. Back in the day, rocket stages were jettisoned as craft were aimed toward their desired position. This stuff, if released high enough, remains in space. It appears that this Centaur rocket, launched in September 1966, is now making its way back homeward, at least for a little bit.</p><p>When 2020 SO arrives at its closest point in December, the rocket is expected to be about 50,000 kilometers from Earth. Its next closest approach is much further: 220,000 kilometers, in February 2010.</p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQzMDk3NC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyODg1MTQ1MX0.HGknDwqp0GmeuczKY_AS7vrPG7KMFUc_XO95tNoI2xo/img.jpg?width=980" id="e5cda" class="rm-shortcode" data-rm-shortcode-id="85eb1f790d8c3ee5b261f7ba13eaa5e1" data-rm-shortcode-name="rebelmouse-image" alt="Centaur rocket stage" />
Centaur rocket stage
What we may be able to learn<p>Earthly space programs being as young as they are, scientists would love to know what's happened to our rocket during a half century in space.</p><p>While 2020 SO won't get close enough to drop into our atmosphere, its slow progress has scientists hopeful that they'll still get some kind of a decent look at it.</p><p>Spectroscopy may be able to reveal what the rocket's surface is like now — has any of its paint survived, for example? Of course, being out in space, it's likely to have been hit by lots of dust and micrometeorites, so the current state of its surfaces is also of interest. Experts are curious to know how reflective the rocket is at this point, valuable information that can help planners of future long-term missions anticipate how well a craft out in space for extended periods will remain able to reflect sunlight.</p>
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