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Why Doctors Die Differently
Wall Street Journal ^ | 2/25/12 | KEN MURRAY

Posted on 02/27/2012 8:01:31 AM PST by rhema

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. It was diagnosed as pancreatic cancer by one of the best surgeons in the country, who had developed a procedure that could triple a patient's five-year-survival odds—from 5% to 15%—albeit with a poor quality of life.

Charlie, 68 years old, 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 his family. 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 something that we like to talk about, but doctors die, too. What's unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.

Doctors don't want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don't want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).

In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the

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To: T-Bird45

Your right, ribs break if you compress in the wrong area of the body. In the hospital, we never had broken ribs because of CPR Too many people don’t know what they are talking about, they just think they know....


51 posted on 02/27/2012 10:23:11 AM PST by goat granny
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To: WestwardHo

You are so right.


52 posted on 02/27/2012 10:31:48 AM PST by iceskater (I am a Carnivore Conservative - No peas for me. (h/t N.Theknow))
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To: oprahstheantichrist

“Aging Atheist Syndrome”

Actually, I believe she does. Although, asked if she is a Christian—she answers that she used to go to church.


53 posted on 02/27/2012 10:32:17 AM PST by freeangel ( (free speech is only good until someone else doesn't like it)
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To: headstamp 2
If you are trained, the Good Samaritan laws should cover the potential liability.
54 posted on 02/27/2012 10:36:38 AM PST by iceskater (I am a Carnivore Conservative - No peas for me. (h/t N.Theknow))
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To: headstamp 2
Well....having done CPR on hundreds of patients I can tell you...yes we break sternums from ribs on occasion. ( Especially on the elderly..)

FWIW-

55 posted on 02/27/2012 10:38:31 AM PST by Osage Orange (E tan e epi tas)
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To: HamiltonJay
Actually....I've done CPR on neonates and peds, and young adults...and never cracked a rib.

And I was doing it right.

FWIW-

56 posted on 02/27/2012 10:51:16 AM PST by Osage Orange (E tan e epi tas)
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To: HamiltonJay
CPR isn't just compressions and ventilation.

It involves cardiac med's and electrical shocks too....Even in the field, if EMS is close.

The odds are much better than you are typing.

That said....the odds are generally not good to survive getting out of the hospital...even if you survive the initial CPR.

Unless your cardiac arrest was from near drowning, electrical shock, drug O.D...etc....

FWIW

57 posted on 02/27/2012 10:58:15 AM PST by Osage Orange (E tan e epi tas)
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To: freeangel
I’ve been saying this for years. MIL is 93 and has 7% kidney function and probable leukemia. But she doesn’t want to die—I can feel dialysis and chemo knocking on my door. What a loon!

Your obvious and early solution is simple: a pillow and a pistol. The sooner the better, before she burns through what's left of her savings. God, don't you just hate these "useless eaters" hanging around and making themselves obnoxious and expensive?

</s>

58 posted on 02/27/2012 11:07:01 AM PST by lentulusgracchus
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To: freeangel

Oh she needs prayer then, saying one now.

I have a lot of that in my family as well. Ask the Lord to send the Holy Spirit to bring her whatever it is that she needs for her inner peace.


59 posted on 02/27/2012 11:16:37 AM PST by oprahstheantichrist (The MSM is a demonic stronghold, PLEASE pray accordingly - 2 Corinthians 10:3-5)
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To: Cicero
The important thing is whether you can trust the nurses and doctors in charge. I was fortunate to have put her in a really good Catholic nursing home. And the hospital doctors were constantly trying to persuade me to hurry her death, but at least they never did anything on their own when I refused.

They will become more insistent, more challenging, if the Obama "worm meme" of "death to the useless eaters!" is successful in eating through the moral substance, what's left of it, of the American Republic and its civilized Western view of life.

It really is a culture of death.

60 posted on 02/27/2012 11:18:53 AM PST by lentulusgracchus
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To: astounded

Sorry if I offended through semantics or word choice, it was not my intent. I agree with you about medicine being a calling since the course of study is so long before actually getting into the real application of the knowledge gained. I am the son of an RN and my observation of the care level of most health professionals mirrors yours.

My comment was not about bad apples or poor care, it was about the special knowledge gained from being on the inside that is not necessarily shared with patients or families making the decisions about how to approach a life-threatening disease like the pancreatic cancer described in the original article. I take the view that there are medical professionals that believe not providing full information is a kindness to the patient/family because the doctors don’t want to dash any hope the patient/family have. I don’t believe this is through any ill intent.

I hope I have provided a little more clarity on my first comment.


61 posted on 02/27/2012 11:28:35 AM PST by T-Bird45 (It feels like the seventies, and it shouldn't.)
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To: HamiltonJay

It’s my understanding that the point of chest compressions is not to start the heart, but to compress the heart to force oxygenated blood to the brain and other organs until such time that the heart can be started (by paddles).


62 posted on 02/27/2012 11:29:12 AM PST by SgtHooper (The last thing I want to do is hurt you. But it's still on the list.)
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To: lentulusgracchus

“The sooner the better, before she burns through what’s left of her savings.”

Nope—she’s gone through her savings—but she doesn’t seem to be at peace in the least. What quality of life do you think a 93 yr old has on dialysis and chemo. For the last 20 years she has been unwilling to do anything but watch TV and do crosswords.


63 posted on 02/27/2012 11:48:00 AM PST by freeangel ( (free speech is only good until someone else doesn't like it)
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To: oprahstheantichrist

Thanks for the prayer. She DOES need the Holy Spirit.


64 posted on 02/27/2012 11:49:56 AM PST by freeangel ( (free speech is only good until someone else doesn't like it)
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To: astounded

“With all due respect, Bird, doctors don’t work in an “industry””

It is most certainly an industry. It consumes 1/7th (and growing) of all our economic efforts. Doctors are an intimate part of it, and they are often passionate and professional about it.

There is no shame or insult in calling it an industry. Many doctors are well compensated for their efforts and education, as it should be (for some of them).


65 posted on 02/27/2012 11:55:45 AM PST by RFEngineer
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To: freeangel
What quality of life do you think a 93 yr old has on dialysis and chemo.

I don't know, why don't you ask her, instead of putting a pillow over her face?

Your indignation at her inconvenient "bitter clinging" to life is pretty self-evident. Gut-check time.

66 posted on 02/27/2012 12:05:48 PM PST by lentulusgracchus
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To: Osage Orange

Of course, you are right.

I just don’t think it hurts to be skeptical and question the motives of people who stand to gain financially based on what they recommend — in any field.

Obviously, the reason you hire a doctor is because he or she is supposed to be an expert, and you want an expert opinion. I am not even saying that “most” doctors are not good people. Money can talk loud.


67 posted on 02/27/2012 12:07:54 PM PST by old3030 (I lost some time once. It's always in the last place you look.)
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To: old3030
Trust, but verify...

Works for me.

68 posted on 02/27/2012 12:15:36 PM PST by Osage Orange (E tan e epi tas)
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To: WestwardHo

I’m not pinging doctors as much as pointing out that their job has hazards, one of which is assuming the worse.

Somewhat like police officers have a habit of eating their gun when things go south for them. It used to be that it was common when doctors got a terminal diagnosis to give themselves a lethal shot of morphine and call it a day.

I personally prefer the Ambrose Bierce solution, of just taking an extended holiday in rural Mexico, making friends with the locals so that when you go, there is not a lot of fuss. Not really different from a doctor who just decides to let nature take its course, just a step further.

I know some cardiologists who have do not resuscitate necklaces, though it is rare that they end up in such a situation, instead getting something long, slow and chronic that they see coming from a mile away.


69 posted on 02/27/2012 12:52:42 PM PST by yefragetuwrabrumuy
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To: RFEngineer

I understand your view, but I think it’s wrong. While the delivery of healthcare services does comprise some 14-15% of our economy, I contend the practice of medicine is not and must not be construed as an industry. That is one reason we’ve got to the point we have with Obamacare. Health care services are not like other industrial services in that they are - ideally - personalized and compassionate.

Medicine, despite what the tinkerers think, is as much art, maybe more, than it is pure science. There is no cookbook, although some would like it that way. It’s just that for most patients, outcomes are unpredictable.


70 posted on 02/27/2012 12:56:41 PM PST by astounded (Barack Obama as POTUS is a clear and present danger to the USA)
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To: astounded

They don’t call it a practice, for nothing.


71 posted on 02/27/2012 1:01:20 PM PST by Osage Orange (E tan e epi tas)
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To: yefragetuwrabrumuy

Good post...............


72 posted on 02/27/2012 1:06:02 PM PST by Osage Orange (E tan e epi tas)
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To: astounded

“Medicine, despite what the tinkerers think, is as much art, maybe more, than it is pure science. There is no cookbook, although some would like it that way. It’s just that for most patients, outcomes are unpredictable.”

A large fraction of medicine is of the lookup table variety, match symptoms to pills, collect the fees direct the patients to your labs, have a nice day.

The Art of Medicine is only the domain of a select talented subset of physicians and surgeons.

We can agree to that much, I think. Nonetheless - they have to have the technology, the manufacturing, the pharmaceuticals the brick-and-mortar facilities behind them.

It is every much an industry as anything else is in this day and age. Deploy capital, serve your market, collect revenues, grow market share etc.


73 posted on 02/27/2012 1:11:07 PM PST by RFEngineer
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To: Slings and Arrows


“The average doctor dies at 48.”

In my town, the average doctor retires at 48.


74 posted on 02/27/2012 1:17:20 PM PST by zeestephen
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To: headstamp 2

Education of end of life care is very important!
Here is a nurse viewpoint:
http://www.codeblog.com/archives/public_service_announcement/how_do_you_suppose_being_coded.html

I wish I had been told this so I could have had discussions with older family members before crisis time. Read, Research and make decisions on what is best for your and your loved ones situations.


75 posted on 02/27/2012 1:35:06 PM PST by An American! (Proud To Be An American!)
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To: freeangel

Give me a call when you’re 93. By then enough laws will have changed so we can legally put a bullet through your head.

I’ll bet she hates you as much as you hate her. Small wonder... You’re disgusting.


76 posted on 02/27/2012 2:09:07 PM PST by LucyT
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To: rhema; All

Actually, doctors and elected officials, when it is their life at stake tend to go to natural herbal medicine, get cured, and live on for a few more decades.


77 posted on 02/27/2012 2:36:47 PM PST by editor-surveyor (No Federal Sales Tax - No Way!)
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To: rhema

Some years ago Mrs. OldPossum and I consulted with our attorney regarding end-of-life care and he provided us with an elaborate questionnaire as to what we wanted done in certain instances. I selected no heroic treatments, none at all.

The advance directive has teeth in it, unlike a lot of stuff stuck on wills. My wife has health power-of-attorney and if the hospital ignores her stated wishes on my behalf she can take them to court.

Now, there’s a language they understand.


78 posted on 02/27/2012 3:11:38 PM PST by OldPossum (ou)
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To: LucyT

“I’ll bet she hates you as much as you hate her. “

What planet are you from? We moved her here from Fla. several years ago where she was spending much of her time in hospitals. She has been maintaining some semblence of health since she’s been here and not had one hospital admission since we’ve been taking care of her. She simply refuses to deal with reality. Perhaps I should take your advice and recommend to her to take every extraordinary measure to extend her life. CPR, tubes, etc. Would that make you happy?


79 posted on 02/27/2012 3:37:44 PM PST by freeangel ( (free speech is only good until someone else doesn't like it)
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To: I cannot think of a name

One thing to remember in this new age of socialist medicine. Leftists lie in the name of science to advance their agenda. They are doing it with global warming; they will commence doing it with medical care now that they control medical care.

We should stick to what we know from experience of those we trust around us. Don’t blindly follow authority now that it is corrupt. The ideology’s central goal is population reduction - beginning with denial care to elderly and handicapped. They will try to scare and gulit old people into ending their lives.

Stick to what you know.


80 posted on 02/27/2012 3:49:16 PM PST by SaraJohnson
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To: freeangel
Sorry you are catching so much heat, from people who don't really care about end of life issues, anyway.

I will never forget the vitriol dished out to those of us who tried to help keep Terri Schiavo alive.
She was not dying from a terminal disease. She merely required palliative care. Food, water, simple nursing for a completely disabled person, with a projected lifespan of over thirty years, before her state ordered execution.
She was forcibly starved and dehydrated, to death.

And yes, her “condition” differed greatly from your family member.

At the end, the huge number of people who claimed they personally wouldn't want to live that way, meant society was somehow justified in actively killing a person who was not in fact, dying.

OTOH, those same people will rail against halting futile medical measures, that merely prolong the death of terminally ill people.

81 posted on 02/27/2012 5:29:46 PM PST by sarasmom ( http://www.youtube.com/watch?feature=player_embedded&v=xZsFe6dM3EY)
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To: sarasmom

It will be interesting to see how Americans react as the Federal government begins targeting useless groups of Americans for death through socialized medicine’s Federal denial of care. It will be announced with claims that their lives are not worth anything and that they cost their families and taxpayers too much.

I bet Americans go for it. This is how the Left in the US will murder it’s Stalin quota. They can target people by politically incorrect generation and by region for death.

As long as they have a good materialistic excuse, Americans will celebrate the executions.


82 posted on 02/27/2012 5:39:46 PM PST by SaraJohnson
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To: headstamp 2

The liability can’t be that high- if someone needs CPR they will definately die without it so it comes down to a choice between broken ribs or death...it has been a while since I was an EMT (1970s-1980s) but at the time we were told the only liability is to do it on someone that doesn’t need it.


83 posted on 02/27/2012 5:58:37 PM PST by Tammy8 (~Secure the border and deport all illegals- do it now! ~ Support our Troops!~)
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To: clee1

Thank You for your honesty.


84 posted on 02/27/2012 6:03:33 PM PST by Randy Larsen (No Romney vote from my family!)
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To: Yehuda

No, it’s what happens when it’s done too hard. Now if you are older or have osteoporosis even the necessary push down could fracture ribs. Normally ribs do not break.


85 posted on 02/27/2012 6:17:25 PM PST by Secret Agent Man (I'd like to tell you, but then I'd have to kill you.)
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To: WestwardHo
I get sick of people dumping on doctors--and other medical personnel.

Will never forget knowing a smug, popular small-town lawyer. Every Christmas his doorstep was overflowing with Omaha steaks, crates of wine and booze, all the expensive fancy gifts from grateful clients. I understand that is common among lawyers who get their clients what they want--and probably don't deserve.

He later lost a fortune on Lehman and Wachovia.

And I also knew a middle-aged ER nurse who got a simple "thank you" letter from a grateful patient. She started to cry, and everyone crowded around as she opened the little card thanking her for saving a life. The card was passed around in awe. Imagine! A thank-you note!

I cried, too, only a few tears of pure fury at the vulgar ingratitude of human beings, who lavish booze on cheesy lawyers but stiff the woman in the ER who saved a life, who was so moved at a scrap of paper that said "thank you"--

So dump on doctors, folks. They're retiring like crazy and you may not be able to find one when you need one.

86 posted on 02/27/2012 6:24:41 PM PST by Mamzelle
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To: Mamzelle
They're retiring like crazy and you may not be able to find one when you need one.

I won't dump on them, but I will say that as it is now, when I need one, I can't afford one.

87 posted on 02/27/2012 6:33:25 PM PST by JoanVarga ("Yes We Can" It's not just a slogan. Apparently, it's a threat.)
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To: An American!

Thank You for this blog!


88 posted on 02/27/2012 6:46:24 PM PST by Randy Larsen (No Romney vote from my family!)
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To: Jack Hydrazine; zeestephen; trailhkr1; goat granny

From another Freeper:

Results: Among both U.S. white and black men, physicians were, on average, older when they died, (73.0 years for white and 68.7 for black) than were lawyers (72.3 and 62.0), all examined professionals (70.9 and 65.3), and all men (70.3 and 63.6). The top ten causes of death for white male physicians were essentially the same as those of the general population, although they were more likely to die from cerebrovascular disease, accidents, and suicide, and less likely to die from chronic obstructive pulmonary disease, pneumonia/influenza, or liver disease than were other professional white men.

http://www.ajpmonline.org/article/S0749-3797%2800%2900201-4/abstract


89 posted on 02/27/2012 7:51:56 PM PST by Slings and Arrows (You can't have Ingsoc without an Emmanuel Goldstein.)
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To: SaraJohnson
Oh yes, a great many of my fellow citizens are going to cheer on the death panels! They've already done so IMHO.

But as to your comment that:
“As long as they have a good materialistic excuse, Americans will celebrate the executions”

No, it isn't due to “materialistic” excuses.

It is due to the fetid, stunted minds of “secular progressives” and their hordes of ignorant usefull idiots amongst various “religious progressives”. It seems they have achieved parity, if not a majority.

Back to anarchy, and the dark ages we all go!

90 posted on 02/28/2012 7:55:31 PM PST by sarasmom ( http://www.youtube.com/watch?feature=player_embedded&v=xZsFe6dM3EY)
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To: Yehuda

I was on the ambulance crew of a medium sized city for a couple of year.

Did CPR lots of times. Only one time that I can recall when the first compression did NOT make that cracking sound.


91 posted on 02/28/2012 8:59:29 PM PST by lightman (Adjutorium nostrum (+) in nomine Domini--nevertheless, Vote Santorum!)
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To: Slings and Arrows

The data used in your comment was gathered between 1984 and 1995.

The life expectancy for all Americans in 2011 was close to 79 years of age.

Women have almost a 5 year advantage on men, and whites have almost a 4 year advantage on Blacks.

High income males have about a 5 year advantage on low income males.

I can’t find the 2011 average life expectancy for white male doctors, but I’m certain it’s over 80.


92 posted on 02/29/2012 1:38:15 AM PST by zeestephen
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To: headstamp 2

Because they are ABSOLUTELY gonna die without it... and probably sill anyway.

You do whatever you can to save a life, because each is precious.... even though usually futile


93 posted on 02/29/2012 3:20:39 AM PST by clee1 (We use 43 muscles to frown, 17 to smile, and 2 to pull a trigger. I'm lazy and I'm tired of smiling.)
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To: clee1
***Coding someone is an ugly, brutal business; and the patient rarely survives***

Don't know where you saw CPR done, but the patient is dead to start with or they wouldn't be coded in 90% of the cases.

In the hospital its an orderly medical procedure...Nurse usually #1 to find patient.calls code,

another nurse brings back board to roll pat. onto.

Nurse starts CPR and within minutes respiratory therapy shows up, to intubate if necessary and takes over CPR,

if patient has no IV lines, nurse puts one in,

doctor arrives and takes over calling out medication to medication nurse that has responded to the code

after a code goes out over the speaker system, its only minutes until everyone that is to respond to all codes is in the room.,

If patient can be borough back and stabilized, they are taken by the bed they are in to ICU or RICU.

I have never heard of broken ribs, but if done by someone not really knowing what they are doing, it can happen.

For some, after a period of time with no responses the patient IE: flat lined and no cardiac response the code is called off and the patient is deemed dead by the attending physician.

artificial breathing by someone from RT is discontinued. If the heart responses and stablilitzed the patient may at that point be put on a mech. ventilator...

Every person in the room has a job and each does it well. any personal not directly involved leaves...

If the person is elderly, I can understand broken ribs due to age and condition of bones that break easily. A healthy young man or woman, broken bones don't usually happen in hospital setting....

I think your % that leave hospital is about right.

Done under the best of conditions, CPR is not a miracle and everyone survives, but they were dead to start with.

To an outside observer it may look chaotic, but it is in fact not.

94 posted on 02/29/2012 4:14:52 AM PST by goat granny
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To: SaraJohnson
I feel sorry for my grandchildren and the american they will mature in..Its not the america I grew up in...The government is in everyone house, lightbulbs, toilets, showers, what you can and cannot do with your property..I have said for years we don't own any property, we rent it from the government in the form of taxes that can go into the thousands for a modest home....Glad I am in my 70's and won't be around to see the worse, and it coming...but each individual has the right to make their own decision of how they will die....I think Obama care will eventually be declared unconstitutional by the S C.

That still doesn't get the government out of our homes, only doing away with departments like the EPA etc. will get them out....

95 posted on 02/29/2012 4:52:40 AM PST by goat granny
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To: Slings and Arrows
Once had a doctor tell me that doctors that drink usually don't get liver problems...its because they know what to eat and keep on a good food regiment...most alcholics quit eating and just drink, or eat crappy. If your going to drink alchol, eat properly....not that I would recommend drinking as a vocation....a fifth of bourbon last me a year. For some its a day....and not a good way to die. I have seen some horrible alcholic deaths..

One patient I remember was in his mid 30's married with 3 children....I went into his room one day and asked if there was anything I could get him. (we keep juices etc on the units) his answer shocked me...he said yea, get me a beer...

96 posted on 02/29/2012 5:33:17 AM PST by goat granny
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To: GrandJediMasterYoda

Wow, I checked and you’re right. 5 year survival rate is 4%. I knew it was bad, but didn’t realize it was quite THAT bad. I’ve known 2 people who died of it and yes, it seems more common than I would have thought.


97 posted on 03/04/2012 2:20:33 PM PST by brytlea (An ounce of chocolate is worth a pound of cure)
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To: markman46

I had CPR performed on me, and if they cracked any ribs I never knew about it. Oh, and I survived. ;)


98 posted on 03/04/2012 2:28:40 PM PST by brytlea (An ounce of chocolate is worth a pound of cure)
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