MUST WATCH: Ain't the Way to Die (@ZDoggMD)

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ZDoggMD (Dr Zubin Damania), once a hospitalist, now a primary care revolutionary with his Turntable Health project, has always made hilarious videos about life as a physician, the patients we see, and the culture of medicine.

Below is his most poignant piece, revealing the difficulties of end-of-life conversations and medical futility both from the patient and the physician perspective. It's not corny or cheesy. It is bang-on.

"Ain't the Way to Die" (a parody of Love the Way You Lie, by Eminem and Rihanna) is so scarily accurate. The same problems he sings about are what I wrote about in "I QUIT! Will the law force us to provide futile, harmful care?"

I have not quit medicine, probably because there are people out there like Dr Damania who understand exactly what it's like to be asked to prolong someone's suffering.

I've never been able to relate to the angst expressed in a rap before, I guess because I don't have a lot of angst. But this video takes the words right out of my mouth, highlights all the heavy-sigh moments of these conversations - it's time to call the family, the relative in another country who says "he'll wake up," or the conflict in the family between ones who know he would not want to be a vegetable and the others who are holding on out of guilt or fear.


The vent-bucking sounds and monitor bleeps incorporated into the end of the song squeeze the adrenals.

Do watch. 

4 minutes could not be better spent.

Lyrics: “Ain’t The Way To Die”

Based on “Love The Way You Lie” by Eminem and Rihanna

Just gonna stand there and watch me burn
End of life and all my wishes go unheard
They just prolong me and don’t ask why
It’s not right because this ain’t the way to die, ain’t the way to die

Patient:
I can’t tell you what I really want
You can only guess what it feels like
And right now it’s a steel knife in my windpipe
I can’t breathe but ya still fight ‘cause ya can fight
Long as the wrong’s done right—protocol’s tight
High off of drugs, try to sedate
I’m like a pincushion, I hate it, the more I suffer
I suffocate
And right before I’m about to die, you resuscitate me
You think you’ve saved me, and I hate it, wait…
Let me go, I’m leaving you—no I ain’t
Tube is out, you put it right back, here we go again
It’s so insane, ’cause though you think it’s good, I’m so in pain
I’m more machine than man now, I’m Anakin
But no advanced directive, I feel so ashamed
And, crap, who’s that nurse? I don’t even know her name
You lay hands on me, to prolong my life again
I guess you must think that this is livin’…
Just gonna stand there and watch me burn
End of life and all my wishes go unheard
They just prolong me and don’t ask why
It’s my right to choose the way that I should die

Doctor:
You ever love somebody so much, you can barely see when you with ‘em
That they, lay sick and dying but you just don’t wanna let ‘em
Be at peace cause you miss ‘em already and they ain’t gone
Beep beep, the ventilator alarms
I swore I’d never harm ‘em, never do nothing to hurt ‘em
Hippocratic oath primum non nocere now I’m forced just to torture ‘em
They push full code, no one knows what his wishes were
His sister heard him say once, “I don’t wanna be a vegetable”
But no one agrees in the family, his caregiver Kate
Wants him comfort care but Aunt Claire lives so far away
That her guilt eats her like cancer
So she answers, “Wait! I think he’ll wake”
Maam, you ain’t even in the state!
Palliate, relieve pain, get him home, explain
Critical care? Just hypocritical when it’s so insane
But they insist I shock his heart again so I persist
Guess that’s why they say that love is pain.
Just gonna stand there and watch me burn
End of life and all my wishes go unheard
They just prolong me and don’t ask why
It’s my right to choose the way that I should die
The way that I should die


Source: http://zdoggmd.com/aint-the-way-to-die/

Must Watch VIDEO: (TEDMED) Are zombie doctors taking over America?

I don't know how I hadn't already seen this. It is perfect.

I've been feeling lately that it is impossible in this system to deliver good quality care and to be 'happy and well and fulfilled' myself, I can related to almost everything Dr Zubin Damania (aka ZDoggMD) says in his TedMed talk.

For years I've enjoyed ZDoggs hilarious videos but for some reason I did not see his TED talk until today.

Physician Zubin Damania, Director of Healthcare Development for Downtown Project Las Vegas, has a plan to fight back against a system that can dehumanize doctors and patients alike.

So much of what he says about his journey into medicine resonates with me, but this one section captures it all perfectly:

"A typical day in my life went something like this:

It begins with a mad scramble from room to room seeing complicated, sick and scared patients and their families, followed by three hours of paperwork using an electronic medical record that's two keystrokes away from becoming sentient and destroying humanity, all the while answering phone-calls from insurance companies, colleagues, and administrators each asking that I do more and more with less and less while improving quality and patient satisfaction. And speaking of which, that patient for whom I refused Vicadin because I was convinced it was destroying his life just ripped me a new one on Yelp! And I get through my 31st voice mail and I'm trying to delete it and it won't delete and I'm thinking I have to call I.T. now and I realized the reason it won't delete is that it's a live person I'm talking to. And it's my wife. And she's asking me to come home.

When I finally do get home, I can't be present with my two little girls because all I can think about is 'could I have missed something in this insane shuffle that could hurt or kill somebody?' Later, rinse, repeat for an entire career."


"Enough was enough. I realized I had a choice to make. I could either submit to this insane system and retire and then do my thing, but have my soul crushed and join the ranks of the swelling physician-zombie apocalypse. Or, I could surrender.

Just give up the external validation, drop the mask, and really surrender to who I actually was and have some hope of reconnecting to my purpose."


I need to do that. Dr Damania and Iora Health understand the fundamentals of providing the right kind of care. If we weren't wasting so much time and energy on all kinds of things that don't really matter, we could start to care for people again.

How can we do it?

- remember "medicine is about human relationships"
- "fix the reimbursement system . . make it an affordable, flat fee that incentivizes everyone to keep everybody well."
- "revolutionize the care model and the culture of the team; health coaches, nurse practitioners, doctors, and patients working together collaboratively non-hierarchically to change the health of the whole community"
- "glue it together with technology that helps rather than obstructs
- "do things FOR people instead of TO people"

I want to be a part of a clinic like that!

Source: http://www.tedmed.com/talks/show?id=34752