BillsFanM.D.

Great read. Very 'real' and many of us feel the same. Here's my favorite quote from your story and I bolded it for emphasis: "My parents went to their first Bills game together in 1994. It was a midseason game against the Chiefs, and I remember this vividly because I was pissed as hell that I couldn’t go."

Seriously! How in the heck can a bunch of criminals have access to equipment that will (errrr....would have) literally be a few feet from the POTUS? Crazy. Somebody's gonna have a career casualty in this one.

It was a good call...just poorly executed. There was a playoff game in the early 90's with the niners and cowboys. The cowboys were deep in their own territory with a four point lead and everyone expected them to pound the ball and milk out the clock by getting a first down or two....or punt it away with minimal time on the clock. The "hair man" went for the throat and the result was a 70+ yard post to Alvin Harper. I always remember that game when folks question these type of calls. JJ is a genius...but Chan is a dope? It was a great call and had Fitz thrown a respectable ball it is either incomplete or game over. Sadly....he did not.

...and the board should have a mandatory 24 hour cooling off period after this picture perfect post! Strong work Sir Dorkington.

Exactly how I do it. I was a busboy in college for four years so I learned to appreciate how difficult those type of jobs can be. Tips should be earned and, when they are, I prefer to be generous in those moments. Edit: Oh...and I thought for sure this was a drinking question re: 'tipping.'

The robots never worked. Should have gone the same path as the 'glowing vapor trail' puck in hockey. Lame, unnecessary and totally stupid.

Faith is the perfect term. Some might define it as belief in that not yet seen. Every Sunday I have 'faith' they will will. I then wait for the proof. Some weeks I feel more convicted but there is no way to 'prove' your feeling about the team unless it is all done retrospectively.

I did not take it as a knock. I took it as a generalization about a field of medicine that faces 'this' issue more frequently than others. My wife, and most oncologists I've worked with, do an excellent job of providing the facts to families and patients. However, I've also known a few oncologists who will 'treat to the grave' so to speak. Why that occurs is very complicated. The poster you were bantering with seemed to imply it was the doctors 'fault.' At times it can be... but clearly MOST physicians do not want to participate in futile care. My mentioning that my wife (as an oncologist) was a big hospice advocate was more directed to the poster who felt doctors did not do enough. Most of these situations, IMHO, are driven by other factors. Re: futile care: There was a thread here recently about living wills etc. My 'point' in that one was how do we define "in the event things are deemed hopeless." Whose definition? Whose values? etc. Everyone, in my opinion, should have a designated health care POA. One who can 'speak' to the doctors in what is always a fluid situation rather than a 'checklist' living will with vague yet supposedly rigid guidelines.

I'll jump in. I agree with birdog in regards to doctors trying to prevent futile care. I've had innumerable lengthy conversations with folks where I've detailed a nil chance of survival. Rarely is that advice heeded. The typical response is just "well....do everything you can doc and we'll let the chips fall where they may." You rinse and repeat the conversation but many folks/society typically refuse to accept death as part of life. The care at that stage is often profoundly expensive and is a true drain on a soon to be unsustainable system. I consider myself a huge advocate of hospice and see it as a very underutilized service. Yes...it takes some nerve to speak of death directly to a patient. That challenge, however, doesn't mean docs don't do it. Of note, I'm married to an oncologist and I assure you she is a bigger hospice advocator than most.

As a matter of fact I do..... http://www.anyclip.com/movies/fletch/the-records-room/

Man...that is a reality smack in the face. Made my day. Thanks.

great article and story. JR..your point is so true. Why do people have to take something so 'universally good' and fight about it? My 'favorite comment' was the one that said the kid stopped to help the other runner because he knew he 'wouldn't win the race anyway.' Good kid there but still a lot of bad humanity walking around.

It would be well deserved.

I dont care who wrote it. Read it again and tell me it doesn't get you a little pumped up. The Bills, of late, have showed a sense of growth and direction lacking for over a decade. This goes back to last year. We may not be 'who we think we are' but we seem to have momentum in the right direction. As for positive national coverage...bring it on.

I think it is a priority and I make it so. It was also stressed as a part of my training. "You have to document Code Status." as for other folks...not so sure. Some do it very well and some avoid it like a disease. Should be addressed as part of routine health maintenance. Certainly should be addressed with every hospital admission. I totally agree that the check boxes offer no wiggle room. Hence, as noted in my original post, I prefer the designation of a medical power of attorney. That person will give the 'directions' on what is and is not to be done. They can be flexible whereas the check box is literally black and white. They can listen to other loved ones; doctors; nurses and make an informed decision for 'you' based on what is almost always a fluid and day to day situation. I typically tell patients to avoid AD's in the form of living wills. I, personally, find them to be nearly useless for all the reasons I stated above. They are rarely on hand when needed in an emergency; offer no flexibility; and are very ambiguous in language: "in the event that things are deemed hopeless...." In addition, a medical person should be present to explain the check boxes if they choose to go that route. I typically do tell patients to have a formal document drawn up and at least notarized. I have served as the 'other signature' along with a witness on many of those types (with no lawyer involved). Having said that, I have also written a note in a patient's chart; had them sign it and have a family member and staff member witness it (Pre-EMR days). That depends on the relationship the doc has with the patient/family. The doctor does need to provide his side of the 'service' as you pointed out. By my definition that includes: explaining the options/weaknesses of both living will check boxes and medical POA (be careful who you choose and make sure they know you); explaining the implications of each and the applications of each; provide scenarios and point out how each would work in the real world etc. In today's world, it is probably better for a legal person to draw up the actual document just because if a dispute develops in the family it theoretically has a bit more leverage. Hence, I think it is better to have a formal item but it doesn't prevent me from 'doing it myself' in the right situation.

I hear you. The fact that it even comes up means 'many' people in this country do agree with the guy having a 'case.' Very sad. Apologies. Did not mean to imply you (or others) felt that way personally though my post does read that way. My bad. It was my knee jerk reaction to what could conceivably be another frivolous lawsuit against someone trying to do 'the right thing.' Mea culpa.

Quite frankly....this.

Don't you bring common sense and humanity to the discussion. Good for those folks who did what they could with what they had. Awesome video and hope the victim recovers. Kudos to "Jim" for bringing some reason to this thread.

15k makes you 'nobody's slouch.'

No time to get into this whole mess. Too much flooding in my area. However, advanced directives are not all that they are cooked up to be. They almost all have an implied clause that states something to the effect of: "in the even that x,y or z doctor deems my situation 'hopeless' I do not want 'this or that.' It leaves the doctor 'in the moment' to determine, along with the family, what is and is not hopeless. Based on whose values/quality of life/truly living? You can imagine the countless debates that ensue between the family members who 'really' know the patient and the long lost brother who now 'wants to be in charge' and has a lawyer etc. In addition, many folks want "cpr" and defibrillation but do not want to be intubated. It is often spelled out that way in their living wills. That's nonsense. They all happen simultaneously in many situations and all are essential to have a chance to survive (in many circumstances). Defibrillation may or may not be necessary but that's another discussion. I cannot tell you how many times folks would bring in a living will for their relative (who had an arrest outside the hosp and were treated with emergency protocols and intubated) and it stated that he 'would not want to be intubated.' In these situations, the patient is already stabilized and many times extubated within 48 hours. The family member almost always says that 'this short term ventilator use is fine'. 'He just didn't want to be on it 'forever.'' I've NEVER had a patient recover and say I didn't want to be on that vent the last two days. This is the most common misconception I have seen...and I've seen it many times. Folks check off the box (most of these are boilerplate forms) that says they would not want to be on a vent thinking it means long term. Do yourselves a favor and designate a medical power of attorney and have an honest and frank talk about what you would want and what you wouldn't. Designate them (and several backups) to be the voice you cannot be. A form can speak for you to a degree but every situation is unique and flexibility is necessary most of the time. Besides, if there is no readily apparent form or medical POA present, the patient is going to get the full court press regardless. If they are then left dependent on the machines and not 'recovering' after a period of time, having a person who knows you is much better than a standardized form. Just my 2 pennies from 'the other side.'

I've been flooded out for days (though not as bad as many in my area) so I didn't even see the game. Now I have a better sense of it. thanks for your effort here. I "really" appreciate it.

Indeed. We're getting old.

so obvious...yet it never crossed my mind. You're spot on.