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In a rare personal message, California’s 77-year-old governor provided insight into his deliberations before deciding to sign a bill allowing terminally ill Californians to legally take their own lives, reflecting on religion and self-determination as he weighed an emotionally fraught choice.
Gov. Jerry Brown, a lifelong Catholic and former Jesuit seminarian, said he consulted a Catholic bishop, two of his own doctors and friends “who take varied, contradictory and nuanced positions.”
“In the end, I was left to reflect on what I would want in the face of my own death,” wrote the Democratic governor, who has been treated for prostate cancer and melanoma. “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill.”
Brown’s signature on the right-to-die legislation Monday capped an intensely personal debate that dominated much of this year’s legislative session and divided lawmakers. Many lawmakers also drew on personal experience to explain their decisions to support or reject legislation making California the fifth state to allow terminally ill patients to use doctor-prescribed drugs to end their lives.
At the center of the debate was Brittany Maynard, a 29-year-old California woman with brain cancer who drew national attention for her decision to move to Oregon to end her life.
In a video recorded days before Maynard took life-ending drugs, she told California lawmakers that the terminally ill should not have to “leave their home and community for peace of mind, to escape suffering and to plan for a gentle death.”
Maynard’s husband and mother were regular visitors to the Capitol, testifying at committee hearings and meeting with undecided lawmakers. Maynard’s mother, Debbie Ziegler, said Brown “listened with a compassionate heart and a discerning mind.”
Ziegler said in a statement that Brown’s decision “allows true principles of mercy to guide end-of-life care for the terminally ill in California.”
The measure applies only to mentally sound people and not those who are depressed or impaired. The bill includes requirements that patients be physically capable of taking the medication themselves, that two doctors approve it, that the patients submit several written requests and that there be two witnesses, one of whom is not a family member.
Supporters hope that adoption of right-to-die legislation in the nation’s most populous state will spur approval elsewhere, although legislation introduced this year in at least two dozen other states stalled. Doctors in Oregon, Washington, Vermont and Montana already can prescribe life-ending drugs.
The Catholic Church and advocates for people with disabilities opposed the legislation, saying it legalizes premature suicide and puts terminally ill patients at risk for coerced death. Opponents targeted Catholic Latino lawmakers, urging them to block its passage.
Opponents said Monday that they were disappointed the governor relied so heavily on his personal experience in his decision and that they were considering options to stop it.
As someone of wealth with access to the world’s best medical care, “the governor’s background is very different than that of millions of Californians living in health care poverty without that same access,” the group Californians Against Assisted Suicide said in a statement.
The passage of the bill by Assemblywoman Susan Eggman, D-Stockton, was the latest attempt to advance such legislation in California. A proposal earlier in the year stalled and the measure was brought back as part of a special session on health care. The law cannot take effect until the session formally ends, which probably will not happen until at least mid-2016.
Some may be familiar with Durham’s start as a tobacco town or the popular nickname “Bull City,” but today Durham is also referred to as the City of Medicine.
Durham’s identity as a healthcare leader traces back to 1906, when Durham pharmacists Germain Bernard and C.T. Council developed BC Headache Powder. In the century that followed, healthcare has become Durham’s largest employment cluster – nearly one in three people in Durham works in a health-related field, and more than 300 medical and health-related companies, medical practices, weight management centers, and pharmaceutical research organizations are located here, with a combined payroll exceeding $1.2 billion.
Today, Durham continues to earn its name as the City of Medicine because it has:
- A physician-to-population ratio almost 4.5 times the national average.
- Over 3,700 licensed physicians and interns and more than 6,000 nurses.
- 46% of the biotech firms based in North Carolina.
- One of three US hospitals to be recognized by the American Hospital Association for leadership and innovation in quality, safety, and commitment to patient care.
- One of the top 10 US hospitals according to U.S. News & World Report.
- Facilities serving more than 200,000 veterans living in a 26-county area of central and eastern North Carolina.
- Six modern hospitals that lie at the heart of Duham’s reputation: Duke University Hospital & Medical Center, Duke Children’s Hospital & McGovern-Davison Health Center, Duke Regional Hospital, Durham Veterans Administration (VA) Medical Center, Lenox Baker Children’s Hospital, and North Carolina Specialty Hospital.
They asked for a miracle, and they got one. Brandon and Brittany Buell are celebrating the first birthday of their son, Jaxon Emmett Buell, a baby born with “an extreme brain malformation that the doctors are not even labeling with a name, and for which there is no cure,” they explain. They’re calling their son’s incredible story “Jaxon Strong.”
Yesterday (August 28), Brandon wrote on Facebook that Jaxon’s first birthday on that day is “a miracle, in and of itself, that through everything Jaxon has already been through, through his diagnosis, by the doubts of several medical teams, and with his perceived prognosis, he is still here, strong as ever, only dependent on a feeding tube, and can hear, see, talk, smile, laugh, and is learning more every day, even how to say ‘Mama’ and ‘Dadda’ directly to us.”
Seventy years ago, a farmer beheaded a chicken in Colorado, and it refused to die. Mike, as the bird became known, survived for 18 months and became famous. But how did he live without a head for so long, asks Chris Stokel-Walker.
On 10 September 1945 Lloyd Olsen and his wife Clara were killing chickens, on their farm in Fruita, Colorado. Olsen would decapitate the birds, his wife would clean them up. But one of the 40 or 50 animals that went under Olsen’s hatchet that day didn’t behave like the rest.
“They got down to the end and had one who was still alive, up and walking around,” says the couple’s great-grandson, Troy Waters, himself a farmer in Fruita. The chicken kicked and ran, and didn’t stop.
It was placed in an old apple box on the farm’s screened porch for the night, and when Lloyd Olsen woke the following morning, he stepped outside to see what had happened. “The damn thing was still alive,” says Waters.
“It’s part of our weird family history,” says Christa Waters, Troy’s wife.
Waters heard the story as a boy, when his bedridden great-grandfather came to live with Troy’s family. The two had adjacent bedrooms, and the old man, often sleepless, would talk for hours.
“He took the chicken carcasses to town to sell them at the meat market,” Waters says.
“He took this rooster with him – and back then he was still using the horse and wagon quite a bit. He threw it in the wagon, took the chicken in with him and started betting people beer or something that he had a live headless chicken.”
Word spread around Fruita about the miraculous headless bird. The local paper dispatched a reporter to interview Olsen, and two weeks later a sideshow promoter called Hope Wade travelled nearly 300 miles from Salt Lake City, Utah. He had a simple proposition: take the chicken on to the sideshow circuit – they could make some money.
“Back then in the 1940s, they had a small farm and were struggling,” Waters says. “Lloyd said, ‘What the hell – we might as well.'”
First they visited Salt Lake City and the University of Utah, where the chicken was put through a battery of tests. Rumour has it that university scientists surgically removed the heads of many other chickens to see whether any would live.
It was here that Life Magazine came to marvel over the story of Miracle Mike the Headless Chicken – as he had by now been branded by Hope Wade. Then Lloyd, Clara and Mike set off on a tour of the US.
They went to California and Arizona, and Hope Wade took Mike on a tour of the south-eastern United States when the Olsens had to return to their farm to collect the harvest.
The bird’s travels were carefully documented by Clara in a scrapbook that is preserved in the Waters’s gun safe today.
People around the country wrote letters – 40 or 50 in all – and not all positive. One compared the Olsens to Nazis, another from Alaska asked them to swap Mike’s drumstick in exchange for a wooden leg. Some were addressed only to “The owners of the headless chicken in Colorado”, yet still found their way to the family farm.
After the initial tour, the Olsens took Mike the Headless Chicken to Phoenix, Arizona, where disaster struck in the spring of 1947.
“That’s where it died – in Phoenix,” Waters says.
What happens when a chicken’s head is chopped off?
- Beheading disconnects the brain from the rest of the body, but for a short period the spinal cord circuits still have residual oxygen.
- Without input from the brain these circuits start spontaneously. “The neurons become active, the legs start moving,” says Dr Tom Smulders of Newcastle University.
- Usually the chicken is lying down when this happens, but in rare cases, neurons will fire a motor programme of running.
- “The chicken will indeed run for a little while,” says Smulders. “But not for 18 months, more like 15 minutes or so.”
Mike was fed with liquid food and water that the Olsens dropped directly into his oesophagus. Another vital bodily function they helped with was clearing mucus from his throat. They fed him with a dropper, and cleared his throat with a syringe.
The night Mike died, they were woken in their motel room by the sound of the bird choking. When they looked for the syringe they realised they had left it at the sideshow, and before they could find an alternative, Mike suffocated.
“For years he would claim he had sold [the chicken] to a guy in the sideshow circuit,” Waters says, before pausing. “It wasn’t until, well, a few years before he died that he finally admitted to me one night that it died on him. I think he didn’t ever want to admit he screwed up and let the proverbial goose that lays golden eggs die on him.”
Olsen would never tell what he did with the dead bird. “I’m willing to bet he got flipped out in the desert somewhere between here and Phoenix, on the side of the road, probably eaten by coyotes,” Waters says.
But by any measure Mike, bred as a fryer chicken, had a good innings. How had he been able to survive for so long?
The thing that surprises Dr Tom Smulders, a chicken expert at the Centre for Behaviour and Evolution at Newcastle University, is that he did not bleed to death. The fact that he was able to continue functioning without a head he finds easier to explain.
“You’d be amazed how little brain there is in the front of the head of a chicken,” says Smulders.
It is mostly concentrated at the back of the skull, behind the eyes, he explains.
Reports indicate that Mike’s beak, face, eyes and an ear were removed with the hatchet blow. But Smulders estimates that up to 80% of his brain by mass – and almost everything that controls the chicken’s body, including heart rate, breathing, hunger and digestion – remained untouched.
It was suggested at the time that Mike survived the blow because part or all of the brain stem remained attached to his body. Since then science has evolved, and what was then called the brain stem has been found to be part of the brain proper.
“Most of the bird brain as we know it now would actually be considered the brain stem back then,” Smulders says.
“The names that had been given to parts of the bird brain in the late 1800s were all indicating equivalences with the mammalian brain that were in fact wrong.”
Why those who tried to create a Mike of their own did not succeed is hard to explain. It seems the cut, in Mike’s case, came in just the right place, and a timely blood clot luckily prevented him bleeding to death.
Troy Waters suspects that his great-grandfather tried to replicate his success with the hatchet a few times.
Certainly, others did. A neighbour who lived up the road would buy up any chickens for sale at an auction in nearby Grand Junction, Colorado, and stop by the family farm with a six-pack of beer for Olsen, to persuade him to explain exactly how he did it.
“I remember [him] telling me, laughing, that he got free beer every other weekend because the neighbour was sure he got filthy rich off this chicken,” Waters says.
“Filthy rich” was an opinion many held in Fruita of the Olsen family. But according to Waters, that was an exaggeration.
“He did make a little money off it,” Waters says. He bought a hay baler and two tractors, replacing his horse and mule. And also – a bit of a luxury – a 1946 Chevrolet pickup truck.
Waters once asked Lloyd Olsen if he had fun. “He said, ‘Oh yeah, I had a chance to travel around and see parts of the country I probably otherwise wouldn’t have seen. I was able to modernise and have farm equipment.’ But it was something he put in his past.
“He still farmed the rest of his life, scratched a living out of the dirt.”
“Take your hands out of your pockets”, these were the words that the Giza governor has used to humiliate a physician in duty during a sudden inspection surrounded by cameras and journalists.
The incident has caused widespread controversy among the medical community in Egypt and several
Facebook pages and protests were carried on to make the governor apologize to physicians for his behavior. The governor has refused to apologize.
Egyptian doctors often work in these difficult conditions for little to no pay. Young doctors are often given as little as LE185 ($30) basic salary for an entire month’s pay. When the incentives are added, usually the total salary is a meager LE900 ($148). And they get LE19 ($3) as a compensation for the risk of infection.
When doctors graduate from medical school, they usually have to complete a residency for two to three years, often far away from home, where they are expected to use the money to cover their living expenses and transportation. The low income often forces doctors to seek work in private institutions alongside their work in public hospitals. However, balancing two jobs is not easy and doctors begin to make mistakes.
1. Your desire to be wealthy
Very few people in medicine ever become hugely wealthy, at least not in Europe. If riches are what you desire there are many many easier ways of getting that involve alot less heartache, money and stress. If you want to be a millionnaire before you’re 30, my advice would be to avoid university altogether. Most doctors are in the profession for genuinely altruistic reasons as well as the satisfaction that comes from knowing that you have the skills and knowledge to save lives and apply these every single day as a routine part of your work.
2. Your desire to change the world
Equally you must, eventually, give up on the idea of becoming some sort of medical superhero who can solve the worlds medical problems one by one. Yes doctors can do some impressive things when applying their skills to the right situation. But remember that however good your intentions, you will not be able to overcome the problems caused by poverty, war, government neglect or abuse, or coorporate profiteering at the expense of the sick. That doesn’t mean you can’t try to help people afflicted by any of these, you’ll just find that you are usually too small to make any real systemic difference.
3. Your free weekends
It starts at medical school when the work starts to pile up, and weekends are sacrificed to meet deadlines and for exam revision. Once you start working as a junior doctor, you’ll find yourself scanning each new doctors rota to work out where your on-call weekends have landed and who can swop with you so that you can still go on that holiday or get married or whatever. There will be sunny weekends when your non-medic friends will be having a barbecue whilst you sweat it out on a ward seeing yet another gastrointestinal bleed wondering why you chose this path.
4. A good nights sleep
Gone are the days where doctors would be on call for 48 or 72 hours and then do a clinic for the boss before retiring to bed. However, modern working arrangements have brought into existence the ‘week of nights’ where you work 4 or 5 and sometimes 7 night shifts in a row.
As someone who has done these I can confirm that doing nights is pretty inhumane. The talk amongst doctors doing nights together often centres around changing specialty or leaving the profession. Don’t worry, it all gets forgotten once normal daytime duties are restored.
5. Your desire to avoid feeling like a fool
You will make mistakes from time to time in this job and your mistakes will all be potentially serious ones, simply because everything you do affects your patients’ lives directly.
Furthermore, there will be times when you have to withstand an onslaught from senior doctors who feel that teaching by humiliation is the only way forward. You will feel like an idiot at times and if the thought of that frightens you you should promptly pick a different profession.
6. Your desire to always put friends and family first
As a doctor your job usually takes priority and you simply cannot shirk your responsibilities simply because you have prior engagements of a personal nature. Over the years I’ve known many difficult situations including a colleague who had to turn down a role as best man for a close friend because nobody could swop his on-call weekend with him and the hospital refused to organise a locum to cover him.
Apart from sickness or bereavement, your first priority will be to your profession. Your friends and family may find that difficult to understand at first. They’ll come round to it with time, especially once they delete your number.
7. Your desire to please everyone
Whether it’s your friends or family, as above, or your future patients you’d better get used to upsetting people from time to time. Telling your wife you need to postpone an evening engagement because you are still operating on a difficult case, or telling a patient you won’t be operating on them as they only have three months to live, are both likely to be met with upset. Each situation has it’s unique challenges and needs some communication skills, but the bottom line is that you will have times when you will have to make someone want to either hit you or cry in despair.
8. Your creativity
Not many people admit this but medicine takes people who are often very creative and turns them into workaholic, automatons who have little room left in their lives for creativity. If you want evidence for this, go to any dinner party that includes more than one doctor. Chief discussion topic will be work and medicine. That’s partly because anecdotes from doctoring are entertaining, but also because if the medics stray from this conversation topic, they will rapidly expose their banality and limited insights in other areas particularly all things creative.
Much of medicine does not allow much creativity in it’s day to day practice and the intensity of the work beats any desire for creative thinking right out of you before you even realise it’s happening.* Of course whilst accepting this fact you must fight this tendency and attempt to keep up your other interests, otherwise, I can guarantee medicine will invade everything you do.
9. Your desire to stay in one place / live close to friends and family
Want to do something competitive, like medicine? You have to realise that choosing your location is a luxury and you may have to follow your dream in a less than ideal location. Even after you graduate, having your heart set on one speciality is a sure way to geographical instability. Some people don’t mind this, but some with strong family ties or a mortgage, the need to move frequently is a pain.
I began to come to terms with this when I found that even the most obscure places have hospitals. Working in these places you’re just as likely to meet doctors who have also had to move from here from the other side of the country. It’s a great way to meet people but easy to lose touch once you move on.
10. Good health
You may not know it, but you’re joining a profession that has high rates of physical and mental illness as well as drug and alcohol misuse. Doctors are also less likely to seek help than other professions which all adds to a rather worrying picture.
Although ill health isn’t guaranteed in a medical profession you should realise the future risk now and take steps to formulate good lifestyle habits to minimise your risk factors. A good network of non-medical friends should also protect you from neglecting your own needs while you’re treating your patients.