Longer Looks: The Bittersweet Decision To Donate Organs

Every week reporter Ankita Rao selects interesting reading from around the Web.

Forbes: City Surgeon: Can The Cleveland Clinic Save Its Hometown?
Delos M. "Toby" Cosgrove arrived at the Cleveland Clinic in 1975 as an "incredibly poor" 34-year-old dreaming of a life as a cardiac surgeon. … As the years passed he became well-known for pioneering the replacement of heart valves, eventually assuming the chair of the department of cardiothoracic surgery. Concurrently he created the clinic’s office that oversaw the licensing of medical devices like surgical clamps and spine screws to companies like Medtronic and Boston Scientific. In 2003 he started looking for a second career, maybe as a venture capitalist in California, figuring that at 62 he was too old to operate. ... Then he was offered the job as the clinic's chief executive. The rough old neighborhood is a distant memory, replaced by a gleaming testament to modern medicine stretching out over 46 buildings and covering 167 acres. Protected by a dedicated 141-trooper force of state police, there is a conference center, a fancy hotel and a farmers' market. Over Cosgrove's tenure the clinic’s revenues have nearly doubled to $6.2 billion (Matthew Herper, 9/4).

The Washington Post: For One Family, Organ Donation Offers A Bittersweet Ending
My 55-year-old brother-in-law, Vince, had arrived at Howard County General Hospital's intensive care unit late Saturday night. Sunday morning, the police called us: Vince was in critical condition, and we needed to come to the hospital. … Over the next few days, family members and friends kept a vigil at Vince's bedside. Nurses came and went, changing bags that fed the IV lines, drawing blood, checking his vitals. It was becoming clear that we would soon be faced with decisions not about his future but about whether to end life support. Like so many Americans, Vince had no advance directive and had not named a health-care decision-maker. In such situations, Maryland law designates decision-makers, starting with next of kin. In his case, that meant the responsibility would fall to his only child, Tory, who at the time was only 23 (Janice Lynch Schuster, 9/2).

Stanford Magazine: Mind Over Misery
The patient looks around frantically. She is sobbing, panicking, overwhelmed by anxiety. She says she can't breathe; her lungs are about to collapse; her heart is about to stop. She feels like she is going to die. Listening to this, Stanford psychiatrist David D. Burns calmly asks, "Do you think you could exercise strenuously right now?" Uncomfortable, nervous laughter breaks out among the 100 psychologists, psychiatrists, social workers, and family and marriage counselors watching the scene unfold on a large video screen. It's part of Scared Stiff!—a two-day seminar on fast, drug-free treatment for anxiety and depression that Burns, MD '70, is giving in a nondescript hotel ballroom outside Chicago.  … Before showing the video, Burns warned that participants might find his approach "threatening or even disturbing." That he would challenge deeply held beliefs and the conventional wisdom they were taught. Particularly touchy is his long-held conviction that—except for those suffering from clear-cut mental illnesses such as schizophrenia, bipolar disease and severe depression—many pharmaceutical treatments have little or no effect (Robert L. Strauss, 9/2013).

The New York Times: In California, Intense Debate Over Home Care
An important struggle over home health care is playing out in California, the nation's most populous state, including nearly five million residents age 65 and older. Unions and organizations representing the elderly have joined together to push for legislation that would license agencies, certify workers and create a publicly accessible caregiver registry. Home care agencies are pushing back, saying they favor regulation but oppose the measures under consideration. ... An estimated 1,400 home care agencies and 120,000 paid caregivers would be affected by the proposed legislation, which is essentially an effort to bring consumer protections to an industry that has been likened to the Wild West. "It's just not right that I can check the license status of an air-conditioning repairman but I can't do so for someone coming into my home to care for a loved one," said Assemblywoman Bonnie Lowenthal, a Democrat and the bill's sponsor (Judith Graham, 8/30).

The Washington Post: A Young Geriatrician On The Struggles Of Alzheimer’s Patient – And Their Caretakers
I walked into the examining room and found my new patient, an 83-year-old woman, silently occupying the blue plastic seat of a wheelchair. Despite her neatly groomed appearance, her eyes were uncomprehending. She muttered some words, but they were devoid of meaning. Glaucoma and macular degeneration had taken her eyesight, and Alzheimer's disease had ravaged her mind. … They had driven an hour to consult a geriatrician, a doctor who focuses on the care of medically complex older adults. An internist getting specialized geriatrics training, I knew there would be no straightforward cases when I chose this field (Ariel Green, 9/2).

The New England Journal Of Medicine: Prescription-Drug Coupons – No Such Thing As A Free Lunch
Visit nearly any official website for a brand-name drug available in the United States and, mixed in with links to prescribing and safety information, you'll find links to drug "coupons," including copayment-assistance programs and monthly savings cards. Most offers are variations on "Why pay more? With the [drug] savings card, you can get [drug] for only $18 per prescription if eligible" or "Get a free 30-capsule trial of [drug] with your doctor's prescription and ask your doctor if [drug] is right for you." Why do manufacturers offer drug coupons? Are they good for patients in the long run? Are they even legal? (Dr. Joseph S. Ross and Dr. Aaron S. Kesselheim, 8/28).

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