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KEN HILLMAN
KEN HILLMAN is a practising intensive care specialist who is a
Professor of Intensive Care at the University of New South Wales.
He is a passionate advocate of improving the management of the
dying patient in acute hospitals.
KEN HILLMAN
Certain names and details have been changed to protect patients and doctors
identities.
The content presented in this book is meant for inspiration and informational
purposes only. The purchaser of this book understands that the information
contained within this book is not intended to replace medical advice or to be
relied upon to treat, cure or prevent any disease, illness or medical condition.
It is understood that you will seek full medical clearance by a licensed physician
before making any changes mentioned in this book. The author and publisher
claim no responsibility to any person or entity for any liability, loss or damage
caused or alleged to be caused directly or indirectly as a result of the use,
application or interpretation of the material in this book.
10 9 8 7 6 5 4 3 2 1
Introduction1
1 The last six months of my mothers life 9
2 Ageing is not for the weak 19
3 Because we can, we do 47
4 Falls at the end of life 57
5 Apoptosis 75
6 Groundhog Day 83
7 Cognitive decline 91
8 Denises manifesto 107
9 Intensive care sans frontires123
10 Diagnostic dilemmas 131
11 Frailty 153
12 It is hard to die 165
A GOOD LIFE TO THE END
Acknowledgements296
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once. This would reflect the reality that old age is not,
unlike cardiovascular disease, a public health issue to
be prevented. It may also inform our society that death
is inevitable; that the claims of modern medicine are
often unrealistic and exaggerated.
In the specialty of intensive care, we use the term
multi-organ failure. It usually refers to an acute insult
such as infection or trauma causing many organs to
malfunction. However, the term could be accurately
applied to the elderly with organs that are all becoming
dysfunctional and failing.
We have certainly made great advances in the improve
ment of so-called chronic diseases in the elderly. There
is no doubt that we are living longer. We have made
inroads into the management of strokes, heart attacks
and diabetes. But we are left with elderly people with
an increasing list of age-related conditions for which
modern medicine with all its miracles is making little
impact. The great advances in medicine have been
classified under curative and preventative medicine.
We are now moving into a different area which is not
obsessed with mindlessly prolonging life but which
is about identifying the limits of modern medicine,
being honest with people and devoting resources to
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