New Jersey Lawmakers Pass Medical Marijuana Bill
TRENTON — The New Jersey Legislature a
pproved a measure on Monday that would make the state the 14th in the nation, but one of the few on the East Coast, to legalize the use of marijuana to help patients with chronic illnesses.
The measure — which would allow patients diagnosed with severe illnesses like cancer, AIDS, Lou Gehrig’s disease, muscular dystrophy and multiple sclerosis to have access to marijuana grown and distributed through state-monitored dispensaries — was passed by the General Assembly and State Senate on the final day of the legislative session.
Gov. Jon S. Corzine has said he would sign it into law before leaving office next Tuesday. Supporters said that within nine months, patients with a prescription for marijuana from their doctors should be able to obtain it at one of six locations.
“It’s nice to finally see a day when democracy helps heal people,” said Charles Kwiatkowski, 38, one of dozens of patients who rallied at the State House before the vote and broke into applause when the lawmakers approved the measure.
Mr. Kwiatkowski, of Hazlet, N.J., who has multiple sclerosis, said his doctors have recommended marijuana to treat neuralgia, which causes him to lose the feeling and the use of his right arm and shoulders. “The M.S. Society has shown that this drug will help slow the progression of my disease. Why would I want to use anything else?”
January 12, 2010
Second Opinion
Facing End-of-Life Talks, Doctors Choose to Wait
By DENISE GRADY
It’s a conversation that most people dread, doctors and patients alike. The cancer is terminal, time is short, and tough decisions loom — about accepting treatment or rejecting it, and choosing where and how to die.
When is the right time — if there is one — to bring up these painful issues with someone who is terminally ill?
Guidelines for doctors say the discussion should begin when a patient has a year or less to live. That way, patients and their families can plan whether they want to do everything possible to stay alive, or to avoid respirators, resuscitation, additional chemotherapy and the web of tubes, needles, pumps and other machines that often accompany death in the hospital.
But many doctors, e
specially older ones and specialists, say they would postpone those conversations, according to a study published onlineMonday in the journal Cancer.
It’s not entirely clear whether these doctors are remiss for not speaking up — or whether the guidelines are unrealistic. Advice that sounds good on paper may be no match for the emotions on both sides when it comes to facing patients and their families and admitting that it will soon be over, that all medicine can offer is a bit of comfort while the patient waits to die.
Dr. Nancy L. Keating, the first author of the study and an associate professor of medicine and health care policy at Harvard, said not much was known about how, when or even if doctors were having these difficult talks with dying patients. But she said that her research team suspected that communication was falling short, because studies have shown that even though most people want to die at home, most wind up dying in the hospital.
The researchers surveyed 4,074 doctors who took care of cancer patients, instructing them to imagine one who had only four to six months left, but was still feeling well. Then the doctors were asked when they would discuss the prognosis, whether th
e patient wanted resuscitation or hospice care, and where he or she wanted to die.
The results came as a surprise: the doctors were even more reluctant to ask certain questions than the researchers had expected. Although 65 percent said they would talk about the prognosis “now,” far fewer would discuss the other issues at the same time: resuscitation, 44 percent; hospice, 26 percent; site of death, 21 percent. Instead, most of the doctors said they would rather wait until the patients felt worse or there were no more cancer treatments to offer.
They were not asked for their reasoning, but Dr. Keating offered several possibilities. One is that doctors may disagree with the guidelines, which are based on expert opinion rather than data.
“Or they may not be
comfortable discussing it,” she said. “These conversations are time-consuming and difficult. Some doctors may feel patients will lose hope. It’s easier to say, ‘Let’s try another round of chemotherapy,’ instead of having a heart-to-heart discussion.” Training may also be a factor, Dr. Keating said. Medical schools spend more time on end-of-life issues than they did in the past, and the greater willingness of younger doctors to broach the subject may reflect that change.
Dr. Daniel Laheru, an associate professor at the Kimmel Cancer Center at Johns Hopkins and a specialist in pancreatic and colorectal cancers, said he was not surprised by the study.
“The natural tendency is not to provide more information about this than you have to,” he said. “It’s such an uncomfortable conversation and it takes such a long time to do it right.”
He added, “People come to us with hope, and if you kind of yank that away from them right away, it’s very
unsettling.”
A terminal diagnosis plus the grim details of “do not resuscitate” orders and hospice care may be too much for a patient to hear in one day. Dr. Laheru said he tried to prepare patients on their first visit for the idea that during later visits they would discuss different possible outcomes.
“They don’t always hear that part,” he said.
Dr. John Boockvar, a neurosurgeon at NewYork-Presbyterian/Weill Cornell Medical Center who treats many patients with malignant brain tumors, said he favored postponing such discussions until the end was drawing close. During his own late father’s illness with leukemia, he said, his family was upset by an oncologist who brought up end-of-life issues early.
“As a patient and a family member, I don’t know if I would have wanted to hear a doctor say, ‘In 18 months we’ll be dealing with hospic
e or end-of-life discussions — do you want to have that discussion now?’ ” Dr. Boockvar said. “I don’t know what the emotional benefit is to the family. I don’t think it’s been studied.”
As a doctor treating patients who are terminally ill, he went on, he did not hesitate to discuss end-of-life issues. But he said, “As the time approaches, there’s usually ample time.”
But Dr. David R. Hilden, an internist at Hennepin County Medical Center in Minneapolis and an assistant professor of medicine at the University of Minnesota, is not so sure.
“I think many of us wait until there’s just a few weeks left and then you have no choice,” he said. “It’s going to happen in a week or two, and they’re in the hospital and they’re on their last legs. The time to talk is much earlier.”
Without planning, Dr. Hilden said, dying patients may wind up in exactly the situation they dreaded most, tethered
to machines in a hospital instead of being kept comfortable at home in their own beds.
“This last week, I had a patient with prostate cancer and end-stage heart disease, who probably has less than a year,” he said. “I talked to him and his wife. ‘How do you want your remaining days to be? How much do you want us to do?’ He and his wife were very receptive. Many patients appreciate it. We had a good conversation. It’s easier when the patient is older and it’s not entirely unexpected. He’s 86.”
The patient said he did not want tubes or machines, but just wanted to be comfortable for his last few months.
“They were at peace with it,” Dr. Hilden said, adding that many patients who get aggressive treatment for advanced cancer might in retrospect have made a different choice.
“They might say: ‘After that last three or four months of radiation and chemotherapy, I’m sick, I’m nauseated, my hair fell out and it didn’t extend my life. I might not have done it if I’d known, if I had had the chance.’ ”
Dr. Keating agreed, saying she thought that often when terminally ill patients choose to continue chemotherapy, they don’t understand its limits.
“They say, ‘I want to do e
verything,’ and they mean ‘everything to cure me,’ ” she said. “They don’t understand it’s not curative.”
Despite the difficulties, she went on, doctors should level with their patients.
“When you know someone’s going to die of their disease, it’s only fair to the patients to help them understand that,” Dr. Keating said. “But these conversations are very challenging. Figuring out how to do it well — it’s so tricky. It’s definitely not something everybody believes in.”
January 12, 2010
At
a Mighty 104, Gone While Still Going Strong
By MANNY FERNANDEZ and MICHAEL S. SCHMIDT
Joe Rollino once lifted 475 pounds. He used neither his arms nor his legs but, reportedly, his teeth. With just one finger he raised up 635 pounds; with his back he moved 3,200. He bit down on quarters to bend them with his thumb.
People called him the Great Joe Rollino, the Mighty Joe Rollino and even the World’s
Strongest Man, and what did it matter if at least one of those people was Mr. Rollino himself.
On Monday morning, Mr. Rollino went for a walk in his Brooklyn neighborhood, a daily routine. It was part of the Great Joe Rollino’s greatest feat, a display of physical dexterity and stamina so subtle that it revealed itself only if you happened to ask him his date of birth: March 19, 1905. He was 104 years old and counting.
A few minutes before 7 a.m., as Mr. Rollino was crossing Bay Ridge Parkway at 13th Avenue, a 1999 Ford Windstar minivan struck him. The police said he suffered fractures to his pelvis, chest, ribs and face, as well as head trauma. Unconscious, he was taken to Lutheran Medical Center, where he later died.
New York is a city of extraordinary lives and events, and here, indisputably, was one of them — one of the city’s strongest and oldest, struck down on a Monday morning by a minivan in Brooklyn.
“Pound for pound, in the feats that he practiced, he was one of the greatest performing strongmen we’ve ever had, if the lifts he’s credited with are accurate,” said Terry Todd, a co-director of the Stark Center for Physical Culture and Sports at the University of Texas, who knew Mr. Rollino for more than four decades. “He certainly wasn’t one of the strongest all-time strongmen, because of his size. To ask a well-trained 130-pound man if he can lift what a well-trained 400-pound man can lift is asking an unreasonable question. But for his size, Joe was apparently one of the strongest men who ever lived.”
Mr. Rollino stayed away from meat. And cigarettes. And alcohol. He said he walked five miles every morning, rain or shine. At the height of his career, he weighed between 125 and 150 pounds and stood about 5-foot-5.
He was a teenager when he watched Jack Dempsey knock out Jess Willard in 1919. He later boxed under the name Kid Dundee, became a Coney Island performer, worked as a longshoreman, fought in World War II and had a bit part in “On the Waterfront” that never made the film, not necessarily in that order.
Among his many accomplishments, Mr. Rollino was proudest of one in particular. “My finger strength,” he told an interviewer for ESPN The Magazine. “Six hundred thirty-five pounds. See the size of it. At 150 pounds, nobody ever beat me in this world.”
He was a legend within that small Coney Island society in which few New Yorkers would want to become known as legends: the men and women who swim in the Atlantic when it is at its harshest and coldest. On a 6-degree day in January 1974, Mr. Rollino and six other members of the Iceberg Athletic Club swam into the waters off Coney Island. The freezing Atlantic was like steel: It didn’t intimidate him.
“People told me he holds the record for swimming every day for eight years,” said Louis Scarcella, 59, a former homicide detective and a member of the city’s oldest winter swimming club, the Coney Island Polar Bear Club. “He was known as the Great Joe Rollino, and he was great. You knew he was great just by standing next to him. He just had that humble confidence and strength. It shined.”
Mr. Scarcella, like many of those who knew Mr. Rollino, has a Joe Rollino story, or several Joe Rollino stories. And though some of them can be neither confirmed nor refuted, they get told and retold and told again, because they are too good not to. Mr. Scarcella heard that one winter in the 1950s, Mr. Rollino recovered the bodies of two people who drowned in Prospect Park, because the police did not have the necessary protective equipment and it was too cold for anyone else to jump in and bring them to the surface.
Mr. Rollino was a longtime member of the Association of Oldetime Barbell and Strongmen. Dennis Rogers, a fellow member and a professional strongman, remembered seeing him at the association’s annual dinner in June, at a hotel near the Newark airport. “He just came in to say hi to everybody and coached some of the guys that were performing,” said Mr. Rogers, who in 1995 prevented four motorcycles from moving at full throttle for 12 seconds, according to his Web site. “He would regularly work out in the gym. He was in pretty good shape. He walked a little slow but looked fine.”
Mr. Rollino had lately been living in Brooklyn with a niece, in a house on 14th Avenue, about a block from where the accident occurred. The driver of the minivan that struck Mr. Rollino, a 54-year-old woman who lives in the neighborhood and who remained at the scene, was not charged. She received a summons for having a defective horn, and the police said that neither speed nor alcohol was a factor. Mr. Rollino had been walking about 40 feet from the nearest crosswalk when the minivan hit him, according to the authorities.
Old photographs of Mr. Rollino are displayed in several neighborhood shops. People called him Puggy. “If he shook your hand, he’d break it,” said James Romeo, owner of Romeo Brothers Meats and Foods on 15th Avenue. “He wasn’t feeble.”
Charles Denson, a historian and the author of “Coney Island: Lost and Found,” first met Mr. Rollino at his 103rd birthday party at a neighborhood restaurant. “He was one of the last links to the old strongman days of Coney Island,” he said. “Coney Island was the training ground for strongmen. He was one of the best.”
Mr. Rollino wowed the crowd at the party, Mr. Denson recalled. He told stories about the old days, of course, but he was more than just talk, even at 103. Mr. Rollino put a quarter in his teeth. Then he bent it.
No comments:
Post a Comment