Robert Martensen
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Robert Lawrence Martensen (January 1, 1947, Lake County,
Ohio Ohio ( ) is a U.S. state, state in the Midwestern United States, Midwestern region of the United States. It borders Lake Erie to the north, Pennsylvania to the east, West Virginia to the southeast, Kentucky to the southwest, Indiana to the ...
– September 26, 2013,
Pasadena Pasadena ( ) is a city in Los Angeles County, California, United States, northeast of downtown Los Angeles. It is the most populous city and the primary cultural center of the San Gabriel Valley. Old Pasadena is the city's original commercial d ...
,
California California () is a U.S. state, state in the Western United States that lies on the West Coast of the United States, Pacific Coast. It borders Oregon to the north, Nevada and Arizona to the east, and shares Mexico–United States border, an ...
) was an American
physician A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...
,
historian A historian is a person who studies and writes about the past and is regarded as an authority on it. Historians are concerned with the continuous, methodical narrative and research of past events as relating to the human species; as well as the ...
, and author.


Career and publications

Martensen worked as physician in
emergency department An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the Acute (medicine), ...
and
intensive care unit An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensive care medicine. An inten ...
settings and as a professor at
Harvard Medical School Harvard Medical School (HMS) is the medical school of Harvard University and is located in the Longwood Medical and Academic Area, Longwood Medical Area in Boston, Massachusetts. Founded in 1782, HMS is the third oldest medical school in the Un ...
,
University of Kansas Medical Center The University of Kansas Medical Center, commonly referred to as KU Med or KUMC, is a medical campus for the University of Kansas. KU Med houses the university's schools of medicine, nursing, and health professions, with the primary health scienc ...
and
Tulane University The Tulane University of Louisiana (commonly referred to as Tulane University) is a private research university in New Orleans, Louisiana, United States. Founded as the Medical College of Louisiana in 1834 by a cohort of medical doctors, it b ...
, teaching
bioethics Bioethics is both a field of study and professional practice, interested in ethical issues related to health (primarily focused on the human, but also increasingly includes animal ethics), including those emerging from advances in biology, me ...
and
medical history The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient is a set of information the physicians collect over medical interviews. It involves the patient, and ev ...
. After
Hurricane Katrina Hurricane Katrina was a powerful, devastating and historic tropical cyclone that caused 1,392 fatalities and damages estimated at $125 billion in late August 2005, particularly in the city of New Orleans and its surrounding area. ...
, he moved to
Maryland Maryland ( ) is a U.S. state, state in the Mid-Atlantic (United States), Mid-Atlantic region of the United States. It borders the states of Virginia to its south, West Virginia to its west, Pennsylvania to its north, and Delaware to its east ...
to work for the
National Institutes of Health The National Institutes of Health (NIH) is the primary agency of the United States government responsible for biomedical and public health research. It was founded in 1887 and is part of the United States Department of Health and Human Service ...
(NIH) as the director of the Office of History. He was a recipient of a 2002 Guggenheim Fellowship towards the completion of his book ''The Brain Takes Shape: An Early History'', published in 2004 by
Oxford University Press Oxford University Press (OUP) is the publishing house of the University of Oxford. It is the largest university press in the world. Its first book was printed in Oxford in 1478, with the Press officially granted the legal right to print books ...
. In 2008, Martensen's book '' A Life Worth Living: A Doctor's Reflections on Illness in a High-Tech Era'' was published by
Farrar, Straus & Giroux Farrar, Straus and Giroux (FSG) is an American book publishing company, founded in 1946 by Roger Williams Straus Jr. and John C. Farrar. FSG is known for publishing literary books, and its authors have won numerous awards, including Pulitzer ...
.Transcript
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Views and experiences

In a 2009 interview with ''
The New York Times ''The New York Times'' (''NYT'') is an American daily newspaper based in New York City. ''The New York Times'' covers domestic, national, and international news, and publishes opinion pieces, investigative reports, and reviews. As one of ...
'', Martensen said
health care in the United States Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments. The U.S. is the only developed country without a sys ...
left many stakeholders dissatisfied. He said hospital
administrators Administrator or admin may refer to: Job roles Computing and internet * Database administrator, a person who is responsible for the environmental aspects of a database * Forum administrator, one who oversees discussions on an Internet forum * N ...
were unhappy because they had to focus on profit, patients felt isolated, and some physicians were quitting because they could not practice
medicine Medicine is the science and Praxis (process), practice of caring for patients, managing the Medical diagnosis, diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, ...
in the way they wanted. Martensen criticized
end-of-life care End-of-life care is health care provided in the time leading up to a person's death. End-of-life care can be provided in the hours, days, or months before a person dies and encompasses care and support for a person's mental and emotional needs, phy ...
in the United States. While most Americans die in
nursing homes A nursing home is a facility for the residential care of older people, senior citizens, or disabled people. Nursing homes may also be referred to as care homes, skilled nursing facilities (SNF), or long-term care facilities. Often, these terms ...
or
hospitals A hospital is a healthcare institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emergency ...
, Martensen said neither are properly oriented to care for
dying Dying is the final stage of life which will eventually lead to death. Diagnosing dying is a complex process of clinical decision-making, and most practice checklists facilitating this diagnosis are based on cancer diagnoses. Signs of dying ...
patients. In nursing homes, management may not want death to occur on-site, so the individual will be sent to the emergency department, and in a hospital, a dying patient may be subject to intrusive
medical technology Health technology is defined by the World Health Organization as the "application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures, and systems developed to solve a health problem and improve quality of liv ...
instead of
palliative care Palliative care (from Latin root "to cloak") is an interdisciplinary medical care-giving approach aimed at optimizing quality of life and mitigating or reducing suffering among people with serious, complex, and often terminal illnesses. Man ...
(which may result from the
incentive In general, incentives are anything that persuade a person or organization to alter their behavior to produce the desired outcome. The laws of economists and of behavior state that higher incentives amount to greater levels of effort and therefo ...
s and disincentives in
health insurance Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...
coverage). Martensen discussed the end-of-life care of both his mother and father. While he was out of town and his mother was in the hospital, her physician called Martensen, saying she had a heart block and he asked if he should put in a
pacemaker A pacemaker, also known as an artificial cardiac pacemaker, is an implanted medical device that generates electrical pulses delivered by electrodes to one or more of the chambers of the heart. Each pulse causes the targeted chamber(s) to co ...
. Martensen, being a physician, knew which medical questions to ask, and he asked for a modest treatment. The issue was her fluids; after she was hydrated her EKG was normal. In Martensen's 2008 book, Chapter 7, "Life in the Narrows", discusses the death of his father. Instead of having a bad death (
dysthanasia In medicine, dysthanasia occurs when a person who is dying has their biological life extended through technological means without regard to the person's quality of life. The term dysthanasia means "bad death" (from the Greek language: δυσ, ''du ...
) that can occur in hospitals, Martensen thought his father's death was relatively good. His father was 86, septic, had deteriorating lung function, an
advance directive An advance healthcare directive, also known as living will, personal directive, advance directive, medical directive or advance decision, is a document in which a person specifies what actions should be taken for their health if they are no longe ...
with a DNR, and he had started to receive
morphine Morphine, formerly also called morphia, is an opiate that is found naturally in opium, a dark brown resin produced by drying the latex of opium poppies (''Papaver somniferum''). It is mainly used as an analgesic (pain medication). There are ...
for
air hunger Shortness of breath (SOB), known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing discomfort that c ...
. Alternatively, Martensen's father could have been put on a mechanical
ventilator A ventilator is a type of breathing apparatus, a class of medical technology that provides mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathi ...
. However, that would have violated both Martensen and his father's wishes. Martensen explained that As the morphine began to act on Martensen's father, his anxiety from air hunger was lessening and he was still conscious. Martensen told his father he thought that life was slipping away, that he thought it was his time, that he loved him, and that was going to remove the oxygen; Martensen's father replied, "thank you."


Education

Martensen was educated at
Harvard University Harvard University is a Private university, private Ivy League research university in Cambridge, Massachusetts, United States. Founded in 1636 and named for its first benefactor, the History of the Puritans in North America, Puritan clergyma ...
(B.A., 1969), Geisel School of Medicine, Dartmouth (M.D., 1974), and the
University of California, San Francisco The University of California, San Francisco (UCSF) is a Public university, public Land-grant university, land-grant research university in San Francisco, California, United States. It is part of the University of California system and is dedic ...
(M.A. and Ph.D., 1993).


See also

*
Futile medical care Futile medical care is the continued provision of medical care or treatment to a patient when there is no reasonable hope of a cure or benefit. Some proponents of evidence-based medicine suggest discontinuing the use of any treatment that has not ...


References

{{DEFAULTSORT:Martensen, Robert American emergency physicians Harvard University alumni Geisel School of Medicine alumni University of California, San Francisco alumni American bioethicists American historians 1947 births 2013 deaths American male non-fiction writers