Robert Martensen
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Robert Lawrence Martensen (January 1, 1947, Lake County,
Ohio Ohio () is a state in the Midwestern region of the United States. Of the fifty U.S. states, it is the 34th-largest by area, and with a population of nearly 11.8 million, is the seventh-most populous and tenth-most densely populated. The sta ...
– September 26, 2013,
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,
California California is a state in the Western United States, located along the Pacific Coast. With nearly 39.2million residents across a total area of approximately , it is the most populous U.S. state and the 3rd largest by area. It is also the m ...
) was an American
physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
,
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 race; as well as the st ...
, and author.


Career and publications

Martensen worked as physician in emergency department and
intensive care unit 220px, 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 intensi ...
settings and as a professor at
Harvard Medical School Harvard Medical School (HMS) is the graduate medical school of Harvard University and is located in the Longwood Medical Area of Boston, Massachusetts. Founded in 1782, HMS is one of the oldest medical schools in the United States and is consi ...
,
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 science ...
and
Tulane University Tulane University, officially the Tulane University of Louisiana, is a private research university in New Orleans, Louisiana. Founded as the Medical College of Louisiana in 1834 by seven young medical doctors, it turned into a comprehensive pub ...
, 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, m ...
and
medical history The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient is information gained by a physician by asking specific questions, either to the patient or to other peo ...
. After Hurricane Katrina, he moved to
Maryland Maryland ( ) is a state in the Mid-Atlantic region of the United States. It shares borders with Virginia, West Virginia, and the District of Columbia to its south and west; Pennsylvania to its north; and Delaware and the Atlantic Ocean to ...
to work for the
National Institutes of Health The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...
(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 university press of the University of Oxford. It is the largest university press in the world, and its printing history dates back to the 1480s. Having been 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'' (''the Times'', ''NYT'', or the Gray Lady) is a daily newspaper based in New York City with a worldwide readership reported in 2020 to comprise a declining 840,000 paid print subscribers, and a growing 6 million paid d ...
'', Martensen said
health care in the United States The United States far outspends any other nation on health care, measured both in ''per capita'' spending and as a percentage of GDP. Despite this, the country has significantly worse healthcare outcomes when compared to peer nations. The Uni ...
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 * ...
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 practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pr ...
in the way they wanted. Martensen criticized end-of-life care in the United States. While most Americans die in nursing homes or
hospitals A hospital is a health care 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 emerge ...
, 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 instead of
palliative care Palliative care (derived from the Latin root , or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Wit ...
(which may result from the
incentive In general, incentives are anything that persuade a person to alter their behaviour. It is emphasised that incentives matter by the basic law of economists and the laws of behaviour, which state that higher incentives amount to greater levels of ...
s and disincentives in health insurance 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. 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 Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a recording of the heart's electrical activity. It is an electrogram of the heart which is a graph of voltage versus time of the electrical activity of the hear ...
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) 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 legal document in which a person specifies what actions should be taken for their health if they are no ...
with a DNR, and he had started to receive
morphine Morphine is a strong opiate that is found naturally in opium, a dark brown resin in poppies (''Papaver somniferum''). It is mainly used as a pain medication, and is also commonly used recreationally, or to make other illicit opioids. T ...
for
air hunger Shortness of breath (SOB), also medically 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 disc ...
. Alternatively, Martensen's father could have been put on a mechanical
ventilator A ventilator is a piece 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 breathing insufficiently. Ventilators ...
. 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 Ivy League research university in Cambridge, Massachusetts. Founded in 1636 as Harvard College and named for its first benefactor, the Puritan clergyman John Harvard, it is the oldest institution of high ...
(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 land-grant research university in San Francisco, California. It is part of the University of California system and is dedicated entirely to health science and life science. It con ...
(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 Bioethicists American historians 1947 births 2013 deaths American male non-fiction writers