Did Medical Science really think this one out?

I so agree with this. And the lack of understanding and compassion in our laws which hobble Hospice from aiding those of us with horrifying diagnoses (CADASIL) is a daily angst. I am on my own here as dementing illnesses are treated differently from cancer, but should not be.

I agree with cwillie's comment. To take it a bit further, we don't have crystal balls to let us know we're going to have some horrible disease or condition later in life that will impact QOL. We deal with the choices we have at the time some condition occurs. If we have an infection, we treat it. Broken bones? Fix them. If we don't, we die, possibly at a very young age. My son had to have his tonsils out at age 3 - he's 40 now and very healthy! Alternative? Let no one get treated and we die whenever. Given we have ways to treat various conditions that can give one a decent life, how/when do we decide that's it?

My mother hasn't had a whole lot of medical issues during her lifetime. She has taken BP meds for a long time, could have had her hearing problem fixed surgically long ago, but chose hearing aids instead (the condition eventually leads to total hearing loss.) Despite dementia, I kept her Mac Deg treatments going until last month, stopped only because she had a stroke. With the hearing loss, the goal was to preserve her eyesight, as she likes to read (doesn't retain a lot, but likes it!)

My mother was okay until her early 90's when she developed dementia. We had done all the legal stuff years before, when dad wasn't well. The paperwork included many pages of what to do scenarios for medical intervention. I don't know why, but these were not included in the "package" we got. I DO know neither wanted extraordinary medical treatment, i.e. feeding tubes, ventilators, etc, and so we have a DNR in place. The ONLY medical treatment I opted for is for keeping her comfortable and pain free. Otherwise, nature takes it own course.

She's just finishing year 4 in MC. I am one of those "seniors" who needs to see to mom's care. I knew I couldn't do it myself, and she has plenty of funds to pay for a nice place. My bros would NOT be a good choice to provide for her care, so I found the best place for her and oversee her finances and care.

My point is it isn't always medical intervention that leads to longer life. Sure, some treatment may have helped one "over the hump" many years ago and now they have little or no QOL, but should we not even try? Again, we have NO way to know who is going to develop cognitive issues or other medical nightmares, so how can we deny treatment to prevent early death or disability? There are plenty of people in their 90s and even 100s that are still active and aware. It isn't always medical intervention, but rather having a safer and healthier way of life and possibly very good genes! The one thing I would dread myself is ending up like my mother, losing memories and living life years ago. I've already told my kids to find a nice place and ensure I am cared for, but as for extensive life saving methods? No. Same as for my mother. She had that stroke recently, so likely it's a matter of time now, but she had a full long life and I wouldn't want to put her through extreme measures to continue her existence. As said in Jurassic park, life finds a way. If we can treat something and improve quality and length of life, go for it. My dad had heart valve issues and an aortic aneurysm, both fixed when he was in his 50s. They were able to fix that (without treatment he would likely just drop dead!) and went on to enjoy a full life! His valve lasted 20 YEARS (usual is 10) and he had that redone. It gave him many more years of QUALITY life. They had a GREAT retirement together. Why would we not want treatment then? Eventually he did develop cognitive issues, but no extensive treatment at that point. He still lasted a few more years.

I can only hope for a meteor to hit my house before I go down that dementia path... Otherwise, to infinity and beyond!!! BTW, I am one of those relatively healthy people, haven't been sick in decades, have never been out "sick" for more than a day, take no medications (Vit D3 OTC) and as far as we know have no medical issues. Potential for even longer life than mom!

Dragon,

I noticed on the birthday section of The Today Show yesterday, all but one person was 100! One person was 104!

One old lady said the key to living a long life was to be classy and sassy! LOL Kind of describes my mom!

I don't think that anyone really thought about "who is going to take care of all of these elderly, frail people?" when medical advances were developed. I'm sure that the initial thought was to relieve human suffering, misery, and premature death.

There is talk about extending the life expectancy to at least 100 through new medical advances. What's the point? Our telomere shortening rate would say that most humans were never meant to live beyond age 80. Should we really be tinkering with this process?

Not to wane philosophical, but there is Psalm 90, verse 10, that states that the lifespan of a man is 70 years, 80 years if he is strong. (paraphrased) The Psalms were written at least 3000 years ago. Even way back then, the author recognized that the human lifespan was, roughly, 70-80 years. Unless a person has exceptional genetics, it is only medical science that has pushed that number higher.

As a result, we have many "adult children" in their 70s taking care of parents in their 90s. This seems so unfair to those children who are now elderly themselves.

Quality of life, or lack thereof, it a huge issue. It is for this reason that suicide among seniors is a growing trend.

Monica,

A hysterectomy in her 90’s! Wow! Interesting.

You’re right about no quality of life left. It’s so sad.

I think the knowledge of Medical Science to pro long life is Awesome znd the closer to death you become, you'll probably think that too.

The thing is, we can all sign a paper to not be resuscitated or kept alive by artificial machines.

So, it's really a choice, if you want to live longer or not.

It should always be the person's individual choice.

They weren't thinking about the big picture. And truthfully that's "not their job". And no one knows what someone's future holds. My grandmother beat cancer twice. The last fifteen years of her life I would not wish on anyone, much less someone I loved. I would have rather let her go with her first bout of cancer. My mother disagrees on that, but sees in retrospect that it would have been better if she had not survived the second time. Both times, we were so happy she beat the cancer - we did not know what the future held.
I often think keeping people alive longer no matter what is not what is best, but who is to know what their future will be? And the medical establishment (and other people who should mind their business) is geared to treat everything aggressively.

I had this discussion with my husband yesterday. I told him I do not want to be like the assisted living residents at my MIL's place who have to be wheeled around everywhere; need help going to the bathroom, showering, dressing, eating; can barely see or hear; and have children who themselves are "seniors" who must take care of/watch over them and their affairs. Just being "alive" is NOT "living." I hope that, when I get to that point, I will have legal options to make my own decision. I would never ask my own kids to give up their own "golden years" because of me, which is what my husband is doing right now. My MIL is 93 and had a hysterectomy a few months ago to delay cancer progression....and she is just getting worse every day, weak, falling, etc.

"They" do not control your life. You or you DPOA are in control.

I am younger than my husband who has dementia and I am caring for him at home. I see the devastation this disease has caused to our family and I swear that if I am ever diagnosed (when I am still lucid) with dementia, I will take my own life. I would not want to experience the existence my husband is experiencing and my loved ones to go through what I am going through. This is not life or living.

It's not really medical science, it's how health care systems apply the medical science. The UK's NHS has a (it seems to me) reasonable approach. I'm in the U.S. and am not knowledgeable about or advocating one way or another for the NHS.

Anyway, this article is worth a read:

In the UK’s health system, rationing isn’t a dirty word
https://www.vox.com/2020/1/28/21074386/health-care-rationing-britain-nhs-nice-medicare-for-all

From the article:
"What sets NICE (National Institute for Care Excellence) apart is that it makes its judgments explicit. The organization uses a measure called quality-adjusted life years, or QALYs, to make its recommendations. One year in excellent health equals one QALY. As health declines, so does the QALY measurement. The difference between being alive and dead is, on this measure, easy to express: Death represents the end of QALYs, a zero stretching out into infinitude. But ill health is trickier to measure. NICE uses questionnaires measuring people’s pain levels, mood, daily activity, limitations, and so on to arrive at rough estimates."

You make a great point when you say “It seems cruel to be still living when you are not able to care for yourself. And for some that are not even able to enjoy doing little crafts and leisurely things, how boring that must be, day after day.

At the same time, I suggest your comments also describe newborn babies to early toddlerhood, yet rarely would we consider them a burden.

I care for my elderly father who has dementia. I wouldn’t choose this unpleasant life. My Dad is difficult, stubborn, angry, etc. As much as I hate the task, it’s what God has called me too.

My mother was kept alive 2.5 years ago rather than be "allowed" to die. By now she is slowly fading, but she has been wheel-chair bound and in a nursing home ever since. 20 years ago my father was resuscitated in a hospital with a DNR at the foot of his bed! He languished in a VA nursing home (pathetic!) for the next 9 months until he finally died.

My mother's Medicare insurance agent, whom I know personally, said when we met a year ago that when you relinquish your loved one to institutional care, they will not allow your loved one to die under their watch. Too much litigation. The DNR exists to make the family feel good, but the institution will ALWAYS opt for resuscitation or death.

I remember one afternoon. One of the countless times I had to call an ambulance for my mom cause she had fallen etc. These paramedics showed up and were so nice and kind. They sat with me and my hubs for almost an hour discussing my mom, I explained how she didn't want help, wanted to stay in her home etc. They couldn't stress enough how important it was to have a Living Will with clear instructions on D N R's and so on. They told me stories of elderly people who had their ribs broken because of resuscitation attempts.

I think it's so important that children have clear instructions from their elders and that they explain to their parents how important that they be realistic about their expectations of how their lives might end up if they allow debilitating conditions to be continuously treated with no end in sight. I don't think anyone wants to just exist.

I was able to help my mom cause I was in my early fifties during her last years but I could not imagine still taking care of someone if I were in my late sixties, early seventies or even older.

Every time this topic come up I have the same response - most of the procedures and medications that contribute to longer lives aren't happening to people in their 80's and 90's, it all starts much earlier than that. We used to think that 75 was a good long life, so should people in their 60's or 70's not treat their cancer or have life saving heart surgery? (just to put that into perspective, that would include a lot of people who are members of this forum) How about all those people who are being diagnosed with type 2 diabetes in middle age, should we just let nature take it's course? Or maybe we should just stop prescribing medications of any kind when we reach retirement at 65, that would solve the problem, right?

This is why so many of our elderly and caregivers suffer with depression and anxiety.

Many elderly people do want to die with dignity. Their best days are long behind them. The caregivers want them to be at peace with no more pain, depression and anxiety.

It seems like it’s a never ending nightmare at times.

Personally, I think every state should be in favor of assisted suicide. It seems very sensible and humane to me. I know that it’s controversial and has to be properly analyzed for every individual circumstance. It seems to work in areas that it is appropriate and approved.

I think that I would choose this route if there was absolutely no hope. Why continue to suffer and burden others with grief of the inevitable?

Just my thoughts. You don’t have to agree with me.

Short answer - No. There was every thought given to keeping patients alive as long as possible and no thought given to the question of how so many debilitated elderly people were going to be cared for. It was always assumed that the adult children would take on that role, even as we know that there are fewer and fewer children per family now, that generally they live separately and often far away from the parents, and that as parents enter advanced old age, the adult children have to grapple with their own health problems, and their spouse's.

Yes, people in their 60's and 70's, sometimes even their 80's, are taking care of elderly parents, and for some it's a terrible hardship physically as well as emotionally. This further reduces the number of adult children available, as the children become disabled or die themselves. My mother had her children quite young, and my oldest sister died two years before my mother did. My other older sister was a caregiver to her disabled husband, and he also died several years before my mother. In other families, adult children who themselves can hardly walk due to arthritis or other ailments are tasked with lifting an elderly parent up, maneuvering them in and out of vehicles, pushing wheelchairs up ramps and over doorsills, etc.

No, no thought was given. And no thought is ever given to the plight of caregivers except by those of us who are there or have been there.

Having run into many doctors over my life--I have had the experience of the ones who TRULY are in medicine to heal, help and make life the best it can be for their patients.

I have also run into doctors that I seriously cannot believe didn't get expelled from med school.

You know what they call the person who graduated last in their Med School class?

Doctor.

Think about that.

We had a PCP whom we absolutely LOVED. I mean, my kids would fake sick so they could go see him. He was in practice with a Dr that absolutely nobody liked, a man so angry and cruel--he actually told me to shoot myself in the head before I thought about calling him AGAIN about my struggles with finding an antidepressant that would work. Of course, it was the BELOVED Dr. who developed a glioblastoma and was dead in 6 months. I have never had a doctor who has even come close to this amazing man.

We need to remember that doctors work for US and we can fire them if needs be. I have done so. I have also ripped into a few lousy doctors in my day. And baked cookies and thanked the ones who CARED and for whom medicine was a calling, not just a way to make money.

As I watch my SIL begin to navigate the waters of 'real medicine' (he just barely finished 14 years of training!) I see the compassion and extra care he gives each and every patient. He also takes time to ask about DH and me--he doesn't need to, he just does.

And he DID have a 'rotation' of sorts about Hospice care, since many of his patients are terminal, he had to learn how to handle that. He is the one who will be there for me when the time comes.

Just as there are bad mechanics or grocery clerks or house painters, there are bad Drs. You FIRE them if they aren't your advocate. I realize not everyone has the ability to be super choosy about Drs., but I tell you, when my Dh had his liver transplant 14 years ago--we were darn sure we had the BEST surgeon in the valley. He was not 'in plan' and we didn't care. Cost us a lot more--but what he did for my DH was nothing short of a miracle.

As far as EOL--do as much as you can to pre-plan. Let your family know what you want and pray that they'll do what you ask for--drs will continue life saving care as long as the patient wants it. Their hands are tied. This is OUR decision, so let's make it before it's needed and spare everyone the drama.

I’m taking care of my husband who has Lewy body Dementia and is not going to get better, he’s incontinent, and not ambulatory. He’s on hospice and I have to fight for anything he needs. Because he has stopped eating, and he has a UTI, they said that they can’t do anything more for him. I’m getting his meds into his drinks, but it’s not easy. I don’t have any help except once a day and he’s on a waiting list for the bath aides 3x a week. I’m very informed about his condition and I don’t let them give him anything I know he’s going to have a bad reaction to. But they don’t want to have to look for anything else other than what they want to give him. I brought him home from the nursing home 10 days ago and he’s happy to be home with me, but he’s not doing anything but sleeping. I’m happy if he just smiles at me. I’m tired and I’m not sorry that I’m doing it. He’s 85, I’m 63 going on 89. I promised him that I would be with him until the end, and I will be. I’m thankful for the blessings of each and every day and I consider myself blessed to be able to be there for him. I’m not a saint but I am not giving up on him until he is ready to go home for the last time. We both have Living Wills, DNRs, and I am his POA and I am getting guardianship to help me with the legal issues. Because we had to divorce so I could get paid to care for him and we could stay in our home. That law is not in force anymore. I’d do it all over again and I know he’d do it for me.

I think it's a hard situation all the way around. I can understand the doctor's point of view: "First, do no harm"- that's leaves a lot for translation. If you are trained that the worst "harm" is death - if that's your mindset - then prolonging life at any cost is within those guidelines.

I'm sure even for the doctors who don't consider death the "worst harm", it's a constant tightrope walk. I'm sure it's an unusual occurrence to have all family members on the "same page" so to speak; add in the constant barrage of T.V. commercials advertising lawsuits against the medical profession, it probably often feels like a "damned if you do, damned if you don't" situation.

Even here, every so often, you see a post talking about how hospice "killed" their loved one. I'm not diminishing anyone's feelings about hospice, but imagine you're the doctor who recommended hospice, and now you are faced with an accusation like that hurled at you. I can understand their reluctance.

As we advise so often - it is on you, as the potential patient, to make it clear to your loved ones what your wishes are. And have the conversation every so often - as people grow older, often we change our minds about what sort of care we would/wouldn't want. If you make your living will/EOL instructions in your fifties, revisit them again in your sixties, seventies, etc. This way, hopefully we mitigate the guilt your LO's might feel when these decisions have to be made, especially if we're in no condition to be able to verbalize them.

I would say there is zero consideration given by medical science to quality of life vs prolonging life unless we are talking the field of hospice. In the mind of the public it's a very murky ethical issue with camps at both extremes and anywhere in the middle.
I know where I stand. I think it is cruel and ghoulish to keep a failing body alive as long as possible. Let me tell you what can happen: constant excrutiating pain, deteriorating skin that tears at the slightest bump and develops sores that don't heal, bones breaking just from standing up, loss of motor function, difficulty eating and drinking, with the constant risk of aspiration, lack of bladder and bowel control, chronic bladder and other infections requiring strong antbiotis that have terrible side effects .....on an emotional level it can be even more horrible, Debilitating fear, desperation and anxiety that permeates every waking day. Not to mention the confusion they have around why they are not getting better. After all they are undergoing constant medical attention.
I say these things because every one of them is what my Mom has been experiencing for far too long. I just thank God, the decision to put her on hospice was just made and the focus will be on her comfort.

Thinking about this, and I have had these thoughts for a while but here goes...
It is the Doctors. It is Medical School.
Doctors do not want to "admit failure"
To tell a patient that there really is not much more that they can do, they forge ahead. The quest for the Unicorn, a cure for whatever is not curable. (this is different than researchers that are the ones that search, and I suppose they need patients willing to be the pioneers)
Telling a patient that "There is nothing more we can do" is probably the last thing taught in Medical School.
There are rotations for almost all aspects of medicine BUT is there a Hospice rotation? I think if doctors were aware of the dedication of Hospice staff and what is done while a patient is on Hospice there might be more doctors willing to suggest Hospice BEFORE they have pushed for "just another round of chemo, just one more trial". Some medical schools may be introducing Hospice but also teaching doctors to discuss with patients End of Life Decisions is important. Several years ago Medicare added this and doctors can bill for the discussion but how many of them actually have a CONVERSATION with a patient before it comes time to make such decisions.
The only conversation I got about EOL decisions was when I signed admitting my Husband to Hospice.
I did have a POLST for him prior to Hospice but when he had to have surgery they told me that the POLST is "suspended" while he is having surgery.
I am going to step down from my soapbox now and make a cup of tea.

Quality of life. Dignity in death. How do we insure any of this? My grandfather died in 1952 of ALS. It's a hideous death. No quality of life, no dignity in death. What advancements have been made for the treatment of ALS in the last 68 yrs? Can't think of any. Remember Jerry Lewis telethons? All the muscular diseases that plagued us then are still here today. What do we do? Although it's not a panacea, determining how you want to die can go a long way in assuring (?) some quality and dignity. I don't mean assisted suicide, I mean living wills, healthcare POAs, and DNRs. Some families may want their loved one hooked up to machines to give another month of life. A living will and DNR will allow your wishes to be honored. And don't forget palliative and hospice care. Their goal is exactly that... quality of life and dignity in death.

My mother has one friend still alive. One.

This woman is in end stage renal failure and goes to dialysis 3xs a week for 6 hours per.

She has COPD from years of smoking. Her liver is shot from years of abusing alcohol. She's mean and awful to be with, and I was shocked to find she is only 70!! I would have pegged her at 85, minimally. She hates me, so if by chance I am at mother's when Wanda shows up I leave, immediately, b/c she hates all us kids--as we do not appreciate our 'angel mother'.

WHY this person is still alive is a testament to the tenacity of one person wanting to keep on living. She still drives, but YB won't allow mother out of the house, so that's a non starter.

Mother is 90--and looks 100. She is in OK health, all things considered. But, she has outlived her 'sell by date' many times over. She's not happy, but she's content enough. The women in my family live for-freaking-ever. Most are in good shape and lived independently, mother needs 24/7 care...has for years and years.

My SIL is a dr and his take is that far too many people take the invasive, expensive and ultimately NOT quality life treatments. Yet, as a Dr. if a patient wants to undergo surgery for something that may buy them 6 months, he says most people go for the procedure. Even knowing they will be 'sick' for that whole 6 months.

Mom has burned us all out. esp YB, with whom she lives. Going on 23 years now. He regrets it tremendously, yet it was the decision mom and dad and YB made and he thought it would be 10 years, at the most, mother's health is pretty fragile.

One thing about having cancer last year: I will NOT treat it again, so when it comes back, and it will, I am going to go gently into that goodnight and not put myself and my family through all that yuck again. There's something very freeing about knowing I will not likely live to 90, probably only 80 or so...and that's FINE.

Yes, the side effect of all this advance in medical care is this. Used to be at the point of needing dialysis it al all over. Not now. And options NOT to take dialysis are never given.
Palliative care is becoming more prominent, and I have great hope in that. People in America are going to have to be more willing to talk about death, about their wishes, and get them written out. I myself have made clear there will be no dialysis, and nutrition once I cannot swallow, and etc.
But palliative care remains RARE. When my bro was in Desert Regional, a huge teaching hospital in Palm Springs, I was shocked to learn palliative care is non existant, and THAT when the resident calling me was taking that as her specialty.
Sadly when there is money to be made, THAT also figures into the equation. A senior I know in FL is currently being treated as something of a "cash cow" in my mind. Everyone trying to get a piece of her on her way out. It can happen when there is no one who can advocate for you, or when the advocate doesn't know your wishes.

I agree with you. I'm all in favor of advances like curing Polio, childhood cancers and am hopeful about Pfizer's new vaccine. But it also seems to me that medical science nowadays comes up with an improvement and views it in a silo as if it doesn't affect some other part of the body or person as a whole. Worse yet, such improvements are applied much too widely and on people who already have a poor prognosis. The result is false hope and poor quality of life for whatever time remains. It tortures not only the patient but the loved ones watching them suffer.

Many people never question the medications prescribed by their doctors. People with diabetes type 2 would be far better off losing weight than becoming dependent on insulin; their knees and hips would also thank them. The movement surrounding "fat shaming" is drowning out taking personal responsibility for one's health. Hypertension is another disease that is usually self inflicted. Rather than cut back on the salt shaker, doctors write a script for blood pressure medication. Same goes for high cholesterol, gout, etc.

Most chronic diseases are lifestyle diseases. The medications enable people to continue on with their lifestyle by popping a pill. And we are starting to see the longterm side effects of many of these medications and they aren't pretty. And I think that's one of the things your question is getting at and, in my opinion, too often no, it was not thought out.

You can plan all you want but not all of us has the money to do so. My GF was a juvenile Diabetic. By her 50s she had a massive heart attack. She could no longer work and was having problems getting SSD. Then her late 50s she lost a leg. Finally received SSD. Her yearly medical bills went passed what insurance would pay. They lived from pay to pay. If they had saved any money for "old age" it was used up in her medical bills.

Science is great but as my daughter says "we are living passed our expiration date". Our bodies and minds wear out.

We need to change our way of thinking. I think early TV romanticized caring for a parent. You saw a happy family enjoying having grands living with them. Yes Dad may need some help getting out of a chair. If there is some senility that was shown grandmom/dad sitting in their rocker quietly watching TV or looking at a wall. Never showing that this person gets paranoid and agitated. That they need to be cared for like a child. What the stress does to the family as a whole.

We can plan all we want but then there is something called life. You can lose that money you invested. Stocks can plummet. A spouse dies leaving the remaining spouse in debt. Illness can eat thru savings. And all you have is family. And you hope that they love you enough to find some solution for you. Doesn't mean they need to physically care for you but make sure you are safe, fed and cared for.

This is why you PLAN.
You make sure that you do not have to depend on your children to care for you.
You willingly enter Assisted Living if necessary.
You willingly hire or let people come in to care for you if you remain at home.
You SPEND the money that you have saved for YOUR care, don't worry about leaving a legacy while the family grumbles about changing you, cleaning you.
You make decisions NOW about what measures you want taken if and when a situation arises.
YOU make the decision that you will not pursue treatment that will extend your life but not extend the quality of your life. Why have quantity and not quality?
These are decisions you make now when you're healthy and able to make them and you make sure the family knows what your wishes are.

I don’t think there’s been any organized effort to keep people alive but miserable. But medical advances have often come with that consequence. We’ve gotten very good at treating disease, not so good at considering quality of life. Hoping for the day we get better at merging the two

We should be grateful for all the advances medical science has made on all fronts. Would you rather they have stayed the same as let's say the 1800's? None of us would probably even be here if that were the case.

I think that is one of many problems in this country, and that is we just don't value human life. Who are we to say that just because a person at any age, who can't care or do for themselves, is not worth being here? Shame on anyone who feels that way.

My husband was completely bedridden in the last 22 months of his life, and was totally dependent on me to do everything for him. He was under hospice care, so I did get some help there, and I also had to hire an aide to come every morning to put him on the toilet for me, but other than that it was me there 24/7. Would he have rather been able to go and do things himself? Of course he would have, but he made the best of his situation, and we had a lot of sweet moments while he was in his hospital bed in our living room, that I wouldn't trade for the world. He was only 72 years young when he died on Sept.14th.

Another story that comes to my mind, is when I was volunteering for hospice years ago, and one of my patients Mary, who had alzheimer's and lived in a nursing home, and didn't even know she was in the world, loved to smile and say hello to everyone. One day when I was outside with her in the front of the facility(as I often took her outside in her wheelchair for a walk), she was saying hello to everyone walking by, a lady came up to me and asked if she was my mother. I told her no, but wished she were, and she proceeded to tell me how much Mary's sweet smile and friendly hello meant to her, as she came to visit her father every day who had had a stroke and wasn't doing very well. She said that she came to look forward to seeing Mary, as it made her feel better and lifted her spirits. Who knew that even though Mary had no clue what she was doing, God was still using her to brighten the days of those around her. That day changed my perspective on those who suffer with any type of mental decline profoundly.

So while the world might look at these folks as if they are no longer "useful", God can still and does use them in mighty ways. You just have to open your eyes and look for it.