Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What an old doctor taught me about palliative care

Monica Williams-Murphy, MD
Physician
October 19, 2013
Share
Tweet
Share

Many years ago when I was a “young” doctor, moonlighting in the ER of a tiny country town, I had an experience that challenged my training. You see, most young, new doctors often think their training and knowledge is superior to that of “old” doctors, which is often malarkey. A wise and sage old doctor in this tiny country town taught me an important lesson on where and how one should die.

I had just walked in for my second moonlighting shift in this small 5 bed ER when the paramedics buzzed by me “bagging” (artificially ventilating) a small elderly lady. All I saw of her as they whizzed by was a dangling pale arm and dyed blue-black hair perfectly coiffed with shiny pin in place.

“Well come on in here, Dr. Murphy,” the charge nurse said as she motioned me into the trauma room of this little ER.

The paramedics gave me a quick report, “She just fell over unresponsive at the beauty parlor (southern term for hair salon). All of the ladies were screaming when we arrived and all she has is a gag reflex as far as we can tell. Her blood pressure is up but heart rate is normal. Whatcha think, doc?”

“Head bleed (slang medical term for intracranial hemorrhage),” I said as I quickly checked her pupils and lack of response to a brisk sternal rub.

“That’s what we were thinkin’ too, doc.” The lead paramedic replied. “And, by the way, the family is on the way.”

Since I was a young doctor with a whole lot of book sense but very little common sense, I proceeded to intubate her, CT scan her and arrange for her helicopter flight to our larger regional hospital, all without asking the family about her wishes or advance directives, or even what their desires for her might be.

All I told the family was something like this: “She has a very large amount of bleeding in her brain, this made her faint and now she is unresponsive. I had to put her on a life support machine and now we’ll need to fly her to our regional hospital so the brain specialist (neurosurgeon) can see her. I can tell you that this doesn’t look good.” (At least I had enough sense to tell them that the situation was grave.)

Basically, my conversation was about what I had already “done to her” and what else we were going to “do to her.” This is too often how doctors and medicine function. You end up in the ER and we place you on the medical train and tell you where the next stop is — without asking your opinion or your family’s opinion about our itinerary.

Fortunately, one of the family members had something to say, “Would you mind calling her family doctor to let him know?”

“Of course!” I responded, “Absolutely, I will call him now.”

So, I got him on the phone.

“Dr. Crane, this is a courtesy call to let you know that your patient, Mrs. P, 75-year-old female, came in unresponsive with a massive head bleed. I am flying her to our regional hospital and I wanted to let you know. I have spoken with the family and they are all here.”

Dr. Crane said, “Pull up the CT scan and I will be right there.”

ADVERTISEMENT

Almost as soon as I hung up and put up the images, he came around the corner.

Dr. Crane looked about 75 himself, and was very striking, with gleaming white hair and glasses framing his bright green eyes.

He shook my hand and at the same time he began to review the images.

“Mmm … hmm,” he said as he examined the images carefully. Then, he turned to give me an unusual look, while pushing his glasses up to rest on his head. It was the same look that my grandmother used to give me when she wanted to gently correct me. I recognized it, but didn’t have the foggiest notion what he was about to say.

“Listen here young doct-uh (southern drawl for “doctor”). With all due respect, I know that you are doing what you were trained to do, but this lady isn’t going anywhere.”

Slightly startled, I asked him, “What do you mean?”

Then came the lesson.

He said, “You see, Mrs. P was born in this town. I have been her doctor for 30 years. Her whole family lives here. She has lived here for all of her 75 years. So, there is no reason for her to die in any other place. Ain’t nobody gonna survive a head bleed that big anyway. There is no reason to send her and her family 90 miles away so that she can die in a strange place, a strange city. It doesn’t do anybody any good. So, we are going to keep her here and keep her comfortable. Her whole family and her whole community can be with her. That’s the right thing to do. Don’t you think?”

I stood very quietly, even reverently.

Then, I said, “Yes, sir.”

I recognized that I was standing in the shadow of a real doctor. I watched as he sat with Mrs. P’s family and held their hands. They all cried together and then he wrote admission orders, and extubation orders.

I cancelled the helicopter, and began to hope that one day I would grow up to be like “old” Dr. Crane.

Monica Williams-Murphy is an emergency physician and author of It’s OK to Die.

Prev

Do you share direct contact information with patients?

October 19, 2013 Kevin 10
…
Next

Finding the most promising innovations to teach value

October 19, 2013 Kevin 2
…

Tagged as: Emergency Medicine, Neurology, Palliative Care

Post navigation

< Previous Post
Do you share direct contact information with patients?
Next Post >
Finding the most promising innovations to teach value

ADVERTISEMENT

More by Monica Williams-Murphy, MD

  • Please address suffering in the care of the dying

    Monica Williams-Murphy, MD
  • 8 unexpected reasons why you should have an advance care plan

    Monica Williams-Murphy, MD
  • I may be the only advocate for my dying patient

    Monica Williams-Murphy, MD

Related Posts

  • Why health care replaced physician care

    Michael Weiss, MD
  • A letter to a cancer patient in palliative care

    Alison Vasa
  • How social media can help or hurt your health care career

    Health eCareers
  • More physician responsibility for patient care

    Michael R. McGuire
  • Patients made this doctor care about politics

    Chad Hayes, MD
  • Health care needs more physician CEOs

    Alexi Nazem, MD

More in Physician

  • How subjective likability practices undermine Canada’s health workforce recruitment and retention

    Olumuyiwa Bamgbade, MD
  • Why judgment is hurting doctors—and how mindfulness can heal

    Jessie Mahoney, MD
  • Why evidence-based management may be an effective strategy for stronger health care leadership and equity

    Olumuyiwa Bamgbade, MD
  • The gift we keep giving: How medicine demands everything—even our holidays

    Tomi Mitchell, MD
  • From burnout to balance: a neurosurgeon’s bold career redesign

    Jessie Mahoney, MD
  • Why working in Hawai’i health care isn’t all paradise

    Clayton Foster, MD
  • Most Popular

  • Past Week

    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Recent Posts

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Decoding your medical bill: What those charges really mean

      Cheryl Spang | Finance
    • The emotional first responders of aesthetic medicine

      Sarah White, APRN | Conditions
    • Why testosterone matters more than you think in women’s health

      Andrea Caamano, MD | Conditions
    • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

      Shanice Spence-Miller, MD | Tech
    • How subjective likability practices undermine Canada’s health workforce recruitment and retention

      Olumuyiwa Bamgbade, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 11 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Recent Posts

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Decoding your medical bill: What those charges really mean

      Cheryl Spang | Finance
    • The emotional first responders of aesthetic medicine

      Sarah White, APRN | Conditions
    • Why testosterone matters more than you think in women’s health

      Andrea Caamano, MD | Conditions
    • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

      Shanice Spence-Miller, MD | Tech
    • How subjective likability practices undermine Canada’s health workforce recruitment and retention

      Olumuyiwa Bamgbade, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

What an old doctor taught me about palliative care
11 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...