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

The discovery period regarding the existence of life 

Kevin Haselhorst, MD
Physician
October 29, 2015
Share
Tweet
Share

What do I need to know as I age?  While scientists ponder the questions of water existing on Mars and if it can essentially sustain life, my duty it to assess if there is life left in Oliver — a nursing home patient transferred to the ER. Oliver was not oxygenating well but appeared to be resting comfortably. Reportedly, Oliver had fallen that day and EMS discovered a sizeable bruise on his chest.   Did Oliver have a collapsed lung or did his underlying congestive heart failure worsen? With age, my need to know about other planets and disease processes in patients approaching the end of life has become more selective and less enterprising.

My need to know seems to waver between being perceived as apathetic and/or negligent and having values and/or priorities. Hospital staff was already preparing to save Oliver’s life while I resisted the need to take immediate action until speaking with Oliver’s out-of-state daughter. I initiated the dreaded phone call from the ED at 2 a.m. Groggy and incoherent, his daughter needed to know all details about her father’s condition prior to making the decision to allow Oliver to rest in peace. By her command, there was no rest to be given to this wretched diapered man with dementia, Parkinson’s and heart disease, along with the new finding of a dusky blue foot.

This unrelenting need to know often works against one’s better nature to leave well enough alone.   In general, society is wrought with anxiety and increasing fear around death. Will our celestial body end up like Mars, seemingly lifeless and dehydrated?  Presumably, we need to know if Earth is following the path of demise similar to both that of Mars and Oliver. This overwhelming concern intensifies the plea, “Don’t let the sun go down on me.” On a more personal level, Oliver’s daughter mandated that I not allow her father to die. One day Oliver’s daughter will come face-to-face with her own end of life. Has she designated an advocate who will need to know everything wrong with her body as disease overtakes her life and death becomes imminent?

It took less than a minute to realize that Oliver was dying. There was nothing more I needed to discover about Oliver’s medical condition that would justify attempting to prolong his life and sacrifice his dignity. When the discovery period ends, the grace period begins. In my practice of emergency medicine, the demarcation between discovery and grace — intervention and mercy — establishes a clear boundary between treating a patient like a guinea pig or a human being. The medical power of attorney rarely allows for a loved one to have a grace period at the end of life. Grace periods stop interest from accruing, but love holds no bounds to medical intervention at the end of life. Nevertheless, having nothing to do might actually turn out to be amazing – like an unexpected day off work. For many patients, having nothing further done is often the beginning of the end – the end of suffering.

The discovery period encompasses advance care planning, physician counseling regarding end-of-life care and patients yearning for a grace period. The need to know how to care with dignity and grace for people at the end of life does not occur through looking outside oneself, but more so from looking within the universal soul of intuitive understanding. Planet-gazing is most useful if it leads to soul-searching. Advance care planning that incorporates soul-searching provides a means to envision storybook endings. I believe life ends happily ever after through the proverbial assertion that ignorance is bliss. The grace period of feeling blissful upends the discovery period of needing to know about the existence of life.

Kevin Haselhorst is an emergency physician and author of Wishes To Die For: Expanding Upon Doing Less in Advance Care Directives.  He can be reached at his self-titled site, Kevin Haselhorst. 

Image credit: Kevin Haselhorst

Prev

Why we need to pay attention to lung cancer

October 29, 2015 Kevin 4
…
Next

My patients have shown me that medicine is a universally spoken language

October 29, 2015 Kevin 1
…

Tagged as: Emergency Medicine, Palliative Care

Post navigation

< Previous Post
Why we need to pay attention to lung cancer
Next Post >
My patients have shown me that medicine is a universally spoken language

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Kevin Haselhorst, MD

  • President Biden: a closer look at leadership, dignity, and aging

    Kevin Haselhorst, MD
  • Advance directives amidst COVID: a critical look

    Kevin Haselhorst, MD
  • April 16th is National Healthcare Decisions Day: Plan for your end-of-life care now

    Kevin Haselhorst, MD

Related Posts

  • How self-awareness helps with patient interaction

    Ton La, Jr., MD, JD
  • Why Medicare cannot stay solvent: a case study

    Steven Reznick, MD
  • What’s going to replace hospitals that downsize?

    Kenneth Lin, MD
  • A story of a good death

    Carol Ewig
  • A patient’s family bridges two worlds

    Ton La, Jr., MD, JD
  • Co-production of care: A different kind of health care than we’re used to

    Sylvester Jones and Laura C. Leviton, PhD

More in Physician

  • Why some doctors age gracefully—and others grow bitter

    Patrick Hudson, MD
  • The hidden incentives driving frivolous malpractice lawsuits

    Howard Smith, MD
  • Mastering medical presentations: Elevating your impact

    Harvey Castro, MD, MBA
  • Marketing as a clinician isn’t about selling. It’s about trust.

    Kara Pepper, MD
  • How doctors took back control from hospital executives

    Gene Uzawa Dorio, MD
  • How art and science fueled one woman’s path to medicine

    Amy Avakian, MD
  • Most Popular

  • Past Week

    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • How the shingles vaccine could help prevent dementia

      Marc Arginteanu, MD | Conditions
    • How to survive a broken health care system without losing yourself [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why some doctors age gracefully—and others grow bitter

      Patrick Hudson, MD | Physician
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • What the research really says about infrared saunas

      Khushali Jhaveri, MD | Conditions
    • How the cycle of rage is affecting physicians—and how to break free

      Alexandra M.P. Brito, MD and Jennifer L. Hartwell, MD | Conditions

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

Leave a Comment

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

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • How the shingles vaccine could help prevent dementia

      Marc Arginteanu, MD | Conditions
    • How to survive a broken health care system without losing yourself [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why some doctors age gracefully—and others grow bitter

      Patrick Hudson, MD | Physician
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • What the research really says about infrared saunas

      Khushali Jhaveri, MD | Conditions
    • How the cycle of rage is affecting physicians—and how to break free

      Alexandra M.P. Brito, MD and Jennifer L. Hartwell, MD | Conditions

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

Leave a Comment

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

Loading Comments...