It was Trevor’s first weekend to relax since moving to Seattle. He was out in a park walking Bailey, his year old lab, when his pager unexpectedly beeped. He called in to the operating room office, where the frantic head nurse told him he had to come in. The scheduled anesthesiologist was very ill with the flu, and no one else was available. He had to come in for at …
In the OR during an appendectomy, an unexpected visitor
“Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my career as a pulmonary and critical care physician, and I have cared for thousands of dying patients. In many cases, both the patients and I knew that they were dying. …
A glimpse of dying from literary authors
In order to be with my Dad, after dinner I’d go on house calls with him. We’d drive to parts of town I’d never seen, and using the car’s spotlight we’d search out the right house number, often with no small difficulty. I’d usually wait in the car. He hefted up his rather large mysterious black doctor’s bag and headed for the door. He spent about a half hour listening …
My Dad never quit making rounds
As doctors in training, we learn to think in patterns of symptoms and can often use “clinical judgement” to fit a patient’s presenting symptoms into a diagnosis. This generally works well, until we are presented with an unfamiliar pattern. For example, in the early 80’s I saw a 60 year old shoe salesman with fatigue and a low grade fever. He had general malaise and some muscle weakness. His exam …
The questions in medicine never change, but sometimes the answers do
I went to court recently sitting quietly in the gallery listening to the testimony of two designated experts who criticized the care of a cardiologist (admired in local medical circles for his brilliance and excellent care of patients). The case on first glance didn’t look very good for this defendant. The patient had presented to the ER with atypical chest pain, was admitted and evaluated with an exercise test and …
The problem of expert witnesses in medical malpractice trials
I could hear the morning call to prayer as I drove toward the Aramco Hospital in Dhahran, Saudi Arabia for my early morning rounds in the ICU. I was hoping that my young asthmatic on a ventilator might be ready to be weaned off and that the medications had kicked in sufficiently. My young Saudi medical student met me on the way in and said, “I think she’s doing better, …
Caring for the patient despite a vast difference in culture
Recently I was sent this commentary on the issue of health care costs. It seemed like a pretty good summary of the problem to me, though it didn’t delve into solutions or the current controversy about the Affordable Health Care Act. In our country, we’ve built up a huge medical-industrial system that can do lots of good but at a huge cost. It seems that we are on the brink of a …
Our medical-industrial system is long overdue for a real shakeup
Should we all have the TB Blues? I think you’d agree that we should after listening to this 1931 classic by Jimmie Rodgers who died from TB.
Tuberculosis is known to have existed in ancient Egypt and TB may have even been referenced in the Bible – “The Lord will smite you with consumption, and with fever, inflammation, and fiery heat …” Deuteronomy 28:22.
Many well known authors, artists, musicians, and …
Singing the blues about tuberculosis
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for “feeling good”, but he did hope that it would help him avoid illness. It was worrisome when he started with some belly cramping and noticed some blood streaks in his stools. It took about a month until he could be scheduled for a colonoscopy. The news was shocking. “There’s a cancer …
End stage colon cancer becomes even more tragic without hospice
Marge was aging and gradually “falling apart”, as she would say. “First it was my back, then my knees, and now my heart is giving out”. She confronted her doctor with this in a frustrated manner, “I’m no good for anything anymore. I can’t really enjoy the things I used to. Most of my friends have died off, so maybe I’m next”.
The doctor in sizing up Marge’s advanced age and …
A POLST form documents what patients value
I have tried to write a letter of thanks but don’t know what to say or even how to begin. I don’t know the persons I am writing to, but part of their loved one is literally now a part of me.
It began with a phone call from my brother. “Jim, what the hell is Fuchs’ Dystrophy anyway – do you have it too?”
I racked my brain and tried to …
A letter of thanks to my organ donor
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for “feeling good”, but he did hope that it would help him avoid illness. It was worrisome when he started with some belly cramping and noticed some blood streaks in his stools. It took about a month until he could be scheduled for a colonoscopy. The news was shocking. “There’s a cancer …
Our society expends huge sums on futile care
Betty was complaining at an escalating rate. She’d been in her nursing home for four years and wasn’t happy. She kept coming up with new symptoms like aching, fatigue, nervous stomach, tingling, dizziness, etc. Her daughter Nancy was getting daily calls from Betty and the staff at the nursing home. Multiple trips to the doctor for diagnostic tests had ensued: blood counts, liver functions, x-rays, thyroid function, plus many others. …
Is it ethical to prescribe a placebo for a patient?
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“Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my career as a pulmonary and critical care physician, and I have cared for thousands of dying patients. In many cases, both the patients and I knew that they were dying. …
Advance planning should be a public health issue
At the University Hospital in Madison Wisconsin in 1938, a patient was dying from a very painful bone cancer which had produced fractures. The young interns knew that more morphine injections were needed but they feared they might be blamed for giving a lethal dose. So a tacit agreement was reached. Every hour or so,one of them would come into the patient’s room and give a shot of morphine. This …
We are seeing more terminal patients being referred to hospice
Cheryl and Susan arrived at the hospital at 6:30 AM. As was their routine, they stopped for their Starbuck’s latte and shared family stories as they walked toward the ICU. The two were well known pranksters but were widely respected for being top notch ICU nurses. The whole crew there was like a family. They went to baseball games, picnics, and vacations together. Today was like most other days. They …
Gallows humor is only a temporary release from a traumatic situation
The voice on the phone is demanding, quavering, pleading; “Dr. deMaine you are going to be the attending critical care doctor when our mother is transferred to your hospital today. She needs to be taken off the respirator and allowed to die. We have been pleading with the doctors at the burn center, but they keep doing more procedures. We want her off life support as soon as she gets …
Medicine is slowly facing the issue of futile care
Marcie transitioned to my care when she turned sixteen. She felt too grown up now to be in the same waiting room with “kids” at the children’s clinic. But she wasn’t doing well.
Her pediatrician had suspected the problem shortly after birth. She wasn’t growing normally, had nasal congestion, and more respiratory infections than usual. A sweat chloride test was ordered which was positive. The diagnosis was cystic fibrosis (CF). The …
Discussing end of life issues with a teenager
Every medical student goes though a process of elimination when deciding what kind of doctor they want to become. We hear the old saying, “Internists know everything and do nothing; Surgeons know nothing and do everything; Psychiatrists know nothing and do nothing; Pathologists know everything and do everything but it’s too late.” We hear that pediatricians wear bow ties, are short, and love to laugh and play; that surgeons …
The decision not to become a surgeon
Erik’s wife had warned him many times, “Stay off ladders dear, leave it to someone younger.” Erik though was a pretty spry 72 years old and had been cleaning the gutters for many years. He had a sturdy 25 foot extension ladder, had years of experience as an athlete, and wasn’t about to slow down for no good reason.
It was an unusually bright crisp November day in Seattle, when Erik …
The secret in caring for the patient is to care for the patient
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