Physicians, nurses, chaplains, and families writing on KevinMD about comfort, dignity, and quality of life in serious illness: hospice and why it is used late, the prognosis conversation, goals of care, symptom management, and what it is like to care for a dying patient. Most contributors work in palliative medicine or hospice, or have been the family at the bedside. For a maintained record of what physicians have said about dying and the decisions at the end of life since 2004, including the assisted-dying debate with both sides at equal weight, see End of life: what physicians say, in their own words.
My 83-year-old patient had outlived peoples’ expectations on several occasions. Faced with a critical illness three years ago, she underwent emergency surgery and spent several months in the hospital with a series of complications, including septic shock, renal failure, and hospital-acquired pneumonia.
I’d seen her in the office for a new visit soon after she was discharged. It took nearly 20 minutes to go through her history before walking into the …
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Letting go when people let go of their lives
The day began in Mom’s room with a 10:00 a.m. conference at Upper Valley Medical Center, west of Columbus, Ohio. In attendance were my 93-year-old mother Joanne (now in her third week of hospitalization), her palliative-care nurse Richard, her Episcopal priest Mother Nancy and myself.
Mom was on high-flow oxygen therapy delivered through a nasal cannula. Despite this, her blood-oxygen levels were well below normal. Clearly, her lung function was declining. …
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Over 2,000 prayers for the dead. This was my hardest.
Returning from my week of vacation, I was greeted by the usual stack of mail, faxes, forms to be signed, throwaway journals, and a fully loaded group of in-basket messages that had piled up in the electronic medical record that needed attending to.
One of the pieces of mail was an unsolicited package with a bright red label on it, along with …
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We have to do better than DNR tattoos
I remember it was raining outside when I told Ester she had metastatic stomach cancer. She cried, as her son sat silently holding one thin hand in two of his. After a while, she asked, how long did she have to live? I explained it depended on how well the chemotherapy worked. She smiled gently, as one humoring a silly child, and said that there would be no treatment. After …
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The broader mission for hospice care
Clutching my duffel bag under my rain jacket, I dash from my truck toward a house that was built by Frankie, the man I’m here to give the last massage of his life.
I’ve been massaging people since I was five and have been a professional massage therapist for 40 years. I don’t make house calls anymore, but it’s an honor to give a man the last massage of his life, …
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The last massage of his life
“Planned death.”
When you put it like that, this can only mean one of two things: suicide or murder. For most of us in medicine, the very idea of “planned death” seems safely outside our purview. After all, the bulk of medicine is concerned with staving off death. And the very nature of death’s uncertain timing enables practitioners of everyday medicine to take refuge in its mystery.
When necessary, we prognosticate. But …
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A critical discussion is needed about planned death
I found you standing on a platform. It was a foggy, damp morning, and your vision was obscured. People came and went, some with urgency, others not so much. Some people you knew, others were strangers. Your husband was usually nearby, often holding your hand, other times out of sight.
At times you could hear his voice, but couldn’t find him with your reach. There were noises that would startle you, …
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When the train comes for you
Every morning, after rounding on Mr. Gregory, I felt like an imposter. As I reported on the worsening crackles in his lungs, his decreasing urine output, the mottling of his hands, we continued to simply give him Dilaudid for pain and continued to ensure that he was “comfortable.”
In this case, I was at a loss for what this “comfort” meant. Mr. Gregory was the first hospice patient I had. And …
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What is the best way to care for a dying patient?
The way I learned the Golden Rule was: “Do unto others as you would have them do unto you.” Basically, it’s from the New Testament, but the concept goes way back to pre-Christian ancient civilizations in Babylonia, Egypt, India, and China.
So here I am, just trying to do my best as a spousal caregiver, and I started to realize that if I were to take the Golden Rule literally — …
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Do substituted decisions break the Golden Rule?
I, like many physicians, am the only doctor in my extended family. To say that they are proud is probably an understatement. I’ve been a practicing physician for seven years now and yet my grandmother each time I see her greets me with, “There’s my doctor grandson.” I have worked quite hard to get to where I am, and I enjoy what I do. I, too, am proud to be the …
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The line between family member and personal doctor
We’re all gonna die.
It’s a simple truth that an astounding number of people neglect to acknowledge or accept. Some people die sudden, unexpected deaths, but most eventually fall victim to chronic or terminal conditions like COPD, heart failure or cancer. As a palliative care physician, I often meet patients who have had conversations with their families about their end of life wishes and have completed supporting legal documents.
While I appreciate …
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How to have an exciting death: 5 tips from a palliative care physician
I left a full-time academic position five years ago because I was literally, “check-all-the-boxes,” burned out. In looking back during that time prior to my decision to leave, I recall months of feeling overwhelmed, emotionally exhausted, depressed, and in a sense grieved for the loss of what I envisioned my career path to be until retirement. It was not until one of my favorite patients, Mr. Young, who knew me …
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How a patient saved this physician from losing her passion for medicine
“Let’s start the powwow,” a man with a brown jacket and braided ponytail said with a smile. Nineteen adults and one child filled the back conference room of the hospital. The hospital had made an industrial cylinder of coffee for the meeting, and it was almost completely drained. I hung the stethoscope around my neck, knowing I wouldn’t use it as anything but a prop to signify my training and …
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A family meeting in Navajo Nation
I’ve been a doctor for a bit under a year now. I am a family medicine intern, working in blocks at a city hospital, wearing a lot of different hats. Sometimes I’m on the labor and delivery floor, helping new lives begin; sometimes I’m on the family medicine service, caring for ill patients who may be dying. Some of the moments that have stuck with me the most this year …
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Talk with family members about their wishes long before you think you’ll need to
I’ve always thought that I’ve understood illness and mortality very matter-of-factly. You live your life, you’ll most likely end up with some medical conditions along the way, and ultimately everyone’s life will come to an end because the body is not designed to function indefinitely. And do I cry at every funeral I attend? Absolutely. I understand physiologically and pathologically why things happen, but also realize human relationships will always …
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How families maintain hope of improvement, regardless of logic and science
Sometimes referred to as “right-to-die,” “physician-assisted suicide” laws make it possible for terminally ill patients to use prescribed medications to end their lives instead of facing a protracted death. The latest state to pass legislation allowing terminally ill patients to end their lives was New Jersey. The law will go into effect on August 1.
The topic of physician-assisted suicide and right-to-die is incredibly complex and emotionally charged. I’m not going …
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The nuances between palliative care vs. physician-assisted suicide
I am a nocturnist (a nocturnal hospitalist). I love my job, but many nights my work can seem unfulfilling. For one, taking care of hospitalized adult patients is primarily spent managing exacerbations of chronic diseases. Therefore, the reality is that most patients will not be cured, only managed. Additionally, there is the loneliness factor, the incessant beeping of my pager, and the fact that I am forced to disturb the …
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How the death of a patient affected this nocturnist
My wife Uzma died peacefully at home. She didn’t take any painkillers for her last three days. Our kids, my parents, and I were next to her. In the weeks leading up to her death, many old friends visited her. Others sent her flowers, cards, and food. It was a good death. Yes, in the last five years cancer and its treatment took a physical and emotional toll. Yes, she left us a …
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Hospice didn’t stop suffering. But what it did for us was priceless.
Are you or a loved one aging, perhaps with a chronic heart or lung condition that limits daily activities? Do you have an older parent in a nursing home or who needs assistance with daily living activities? If so, read on and make the pledge.
As physicians, we see death every day. We see death made worse and more painful by poor advance care planning. Yet, despite the certainty of death …
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Pledge to end your fear of death and end-of-life care
