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.
Otis was our first baby. He was covered in a caramel-colored fur, weighed 150 pounds and was the best bullmastiff dog anyone could ask for. He protected me from my husband’s incessant tickle attacks and thought that my lap was the best place for him to try and sit.
Two years ago, I was walking Otis and he suddenly collapsed. After an extensive workup, including an EKG, blood work and an …
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We give pets dignified deaths, why not our loved ones?
Man has been dying on a regular basis for millions of years — should we not be end-of-life experts by now? Why do I feel the need to devote pages and hours to this depressing topic? Is there a goal to my project, beyond venting the shared suffering which soaks my soul? What is my purpose?
For humans, denial of death and marginalizing its effect on our lives is a major …
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When we stop denying death we empower ourselves
Do you know what the operator or person at the front desk is saying about palliative care? When people call, saying the want palliative care, how are they responding?
A study being presented in abstract form at the palliative care and oncology research symposium addresses this simple but critical question.
Researchers at Duke (Kathryn Hutchins, third-year medical student first author, Arif Kamal, oncopal researcher, senior author) cold called 40 major comprehensive cancer centers. They …
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Do you know what your staff is saying about palliative care?
David was 42 when he died from stomach cancer. He spent the last year of his life receiving useless chemotherapy and debilitating radiation. David was in terrible pain all of the time. He stayed in bed for months as cancer destroyed his ribs, back and lungs.
Finally, David was rushed to a hospital, plugged into a breathing machine and pierced by countless IV drips. He died despite a battery of tests, …
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How one patient’s end-of-life care can affect us all
When Kara Tippetts, a 38-year-old mother of four, died of breast cancer last year, more than 17,000 people live-streamed her funeral. Tippetts gained national prominence through her blog, where she confronted her impending death directly and offered a refreshingly frank take on what it’s like to have a terminal disease.
Unfortunately, the openness Tippetts displayed is usually missing where it’s needed most: hospitals. Doctors, nurses and other caregivers are often reluctant …
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Silencing end-of-life discussions fails our terminal patients
It started, as far as I know, with a twinge. A back spasm in a healthy, but prone to back spasms, 68-year-old man, who soon was reduced to near tears in the parking lot of the Thai restaurant where we’d gone to get take out. It was early summer, and I was on a short visit to the east coast. My mother was the one to worry about. She had …
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I owe it to my father to argue for death with dignity
“Food is love,” my partner jokes as she unloads mountains of food from her latest trip to Costco. “I can’t help it! I’m Jewish!” she protests, when I wonder aloud how the two of us will ever manage to consume all that food.
As the lineups at superstores attest, for a great many people being able to prepare and serve meals is a vital way of showing love.
I never expected to …
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Helping during hospice: Being present is much more important than being busy
Hospitals have always served as a lifeline to survival. Whether from pneumonia, heart attack, stroke, or trauma, they have been a community safeguard between life and death.
Today, a cost of care has been added to the patient treatment discussion forcing medical decision-making to look closely at expense. Financial considerations have come to the forefront as preservation of resources will be important to national health care. This can be a threat …
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The ambiguity of diagnosing brain death
Mom. She was a feisty 100 percent Italian, straight from New Jersey. Her dad, straight from Italy, was a tailor and made the finest suits for New York and New Jersey businessmen. Mom learned this trade well. She could sew some of the most beautiful tailored suits for herself. She loved to cook and every night was a banquet, a feast which required up to 2 hours of clean-up time …
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She asked for comfort
The world can be a lonely place. Despite technology designed to bring us closer, it seems we’ve become more isolated. We view profiles rather than embrace complete individuals. We spend hours crafting a persona, a smooth and unblemished public face. Raw, unattractive emotions: grief, insecurity, jealousy. We mask those from others and even hide them from our deepest selves. Ultimately, rather than becoming more connected, I suspect we are cast …
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The true essence of what it means to be a companion
I knew it was bad when she couldn’t tell me her name. I watched her face fill with frustration as a word she had uttered countless times over eight decades somehow got lost between her brain and her lips.
It was 2 a.m. and I was on call as the surgical resident. I had been told that a patient with bladder cancer was being transferred from another hospital, and, as these …
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Death is not the enemy. More physicians need to realize that.
During the first few days that my mother spent in hospice, I silently sat by her bed watching her chest rise and fall, listening to her moan, counting her doses of Ativan, Tylenol, and Morphine, and tallying the days she’d been without food and water.
On day five of my vigil, I asked her nurse, “How long can Mom live like this? She hasn’t opened her eyes or eaten or had …
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At the end of life, searching for the right word
Ruth was a spry, but frail 98-year-old woman who was stiff and sore following the 6-hour drive from California to Arizona. She had suffered a recent wrist injury and was not recovering well after spending three weeks in a rehabilitation center. She was in the midst of upheaval and discontent — in the throes of relocated to an assisted-living residence closer to her son. The facility’s coordinator had begun to …
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Fixing the breakdown in patient satisfaction
The only thing I love more than complaining about being a doctor is actually being a doctor. Intern year sucks. There’s no way around it. I wake up at 5:15 a.m. to get to the floor at 6:00 a.m. and I rarely leave at 5:00 p.m. when my shift is scheduled to end assuming I’m not on call until 9:00 p.m.
I often feel my stomach growl at 9:00 a.m. and …
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The worst thing about being an internal medicine intern
They said, “Do everything.”
She knew something was wrong. And by the time she was 85, she had forgotten the names of her children, the town she raised them in, and even the name of her deceased husband. In her 70s, she was diagnosed with Alzheimer’s. Still coherent, she talked to her physician about becoming a DNR: do not resuscitate. She did not want to live on a machine that would …
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The family said, “Do everything.”
I make my way down the aisle of the plane, squeezing past my fellow passengers and plop down in my assigned seat. Sitting next to me is a middle-aged woman with a kind smile. As the plane takes off, she begins making small talk: ”What do you do?”
I silently debate, do I adopt my travel persona or answer truthfully? Answering honestly will result in one of two things; either we …
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This is why hospice work is so fulfilling
I slipped and fell. My hip fractured, surgery would make it better. But it didn’t. My body was too weak to fight. I couldn’t cough and deep breathe; I stayed in bed. I had nausea and vomiting. I couldn’t breathe. I became weaker and weaker, until my family noticed. The medics rushed me into the ER. My blood pressure was 62/34. For how long? The ER nurses and doctors tried …
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I didn’t get to say goodbye
Physicians are accustomed to seeing patients at the end of their lives. It is difficult to let families know they may lose their loved one. Clinicians are often accepting of patients DNR orders before family members are ready. This story is about a time where the health care team was ill-prepared, yet a parent made the difficult decision to discontinue intervention. It taught me an unforgettable lesson.
During the first ICU …
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A child’s father knew when to let go. The health care team didn’t.
I hoped that my feisty patient who prevailed over brain cancer would be spared another terminal diagnosis, but after two years in remission, her mammogram showed breast cancer. She agreed to surgery, but declined further chemotherapy. When the time comes, she asked, would I help her end her life?
The End of Life Option Act goes into effect in California on June 9, 2016, joining a handful of other …
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California’s End of Life Option Act will provoke meaningful conversations
When asked during a recent ICU rotation if I was considering critical care as a subspecialty, I offended more than one person with my response: “No, I really don’t enjoy torturing old people.” Granted, that unfiltered comment came at the end of a long and sleepless 28-hour shift, but the sentiment holds true.
As doctors, we have a number of tools to assess quality of life in research. We use fancy …
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The myth of critical care
