Palliative Care

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.

The stress of being a caregiver to an elderly parent

Val Jones, MD

Physician

November 22, 2015

My patient’s son stood vigil outside her hospital room day and night. His eyebrows were frozen at an anxious angle. Although his mom was healing well from her injury, I could see that he was worried about next steps. He asked staff repeatedly about his mom’s pain management, and reviewed every therapy session she attended.

His mom, on the other hand, was deceptively charming. She was a thin, well-groomed elderly woman …

The palliative caregiver shines a balanced and soft compassionate light

Kevin Haselhorst, MD

Physician

November 21, 2015

I never realized the true meaning of palliative care amidst the harried practice of emergency medicine. The pressure being placed on me to do more often becomes the same expectation I place on patients to receive more treatment.

Gloria, the wife of my patient with terminal mesothelioma, shed a light on palliative care for me with the insightful words, “We know that there is no cure — we just want to …

Why doctors won’t use the new end-of-life Medicare counseling codes

Lucy Hornstein, MD

Physician

November 14, 2015

Poor bored government. So much time on their hands; so little real work that needs to get done, all they can do is micromanage poor physicians like me to death. Well, they can try.

For its first forty-five years, Medicare was (in)famous for the very narrow limits on things it covered. It would pay for medical care when you were sick or injured, and that was basically it. No preventive care. …

Physician assisted suicide is our moral indicator

Stephen Kamelgarn, MD

Physician

October 31, 2015

On September 12, 2015, the California Legislature passed a controversial bill legalizing physician-assisted suicide. California would become the fifth state to allow doctors to prescribe lethal medication to terminally ill patients who request it, after Oregon, Washington, Vermont and Montana. During the debate over the passage of the bill, everybody weighed in: patient’s rights advocates, dying patients and their advocates, religious groups. The one group that I didn’t hear about …

The discovery period regarding the existence of life

Kevin Haselhorst, MD

Physician

October 29, 2015

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 …

Ease the transition to hospice care in the family home

Regina Holliday

Patient

October 28, 2015

It is a pattern oft repeated in a lifetime:

You go to the doctor’s office, get a prescription, and go home.

You go to the urgent clinic, get care, and go home.

You go the hospital, get better, and go home.

But some people are very surprised when they go to inpatient hospice, are stabilized and told to go home.

Inpatient hospice could be within a hospital, nursing home, or a dedicated hospice facility. The …

A patient’s death drove this physician to tears

Anonymous

Physician

October 21, 2015

“Doctor, I am ready to die.”

I knew her from a few years back. This patient of mine.

I am a hospitalist and the patients in my care come and go, making it difficult to really form relationships like the ones primary care physicians have with their panel of patients. But this patient was different. I saw her once many years ago when she was gravely ill, and we managed to pull her …

The strange landscape of living and dying in the United States

Michael D. Fratkin, MD

Physician

October 20, 2015

The extraordinary pain of many people around you is unaddressed, and the scale of that unmet need would shock you if you saw it. Compartments of privacy separate you from the experience of your neighbors and even your own families. I understand that you have been unaware as well as hopeful that our medical system will either fix the problems or, at least, soothe the pain. It does neither consistently. …

Terminal dehydration: A gentle way to die?

Christopher Stookey, MD

Physician

October 7, 2015

My father suffered a massive stroke on a September night not long after his 83rd birthday. It left him conscious yet unable to talk and communicate, unable to swallow and almost completely paralyzed.

After numerous scans and other tests, his doctors determined that there was no chance of recovery. My father would never walk, talk, or swallow food again. With nothing more to do for him in the hospital, we — …

When it comes to end-of-life care, perhaps we do need a bigger hammer

Richard D. Sontheimer, MD

Physician

September 25, 2015

While sitting one evening with my terminally ill elderly mother, she again asked me to help her end her suffering. This time it was, “Could you just go get the hammer and hit me in the head?” Her previous requests had included “Son, you are a doctor, can’t you do something to help me with this?” And then, “They treat animals better than this.”

On previous occasions, I had to remind …

Caring for the dying patient is a rewarding challenge

Earl Stewart, Jr., MD

Physician

September 17, 2015

I walked silently into the pristinely decorated room of the hospice facility and was greeted by her family. She lay there, not particularly responsive to her surroundings under the pressure and influences of metastatic stomach cancer. The warmness and smiles on the faces of her family told me that at some point and somehow, in the midst of actively witnessing the transition of their mother, aunt, sister, and grandmother, they …

Ain’t the way to die: The stories that this physician will never forget

Zubin Damania, MD

Physician

August 14, 2015

shutterstock_240724267

Like so many other medical professionals, I felt voiceless in the face of a gargantuan health care non-system built to do things to people, rather than for people. But after a decade of hospital practice, my “cry for help” looked slightly different than the typical midlife crisis: It involved the creation of a somewhat ridiculous blue-scrubbed rapping doctor alter ego. “ZDoggMD” could …

Slowly, slowly

Christy Duan

Physician

August 11, 2015

“What is the meaning of life?”

A perfectly reasonable question, albeit a strange one considering that I was in the third grade, it was recess time, and I was having a philosophical conversation about death with a grasshopper I had just caught.

Ever since I could remember, I was fascinated by death. But my life was characterized more by loss than by death. When I was three, there were no funeral processions …

Read more…

Slowly, slowly

Culture influences end of life decisions

Vincent DeGennaro, Jr., MD, MPH

Physician

August 5, 2015

“Either way, no matter what we do, you’ll live less than 12 months, probably less than nine. Even if we were in the United States, your disease is incurable.” He nodded slowly in understanding. Jean Dominique was only in his 40s and had teenagers at home. “We can treat your pain and other symptoms, but we can’t do anything to treat the …

Doctors and nurses need to be better trained in palliative care

Anonymous

Conditions and Diseases

July 15, 2015

Doctors and nurses said patients and their families created the largest obstacles to end-of-life decision-making in the ICU in a large survey published in JAMA Internal Medicine.

About 1,300 staff at 13 academic hospitals in Canada rated barriers to end-of-life goals of care on a 1 to 7 scale. Doctors and nurses considered the largest barriers to end-of-life …

Pediatric palliative care: We must do more

Joanne Wolfe, MD, MPH

Physician

July 14, 2015

How is it that, in this day and age, a talented teenager treated for lymphoma emerges cured but with a life-threatening eating disorder? How is it that, in our nation’s capital, a boy dying at home from neuroblastoma experiences excruciating pain in his final moments? How is that, when we develop new drugs to treat children with cancer, we do not, at the same …

Comfort may be the most important thing that physicians can provide

Amrapali Maitra

Physician

July 13, 2015

A hospital can be full of discomfort. My patients tell me that the food is unappetizing. The beds hurt their backs. The noise echoing through the hallways at night makes it impossible to sleep. And for those patients near the end of life, the treatments being offered may no longer be of benefit, causing more pain than good.

The answer to discomfort for those who are very ill is comfort care, …

Why you should have your end-of-life discussion now

Gene Uzawa Dorio, MD

Conditions and Diseases

May 26, 2015

Draping a shroud of 30’s Depression on any dust bowl child can thicken the skin, so my 88-year-old patient learned to be fiercely independent with a “talk to the hand” attitude, and “don’t get in my way” personality. Even after her husband passed away, she remained autonomous traveling and golfing in her social circuit.

Living life as a smoker was always a threat to her health, and this year became a …

POLST and well-intentioned advance directives

Heather Alva

Physician

May 12, 2015

Somewhere along the way I learned to believe that if a declaration is written down on physical paper and signed, it carries with it an almost magical certainty of follow-through: it can be framed, cited, stored in a safe, and, if need be, brandished in a court of law. This is an interesting idea in the realm of advance directives.

Well-intentioned advance directives

The goal of an advance directive is to protect …

Invaluable lessons about what a “good death” might look like

Shoshana Ungerleider, MD

Physician

May 7, 2015

I became a doctor because I was excited by the idea of helping people every day. Following a lifelong fascination with science, I found myself in medical school, surrounded by bright classmates. We bonded over late night study sessions at the library and kegs of beer after each exam. As all medical students do, we memorized the 640 skeletal muscles that …

Palliative Care

Most Popular

Past Week

Past 6 Months

Recent Posts

Subscribe to KevinMD and never miss a story!

Most Popular

Past Week

Past 6 Months

Recent Posts