When my 82-year-old uncle had a heart attack in the kitchen of his home, I was on the next plane to the East Coast. No one knew how long his brain had been deprived of oxygen before he’d been resuscitated. As I stood next to his bed in the hospital’s ICU, I feared that my uncle would not make it. I …
Where is compassionate end-of-life care for the elderly patient?
It was my first day at my new job, practicing a new specialty. Having spent fourteen years as an ICU physician — including a four-year pulmonary/critical-care fellowship in this very hospital — I had just completed a palliative care fellowship. Now I was the hospital’s palliative care consult attending.
When I set eyes on the patient in room 1407, my first thought …
A palliative care dilemma on the first day of the job
“All your patients will die. Maybe not today, but someday. The defining fact of life is that it ends. Only a fool would dedicate their career to fighting something that can never be beaten. Therefore, a doctor’s task cannot be to fight death. A doctor’s task is to heal when possible and prevent suffering always. Our calling is to support life. Fighting death may deprive patients of the opportunity to …
A twisted argument against end-of-life care
She was nearing the end of a long and interesting life. Her birth was announced on the party line in her rural community’s first telephone system. Her death, which would come soon, would be shared on Facebook and via cell phone. She had graduated with a degree in home economics from the University of Minnesota in 1938 and had worked for a meat packing company during and after World War …
A question you can never prepare for
We speak of everyday decisions in terms of cost-benefit analyses. Many of our patients can’t afford a healthy meal, let alone a hefty hospital bill, thus making cost awareness increasingly relevant. But on the day that I met Mr. R., it wasn’t the financial aspects of his care that concerned me. I was thinking about the patient, his family, and two roads diverged in a hospital ward. I was thinking …
Cost-benefit analysis: A case where conservative management wins
“He’d feel okay about not replacing the pacemaker’s battery when it ran down, he said. But turning it off, he said, would be ‘too active.’ Later he would tell me that it would have been “like putting a pillow over your father’s head.”
These are the words of Katy Butler in her book Knocking on Heaven’s Door – The Path to a Better Way of Death in which she writes about her …
Deactivating a pacemaker: Is it euthanasia?
Ever wonder what a “gomer” is? While certainly passé and unprofessional, does it shed light into the frustrations both doctors and patients have with end-of-life care? Emergency physician and author Brian Goldman explains the origins and use of such medical slang in his book, The Secret Language of Doctors.
What is a gomer? And why should you know about it?
I live and work in the house medicine. You would think that those of us who have chosen this profession would actually know what dying looks like. Furthermore, one would hope that if the doctor could identify dying, he or she could share this with the patient and family (given that this is fairly significant medical information).
I never cease to be amazed that most doctors cannot speak straightforwardly and compassionately about …
Doctors cannot speak about the reality of death and dying
Most of the time I feel as though I am running in quicksand attempting to bring patients to a place of grace and dignity in dying. On occasion, there is someone who jerks me out of my quicksand and plants me squarely on stable shore and then proceeds to show me what grace and dignity in the face of death really look and feel like.
Please meet Mr. Jefferson.
Mr. Jefferson had long, lacy …
This surprising request brought an emergency doctor to tears
Jack was the very first palliative care patient I met. Visiting him in his home, I feared the worst: emaciation, pain, a fluxing state of consciousness, and the otherwise bed-bound shadow of a former life. Instead, the first sight I was greeted with was a beaming smile beneath a bushy moustache. But for his IV lines and analgesia pump, Jack might have passed for a completely well middle-aged man, certainly …
Palliative care: A medical student’s reflection
The worst thing anyone ever said to me was, “You think you know everything, but let me tell you: You don’t know jack!” I was six weeks into my social work internship at a hospice and it was my student supervisor who decided I needed an attitude adjustment. Needless to say, I didn’t stay there. I was angry and hurt for a long time but now I’ve come to realize …
7 assumptions about end of life care
I was taught in medical school (some 50 years ago) that doctors had a special duty to protect the patient. That seemed self evident and logical. “Do no harm” was a first principle dating back to Hippocrates. However the teaching I received extended the concept to also protect the patient from bad news, and to make “the right” decision for them — not necessarily including them in the conversation or …
The evolving physician role in end of life decision making
My grandmother recently went into hospice care. At 94, she has lived a longer, richer life than probably most of us will ever hope to. Given the nature of the work I do, end of life care is not a topic I’m unfamiliar with. Initially, I spent a lot of time asking my mother probing questions about the care my grandmother was receiving. I imagine I did this partly out …
The parallel world of hospice care
ADVERTISEMENT
One of the skilled nursing facilities I work with has a hospice unit. We occasionally have patients on the hospice unit who might benefit from physical therapy. The physical therapists that see patients in the skilled nursing facility say they will talk with the patient about their goals, and if their goals are to maintain their current level of functioning, they will work with the patient. If the goals are …
Hospice patients can use functional improvement too
I recently talked about how we might approach the idea of our own death. I wanted to start a discussion about how individuals engage with, think about and plan for the end of their life. In offering a medical perspective on what death is like, I hoped to stimulate self-reflection about this scary and foreign topic.
However, when we think about death, we don’t just think about our …
Have a conversation with your family about the end of life
Hospice is a set of services that we all may need someday — if not for ourselves, for our parents. While death is not an option for any of us, we do have choices about the services we use at the end of life. Hospice is undoubtedly the best option in the last months of life because it offers a whole …
16 questions to ask when choosing a hospice
A few months ago, I walked into work on a late-night shift. One of the nurse practitioners came up to me and said, “There’s someone you need to see right away.”
The patient was a woman of about 60, and it was clear that she was critically ill. According to her husband, she’d been diagnosed with cancer six months ago. It had metastasized throughout her body. Her oncology team made several …
Empowering patients: Emergency department palliative care
Palliative surgery is tough stuff. Nobody wins much, and it often challenges one’s ability to think clearly, let alone to tell the truth. Sometimes, I think, it borders on the deceptive; it makes me wonder who’s the object of comfort. And yet, when there’s nothing else to do, it’s often just the right thing. I hate it.
To be clear: We’re talking about surgery to relieve some sort of specific problem, …
Palliative surgery: A surgeon reflects
Agnes was out shopping at her local corner store. At age 82 her body was beginning to show typical signs of aging. She had survived breast cancer surgery, a hip replacement, and cataract surgery. Her doctors told her she had osteoporosis and low vitamin D. She took medications for her hypertension, cholesterol, and osteoporosis. Her spine had begun to curve and her gait was a few steps slower.
Yet, with her …
CPR without informed consent in the elderly
The last time I was in Israel, I went on some home visits with a palliative care physician in the town of Sfat near the Sea of Galilee. My colleague, a devout Jewish doctor, took me to several homes to offer advice on managing his most serious, terminally ill patients. One older Chassidic Rabbi was dealing with an advanced lung cancer, and having a difficult time accepting any kind of …
Not acknowledging death does not make it go away
Get free updates delivered free to your inbox.
