“For someone who went into medicine to ‘help people,’ you sure do talk about dying a lot,” my mother told me one day on our brief weekly phone call. I try to get in a phone call to my mother once a week so she knows I’m alive, surviving my intern year. I had been on medical intensive care unit (MICU) service and it had been a rough week. Being …
Doctors cannot predict when the end of life truly comes
Whether they are young or old, we do not want our loved ones to die. Period. Even if we live with faith in our eventual, eternal reunion with them, we know that their passage will leave a void. I completely understand.
But I want to take a few lines to try and make things clearer, or easier, for those who have family members who are very aged and infirm. You see, …
We don’t really get to die of old age
I’ve learned that people will forget what you said,
People will forget what you did,
But people will never forget how you made them feel.
-Maya Angelou
We are often asked, “How can you do that?” How can you stand to do that work? Such a dreary subject. Grim but supposedly necessary. Don’t you get depressed with all the talk of dying? Facing death and its consequences every day must be the prime route …
Public misperception of the grief counselor
Why must everything be so difficult?
Soni pushed her mother quickly into the building from the parking lot, she wore a strained look on her face. The wheelchair appeared preposterously large for the aged figure cowering under the haggle of blankets. They were enjoying the brisk air, taking a walk around the facility, when the elderly woman called out. Her lips curled and she moaned deeply.
Now Soni’s mother had stopped talking …
Nonsensical rules are binding the hands of caregivers
When I first started facilitating a grief support group shortly after moving to New York, my aim was simply to create a supportive environment for members to heal from their grief and to form long lasting bonds of friendship. In the course of five months however, I’ve begun to wonder whether emotional and psychological healing can be contained into an end goal with a finish line.
For the most part, authors …
After grieving and healing: Transformation
Les called me about his PSA.
“Jim, it’s rising and now up to eleven and they’re recommending treatment. What would you do?”
Even as a long retired MD, I still get medical calls from friends and relatives. Actually, I feel honored and try to do my best, researching the latest journal articles and editorial opinions. Of course, the prostate cancer literature is cloudy at best with scant evidence that the huge number …
Hospice stays remain far too short
How dare you!
Life can change in a heartbeat. Most of us believe that our lives, our loves and all the that things that make us who we are is a gift from a higher power. One that can be taken away as swiftly as it is given. But somewhere in the shuffle of taking kids to practice, catching up on emails, worrying about bills, and the search for the perfect …
When end of life care becomes a confrontation
So a guy has his car towed to the mechanic. All four tires are slashed. He has a simple request.
Please replace the tires.
But this is one of those comprehensive care mechanics. He not only examines the tires, he does a full once over. He pops the hood and immediately knows that the engine is shot. It’s fried. The cost of fixing the engine is more than the value of the …
Unlike mechanics, doctors have been denied the basic logic of futility
When I graduated residency and started my first job, I walked around the ED confidently, chest slightly pumped up at all times. I knew I was well-trained. If there was a sick patient, I was going to resuscitate them. If there was an impossible central line that was needed – I was going to get it. Difficult intubation? No problem. There was no procedure that was too difficult for me.
Many …
The conversations can be more difficult than the procedures
“Throw grandma under the bus” clearly conveys anger, sympathy, and fear when health care decisions are made outside the realm of medical professionals. Within the doctor-patient relationship, alignment of physician expertise with an individual’s personal decision should keep insurance company executives, hospital CEOs, and government authorities from interfering.
Are we naive to believe interference isn’t already occurring?
A doctor orders a breast MRI to further evaluate an abnormal mammogram, but the insurance …
We’re already throwing grandma under the bus
Once upon a time, I was a newspaper journalist: I chased down sources and sweated over deadlines. Then, in mid-career, I switched to doing marketing and communications for a regional healthcare system. This consisted of a large hospital and many outpatient clinics, including a community cancer center.
Because I handled communications work for the cancer center, I also had a seat on the cancer committee — an oversight group of oncologists, …
We really need to give our outpatients palliative care
I lost another patient to hospice last week.
She was 49-years-old. Three years ago, she was diagnosed with stage 3 cervical cancer. She was treated with surgery and chemotherapy and went into remission and stayed there until she died. After the chemotherapy, she stayed anemic. She was weak, didn’t take care of her insulin properly and didn’t eat. Her kidneys slowly lost function because of her noncompliance, her HgA1c climbed to …
Before you can even form a thought, emotions are influencing your judgments.
-Zimmerman and Lerner
It’s 9am on a Monday, and our palliative care team circles a table to prepare for the workday. Before us is a list of names, each representing a patient and his or her needs, support system and care team. Many are referred to us because they are suffering — be it pain, agitation, emotional distress, existential crisis …
Balancing emotions and reason at the end of life
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I think we are overly limited by our descriptive terms. We throw around concepts like hospice and palliative care, but in reality the medicine I practice is much more a hybrid. Many of my patients are elderly, demented, and plagued by metastatic disease. Often when one of them becomes ill, it is unclear if they are merely treading water, or about to drown. The problem with our modern definitions is that they leave little …
Introducing the palliative care ICU
While recently confronted with a cancer scare and several months of inconclusive diagnostics, I found myself thinking about how I want to die.
Following some reading, my first answer was to die at home, with control over my care, and without substantial pain, views that are widely shared by others. But the more I thought about this, the less satisfactory the answer seemed.
For instance, being at home was never of high …
Second thoughts about how to die
It is in our nature to lie. Falsehood is one of the most creative things we do and the most remarkable of the human arts. We construct castles from ether and support their ephemeral walls on a foundation of accepted truths, which themselves are wisps of previous lies. The more we live within lies, the greater the challenge and more the harm. We pay a heavy price for fabrication. What happens …
What happens to us when we lie about dying?
We never know how high we are
Till we are called to rise.
-Emily Dickinson
It could be suggested that the “good death” is falsely named in the field of thanatology and in the popular press. It implies an ideal state, one which of course we cannot have. Never agonize over ideals when the problem is as urgent as death. Perhaps it should be renamed “the good-enough death,” one that is …
There is a cure beyond saving a life or the curing of an illness
New Jersey is considering following four other states in legalizing physician-assisted suicide. The Death with Dignity Act would allow people with less than six months to live to receive a prescription for a fatal cocktail and then to commit suicide at the time of their choosing in the privacy of home. Recently, I had the opportunity to participate in a debate on the merits of the proposed law. While I oppose this …
An argument against physician-assisted suicide
As physicians, we bear witness to the health and life events that unfold for our patients. We diagnose and treat diseases. We watch as our patients find partners and celebrate as they bring new life to their families. Yet when the challenge becomes great for our patients, our role must change. We must do more than bear witness. We must shepherd.
When I first began seeing John as a patient, he …
A gift to bear witness to the changes in my patients’ lives
For reasons I confess I don’t quite understand, zombies are in these days. They populate blockbuster movies, TV shows, and even commercials. There are the classic, grisly, menacing variety, and even some new-age variants that seem almost cuddly, in a creepy sort of way.
But whatever explains the fascination with zombies, they seem to belong to that same taxonomic category of interest as purple cows of silly poem fame: People …
Our children will be living a growing number of zombie years
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