Seven months ago, in Carbondale, Colorado, staff at the skilled nursing facility where my mother had resided for over a year recommended that she be placed on hospice. My mother has severe advanced dementia and can no longer walk, speak, feed herself or recognize her family members.
As much as I know about hospice care for cancer patients here in San Diego, I knew nothing about hospice care in Carbondale for …
Why is Medicare going after hospices?
Please raise your hand if you are not going to die.
If you haven’t found the fountain of youth and we haven’t perfected anti-aging technology, then you my friend are going to die. But you are not alone, so am I, and so is your mother and your father and your brothers and sisters and even little Johnny down the street.
Now that I have reminded you of your own mortality. Does …
What if I told you that you were going to die tomorrow?
Hospitals are busy places to work. The work is fast paced, and never seems to stop. For most physicians, the work ends when the work is done, or until you fall over, whichever comes first. So as a consultant, when I am seeing a patient wherein there is no longer anything that I am contributing to a patient’s care it’s routine that a physician would “sign off” the case, meaning …
Offer hospice patients a smile
A grandfather-father-husband-salesman-cook-gardener-hiker-gentleman, adored by many, is struck down by cancer. His disease is particularly horrible, spreading quickly though his body causing damage not only to bone and organ, but to sinew and nerve. He suffers terrible pain for weeks, relieved poorly with inadequate doses of inferior medications, thrashing in misery witnessed by his kin, always at the bedside, ages seven to seventy. Finally, uncomfortable and agitated until the end, he …
A poorly managed end of life experience can transform families
When you set out on an unfamiliar journey, you will need a map to get to your desired destination. You may pass landmarks, but not know exactly where you are unless you are able to identify these landmarks on your map. The same is true for the journey of life, and specifically, the path at the end of life.
You may know …
At the end of life, never underestimate the power of a map
For years I’ve been asked the same question: “How can you work in hospice and be around death everyday?” As if death, like this year’s flu, were something we could all just avoid so long as we stay away from it. This question, however, takes on a bit of a different form this time of year as people’s thoughts are centered much more around family. The question becomes more of …
Learn to celebrate Christmas: Lessons from hospice patients
About thirty years ago, after I’d completed my internal medicine residency and a rheumatology fellowship, my wife and I moved with our three-year-old son to my wife’s hometown.
There I joined a multispecialty group practice as the second rheumatologist. Over time, the plan was for me to build a rheumatology practice, but while that was happening I took on all kinds of patients, both primary-care and intensive-care. I felt very comfortable …
Telling someone of a loved one’s death never gets easier
The human capacity to deny reality is one of our defining characteristics. Evolutionarily, it has often served us well, inspiring us to press onward against long odds. Without denial, the American settlers might have aborted their westward trek somewhere around Pittsburgh; Steve Jobs might thrown up his hands after the demise of the Lisa; and Martin Luther King’s famous speech might have been entitled, “I Have a Strategic Plan and …
Prognosis near the end of life: We need better tools
I pulled the stifling surgical mask off my face as I left my last patient’s room. I had just finished suturing a complicated facial laceration and was bone-tired from the evening. Glancing at the clock, I saw that mercifully, my shift was over.
Collapsing into my chair to finish up my charting, I was slightly annoyed when my nurse held a clip-board in front of my face, “Here is your next …
A rare case when needs of the dying should be secondary
Visiting the dementia unit of a nursing home is never easy.
First off, you have to find your patient amid the assemblage of people–mostly women–seated in wheelchairs, recliners, wingbacks, sofas and assorted walkers, or wandering around.
Then, you must make yourself known to the person you’ve found. Here’s where the harder questions arise: How can I introduce myself and convey my role–a hospice chaplain–to someone who has outlasted language? Is my state …
The long years between the last words and the final breath
During an internal medicine residency, newly hatched doctors are responsible for some of the sickest patients in their teaching hospitals. This is because those patients often don’t have private doctors to attend them and are poor and sometimes self abusive, with the complex problems that go with smoking, drug and alcohol abuse and lack of regular medical care. These patients often present with their diseases late in game, when much …
An end of life discussion is one of the most important to do right
There is a serious cost problem in USA health care which no one denies.
Yet when it comes to suggested solutions, there is a wide divergence of opinion. Attempts to use experts and evidence based guidelines for care are somehow viewed as government interfering with decisions which should be between the doctor and her patient.
States and insurance schemes have made varying attempts to deal with this. The Oregon Health …
Does Oregon have the answer to rational rationing?
A palpable tension was present in our cab as we drove west. The taxi driver taking us to the retirement home of our patient filled the air with stories of the local prisons and the beauty of this area in the summer time. I am sure that I laughed at his light-hearted anecdotes but all I really could focus on was my heartbeat, its obvious crescendo as we drew kilometer …
Death is not supposed to be a comfortable subject
ADVERTISEMENT
There is a broad consensus among healthcare policy wonks that the 800 pound gorilla in the healthcare cost debate is that a big chunk of the medical care we provide — some say as much as a third — does not help. It may even make things worse for patients. Aside from the ethical issue of doing things that don’t help, and may hurt, this useless and dangerous care is …
There is more to life than avoiding death
I’m sorry.
I really am. No one deserves breast cancer. Especially the kind that spreads to your liver, lungs and brain. The fact that you lived to your eighth decade doesn’t detract from the sadness. You deserve to live. I can’t blame you for not being ready to go.
I apologize that our meeting was so abrupt. I was consulted to see you in the nursing home to address various issues. I …
I’m sorry I was your last memory before dying
He had been in the hospital for 3 months. A rocky 3 months, much of it in the ICU. Now, when it looks like he will be leaving on his way to a near full recovery, his wife tells me she can’t thank me enough telling her husband “she never lost faith in you.”
I felt as if my medical practice had suddenly been realigned. All the recent years of practice …
A reminder of medicine’s main purpose
Some things are just so damned hard to write about. People often ask me, “Why do you have so many animals?” The current count is 4 dogs, two horses and a cat. I used to say, “Because it’s good for my children to learn responsibility. Having a dog, whose life is so much shorter than our own, teaches them about love, and about death. They get to practice parenthood, before …
Doctors are notoriously awful about dealing with death and dying
One of the most difficult decisions that patients, families and physicians face involves end-of-life care. The advance directive or “living will” has become an accepted framework for patients to delineate their own preferences about what treatment they would or would not want when faced with a life-threatening disorder. But it was not always this way.
In the past, physicians and families often shielded those with potentially fatal illnesses from candid conversations …
Why do patients often deviate from their advance directives?
I just took care of a precious little lady, Ms. King (not her real name), who reminded me that, too often, we doctors are practicing irrational medicine at the end of life. We are like cows walking mindlessly in the same paths; only because we have always done things the same way, never questioning ourselves. What I mean is that we are often too focused on using our routine pills …
Doctors are practicing irrational medicine at the end of life
The baby boomers, the largest generation in American history, are now almost all in the last third of their lives (if average life expectancy is 78). They have spent the previous, early and middle thirds of their lives transforming cultural ideas, expectations and practices (e.g with the civil rights movement, environmental movement and women’s movement, etc).
The question now is, “Will the baby boomers also transform our cultural ideas, expectations, and …
How baby boomers will change end of life care
Get free updates delivered free to your inbox.
