I have failed Jerry, and now I’m replaying every word I ever said in my head, over and over, the whole exercise consuming my being.
Jerry was not old. He just turned sixty, a good few decades of retirement awaiting him. Then, he was diagnosed with stage 4 esophageal cancer. It seemed that he had spent his entire life working up to that moment, only to be stolen away unjustly, by …
The only thing I had to do was to help Jerry and I failed
“Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my career as a pulmonary and critical care physician, and I have cared for thousands of dying patients. In many cases, both the patients and I knew that they were dying. …
A glimpse of dying from literary authors
Earlier this year, I made an announcement that may have made a few people think I was half a bubble off level. I’m leaving CCU.
I’ve worked in CCU (and CVICU) for 14 years. 5 years ago I had a baby, and reduced my hours to one day per week.
It took me just about all of those 5 years to fully comprehend that one just can’t keep up with all there …
Why this nurse left the intensive care unit to go into hospice
Recently, a former clinic patient was admitted to the hospital. This man and his family had been struggling with his cancers for several years. His first cancer had led to a total voice box removal with tracheal stoma placement years ago, which prevented him from talking. His post-operative condition made communication even harder for this non-English speaker, who then depended upon an English-speaking family member to translate.
Then, two years ago, …
End of life ethics and the importance of doing the right thing
I’ve talked to hundreds of people about the health care options and decisions they face at the end of life. It’s a challenging time and understandably many have little knowledge, while others have misconceptions, and some have bitter disagreements.
Here’s a basic primer for two common approaches: hospice and palliative care.
Hospice care
Two myths about hospice care are prevalent. First, many people believe hospice is provided in a place like a hospital. …
Hospice care and palliative care: What’s the difference?
The names of things often greatly affect our perception. In end of life lexicon, there is a movement underway to change the name of the medical order DNR (do not resuscitate) to AND (allow natural death). No change in the medical reality of what occurs, but a radical change in our emotional reaction to the each term.
DNR: “They withholding a medical intervention” (evoking negative feelings).
AND: “They are giving care that …
Artificial death extension: It means that I actually care
Mr. Omer had once held a position of social prominence, a moral influence on the lives of individuals and communities. Until one year ago. A construction accident changed everything. He suffered injuries that left him in control of only one side of his body and his mind functioning as a 5-year old child.
Most recently, he had resided in an extended rehabilitation nursing facility, until yesterday.
When the nurse tried to arouse …
We have kept Daddy out of heaven with what we have already done
I gently rotated his arm as the beads of sweat formed on his forehead. The pain came in waves. His face contorted and relaxed in repetitive spasms. I wondered if my exam was in vain. The cancer had spread from his lungs to his liver and into his bones. Once the blood stream had been tainted, the aggressive cells took flight and landed in various organ systems.
We already had the conversation. I …
A tragedy based on administrative decisions
When we love someone, we want for them the best. We fight for and with them. We push them to attack disease. Is it possible that our very love can cause suffering? Can we mistake our eternal love for each other with a futile fight for immortality? Does our caring crush the ones for whom we care?
In a fascinating article, the Wall Street Journal followed the terminal case of …
Does our caring crush the ones for whom we care?
Most of us do not want to die in the ICU tethered to tubes — not the quality of life we expect. Yet only 30 percent of us have made arrangements to prevent this from happening. Death and dying is a tough subject for us to broach. Be aware that very few of us will die in our sleep — most have a slow sometimes excruciating decline to death.
As we …
What is the goal of palliative care?
Here is the setup. You’re working in the ICU. You want to communicate a prognosis to the family of a patient who is so ill he cannot make decisions. You sensitively state the facts: the patient has less than a 5% chance of survival. Or perhaps you say “he will definitely not survive.”
The family confers, and decides that they want to focus on keeping him alive as long as possible. …
Psychological factors influence how patients interpret information
I had just put him on a ventilator. Mr. Barnes (not his real name) had come in by ambulance sweating, barely responsive, gasping for air. The paramedics said he was from the local rehabilitation hospital and had just been sent there 2 weeks ago after a protracted hospitalization for a stroke which had left him partially paralyzed. Then they showed me medical orders indicating that he was “full code,” medical …
5 questions to change your end-of-life path
Recently, I listened with interest to an interview on NPR that posed the question of who needs long-term-care (LTC) insurance. Only one percent of Americans own LTC insurance which defrays the cost of custodial care.
Because of recent experiences I’ve had with my mother, I’ve have been thinking about how I’d like to spend the rest of my life when or if (I admit to fits of denial) the time comes …
Think about the eventuality that comes to ourselves and our parents
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Those who know and work with me have heard me state without hesitation that it’s morally wrong to do CPR on 90-year old great grandmas. So, it was with great relief that I read the “Do Not Offer CPR” option in a recent JAMA article urging a revision of our present approach to the use of CPR for those who are unarguably at the end of life.
This is a change …
Burdening families with CPR decisions in the face of futility is cruel
Never heard of the 90-80 dilemma? That’s because I have just coined the phrase. You see, tied into soaring healthcare costs in this country, is another humanitarian crisis of massive proportions.
A huge gap exists between what Americans want for end-of-life care and what they actually receive. 90% of people wish to die at home, yet nearly 80% of us actually die in institutions (hospitals and nursing homes.)
So, how did we …
Create peace and dignity at the end of life
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during my career. How a physician goes about this process can make an enormous impact in the lives of those affected by the news that must be delivered.
Precious little time is devoted to teaching this essential communication skill in the training of physicians today. I can remember back to …
How we deliver bad news is critical to how families deal with grief
He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I thought the patient was dead. He was nearly the same color as the pale sheet covering his thin frame. His cheeks were sunken in and his eyes were gazing upward, in what I sometimes call the “death stare.” Then, surprisingly, he moved his arm upward to push his …
His father’s suffering had already been too great
I was honored to be part of a beautiful experience in late January of 2011. It was the death of my mother-in-law at the direction of Trinity Hospice in Aiken, SC. Having never thought I would describe death as beautiful the word choice comes as a surprise even to me, a Sagittarius and straight shooter, and in combination with mother-in-law, I would also guess, very suspect. However, sharing in her …
How death can be a beautiful experience
Theirs is a lonely journey; to be moving towards the separation and end of all things known and loved.
Being with a dying person is challenging; it penetrates through discomfort seeking honesty and courage. It brings you confrontationally into the present which is shocking for many. But if you spend time with the dying you’ll find that their needs are not so different from ours, only they have a limited time …
What meaningful encouragement can be given to someone who is dying?
The ambulance crew rolled him into my ER breathless in his pajamas, O2 mask on his face, gasping for air, his short cropped hair a mess, standing straight up. Eugene was what the staff called a “frequent flyer.” As the nurse injected some IV Lasix I reviewed his chart to find a classic downward spiral.
It was a busy evening. The bays were full of the usual cuts, broken bones and …
Death with dignity in the emergency department
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