I recently talked about wondering how those I had met through my own patients were doing, especially after my patients had passed on. I wondered if they were all right and whether they were able to move on. Well, I’ve been thinking about it again, though this time in the context of cancer survivorship.
The Office of Cancer Survivorship of …
When do I stop being someone’s oncologist?
The sage doctor who stood at the bedside as I held my dying grandmother said, “We seem to die one organ at a time.” I, however, have come to believe that we are too focused on the failing of the organs to rightly perceive the dying of the person.
Death comes in many different ways, in many different packages. Sometimes it arrives wrapped thoughtlessly in advanced dementia, other times the package …
Death arrives in many different packages
Everyone suffers when communication fails at the end of life. Though we may “know in our hearts” what to do in difficult situations; anxiety and bias close us down. We lose our ability to say and act on what we know is best.
Physicians and nurses suffer when they “know in their hearts” that they are doing harm performing CPR on people at a natural end of their lives on people …
What does it take to have successful end of life conversations?
In the fall of 2010, Atul Gawande, surgeon at Brigham and Women’s Hospital in Boston and an associate professor at Harvard Medical School, delivered a touching speech at the October New Yorker Festival. My husband attended with a friend and, because he said it so profoundly impacted the audience, I watched it myself on video the next day. It was indeed amazing. Dr. Gawande, author and national health care presence, …
4 perfect questions when facing an end of life situation
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for “feeling good”, but he did hope that it would help him avoid illness. It was worrisome when he started with some belly cramping and noticed some blood streaks in his stools. It took about a month until he could be scheduled for a colonoscopy. The news was shocking. “There’s a cancer …
End stage colon cancer becomes even more tragic without hospice
About four months ago I found myself an unlikely participant in an unlikely situation, after having endured the unlikeliest of journeys. At the end of October myself and three others from Solaris (Andy Milligan, Luke Oyler, and Robbie Surratt) boarded a plane in Dallas and made our way towards Nepal. We were traveling halfway around the world in order to help a non-profit organization called MountainChild bring medical care to …
An opportunity to serve an extraordinary purpose every day
Christopher Hitchens, noted author and philosopher, died December 15, 2011 leaving behind many essays, books, and other writings as well as contributing to several lectures, ethics/religion debates, and TV talk shows. His acerbic style often ruffled feathers as he attacked religious dogmatism.
As one of the most famous outspoken atheists of this era, his thoughts on being diagnosed with an incurable disease would be a powerful insight into how atheists might approach …
Christopher Hitchens and the universal experience of dying
Full code is the universal default status for patients who haven’t chosen otherwise, but I suspect most physicians believe this policy is wrong. We know in our hearts we’re doing harm when we perform CPR on poor souls at the natural end of their lives, whose bodies can do nothing more than suffer.
Appropriately timed end-of-life discussions are the supposed answer, but for doctors, they are emotionally draining, interpersonally complex, and …
Why full code should not be the default status for patients
Most people wish that they knew what to say and do, and how to be when approaching dying, death and grief.
Because we’re uncomfortable and unprepared for end-of-life encounters, we either stay away, say and do things that don’t help; or act in ways that are neither becoming nor helpful to the people about whom we care.
What if you did know what to say, what to do and how to be …
3 tools to start the end of life conversation
Marge was aging and gradually “falling apart”, as she would say. “First it was my back, then my knees, and now my heart is giving out”. She confronted her doctor with this in a frustrated manner, “I’m no good for anything anymore. I can’t really enjoy the things I used to. Most of my friends have died off, so maybe I’m next”.
The doctor in sizing up Marge’s advanced age and …
A POLST form documents what patients value
Ok, you caught me. I am mortal. After four score or so years, my body will fail and I will live no longer. Dust to dust. Not thrilled, but I expect most of you are the same. I have but two final requests. Let me end my life in peace, surrounded by family. Second, please, do not let me “pass”… I really want to die.
Like you, I have struggled through …
Let me end my life in peace, surrounded by family
It isn’t that it was a bad day, because it wasn’t really. There was too much work, yes, and I ended up staying late, but it was mostly made of good interactions and I felt generally competent. So, no, it wasn’t just a bad day. Still, this evening I feel like the best possible future would be one in which there was no technological medical care, where we just worked …
Complex, painful and expensive medical procedures at the end of life
Last week was tough. I had to refer several patients to hospice, and a few more received bad news regarding their disease. This has always been the toughest part of my job, but it’s also the part patients need me to handle best. I have to remind myself that no matter how hard it is for me to give bad news, the patient and their families are the ones receiving …
Doctors need to be better trained to deliver bad news
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Suzie remembers what it felt like to be fifteen. She can still hear the creek of the steps leading to the third floor and the quaint finished bedroom that housed her grandmother that fateful summer.
Originally, Grandma was set to move into the small room next to Suzie’s parents. But after his first night in the attic, Billy refused to set foot up there again. So Dad lovingly wrapped Grandma in …
Reaching the pinnacle of medical education
There was an exceptionally well-written piece published in the Washington Post recently. I presume a hospitalist wrote it, which magnifies its significance. In it, he describes the difficulties in caring for terminally ill patients.
As I read it, it reminded me of a story my dad told me several years ago. His friend, I will call him Steve, was experiencing a great deal of stress because of his dad’s ailing …
Overtreatment and the ethics of end of life care
For the past month, the case of Amanda Trujillo has resonated deeply among nurses, triggering an avalanche of postings on Facebook, Twitter and in the nursing blogosphere. Trujillo is the Arizona nurse who was fired in April 2011 after providing education and making a hospice care consult request for an end-stage liver disease patient. This patient was slotted for pre-transplant evaluation …
Why physicians should care about Amanda Trujillo
“Twenty years ago, I helped save a man’s life.”
So begins this New York Times essay by Peter Bach, MD, where he talks about the inadequacy of resource use at the end of life as a policy metric. Now, I am not very fond of policy metrics, as most of you know. So, imagine my surprise when I found myself disagreeing vehemently with Peter’s argument. Well, to be fair, I did …
Turn away from interventions that merely prolong dying
No one wants to die. Even people who want to go to heaven don’t want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because death is very likely the single best invention of life. It is life’s change agent. It clears out the old to make way for the new.
-Steve Jobs, …
The orders came indirectly from the government.
Reduce hospital re-admissions. Cut costs.
So, the hospital contacted the local hospice-palliative care center and asked for help. Of course, overwhelmed with work and understaffed, the project was handed off to me.
My task sounded simple. Create a palliative care program at the nursing home. But as I gathered for the first meeting with the administrator, social worker, and clinical staff, I knew there would be …
The challenge of creating a palliative care program
Visiting someone who is dying or critically ill is an experience many of us will have in the course of our lives. Whether your visit is to be in the person’s home, a hospice or a hospital, there are a few rules of thumb to guide your time together so that it can be mutually satisfying.
This post introduces some of the basics.
1. Call ahead. Find out what prime visiting times …
Preparing for your visit with someone in hospice care
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