I was the “stranger” at my father’s bedside. Shortly after his 84th birthday, my father fell and landed in the hospital with a split scalp. His metastatic prostate cancer was an incidental finding, and superimposing this wildly invasive tumor on his Parkinson’s-compromised body marked his first steps onto his death path.
I came to my father’s final illness as his daughter, a doctor, and a clinical bioethicist. While I was unable …
“I cannot escape death, but at least I can escape the fear of it.”
– Epictetus
I wish more people knew that quote during the pandemic. I write this on November 1st, celebrated as Dia de Muertos or “Day of the Dead.” Epictetus and the other Stoics knew that death is inevitable, that life can change in an instant, and viewed it as a reminder to live each day purposefully and virtuously. …
Dame Cicely Saunders, the founder of the modern hospice movement and palliative care, famously said, “You matter because you are you, and you matter to the last moment of your life.” This quote has become the central philosophical tenet of palliative care. It implores us to remind patients, who may be feeling helpless, hopeless, or worthless, that they matter. There is abundant evidence that patients approaching death are susceptible to …
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Join Thaís Salles Araujo, an internal medicine resident. Discover the potential benefits, challenges, and the need for greater awareness and education in integrating these therapies into modern medicine. Gain insights into the evolving landscape of patient care, with a …
Finishing up a consultation in the ICU, the nurses approached me to see how it went. “Did you get the DNR?” I explained that I enter these conversations without an agenda. My first goal is to develop rapport, reading the room to gauge how far I can take this conversation. What are they ready to hear? This phase of the consult is akin to preparing the soil for planting. The …
An excerpt from The Adventures of Dr. Anonymous.
During the COVID pandemic, I wished I could put out a public service announcement for physicians, patients, and families about end-of-life care. Palliative care is critical to hospitalist practice and one of the least discussed fields of medicine. It also is a major …
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Join Althea Halchuck, a patient advocate. We explore critical insights into end-of-life care, the ethical considerations around antibiotic use, and the quest for a peaceful, dignified death. Delve into the complex world of health care decision-making in …
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Join Vickie Leff and Terry Altilio, both palliative care social workers, as we delve into their book, Mirrors and Windows: Reflections on the Journey in Serious Illness Practice, which offers a profound exploration of the experiences of health care professionals, including palliative social workers, in the world …
An excerpt from A Caregiver’s Love Story.
Whether you are the dying or the caregiver, living life to the fullest remains your goal, but somedays it’s just too darn hard. When you are so busy that it doesn’t seem you have time to take a breath, where does living …
Each year, Congress goes through its annual budget process to determine how to spend more than $6 trillion on America’s priorities. This year, as part of the discussions on how to spend Medicare’s $900 billion budget, we are being told the Medicare Trust Fund, which is projected to spend $415 billion in 2023 for Part A expenditures, which cover inpatient hospital, skilled nursing facility, nursing home, home health, and hospice care, …
Reality knocked me for a loop one evening when my father-in-law called from his home in another state and asked for help. This kind of request was very uncharacteristic for him. We responded immediately and drove to his home. After much conversation and many questions from both sides, we eventually came to the hard truth. His cancer had progressed and, to my mind, was most likely terminal. I dug in …
“If you don’t know how to die, don’t worry; Nature will tell you what to do on the spot, fully and adequately. She will do this job perfectly for you.”
– M. Montaigne (1533-1592)
In 2021, former U.S. President Bill Clinton was rushed to a California hospital suffering from a urinary tract infection that had developed into sepsis, a life-threatening blood infection. According to the National Institute of Health and Care Excellence, …
An excerpt from Mirrors and Windows: Reflections on the Journey in Serious Illness Practice. This reflection was written by Chris Onderdonk, one of over 50 contributors.
I’m sitting next to Tony in the surgical intensive care unit doing my best to make out what he’s writing. He’s intubated and I’ve just …
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Join Tyler Jorgensen, an emergency medicine and palliative care physician, and discover the profound insights he shares on the value of home visits in patient care. Explore the complexities of handling challenging situations, such as encountering conflicting …
My wife, Ruth, passed away in April, and I am currently struggling with the immense loss. I deeply miss her, and for the most part, I feel terrible. I haven’t reached a point of “getting over it.”
Since her death, numerous people, including relatives, friends, acquaintances, and caring individuals throughout my day, have approached me with the same question: How am I doing? Despite multiple attempts to respond, I still haven’t …
Death is an inevitable part of life, and in medicine, it is a topic that is frequently encountered. As medical professionals, we see patients who are faced with terminal illnesses and inevitably nearing the end of their lives. Dealing with death can be a daunting task, and it’s a topic that requires sensitivity, empathy, and compassion.
At the forefront of end-of-life care are the principles of compassionate care. It is about …
“One should . . . be able to see things as hopeless and yet be determined to make them otherwise.”
– F. Scott Fitzgerald
I’m in a massive ballroom with numerous tables and promotional placards lining the walls and center. In attendance are every pharmaceutical manufacturer and their sales reps. All the biggies are here; Pfizer, Merck, Novartis, and AstraZeneca, to name a few. Their drugs are household names because they advertise …
“I don’t know how you do what you do.” About 90 percent of the time, this is the response I get when I tell people that I am a hospice physician. “Isn’t it sad to work with dying people all the time? You lose all of your patients… that must be so difficult.”
Having been exposed to the many different ways that people can die throughout my medical training, I see …
A KevinMD article about Jimmy Carter’s end-of-life care decision, “The heartbreaking story of Jimmy Carter: a call for Medicare reform in end-of-life care,” indicated that the former president’s decision was heartbreaking. However, I have a different view. In my opinion, the 39th president, at age 98, made an autonomous and well-informed decision.
On February 18, The Carter Center announced in a statement that “after a series of short hospital stays, …
The purpose of the serious illness conversation is to offer patients a clear choice between treating and not treating an incurable disease like liver cancer. The goal is to give the person permission to alleviate pain and suffering. The individual might decide to be treated as a patient or honored as a person if given this option near the end of life.
A non-serious illness conversation ends with the patient wishing …
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