Physicians, nurses, chaplains, and families writing on KevinMD about comfort, dignity, and quality of life in serious illness: hospice and why it is used late, the prognosis conversation, goals of care, symptom management, and what it is like to care for a dying patient. Most contributors work in palliative medicine or hospice, or have been the family at the bedside. For a maintained record of what physicians have said about dying and the decisions at the end of life since 2004, including the assisted-dying debate with both sides at equal weight, see End of life: what physicians say, in their own words.
Extreme longevity People claim they want to live to be 100, yet is that a good thing? How you get there may make all the difference. Here's my take on Blue Zones and the prospect of living to 100. "Blue…
Extreme longevity
People claim they want to live to be 100, yet is that a good thing? How you get there may make all the difference. Here’s my take on Blue Zones and the prospect of living to 100. “Blue Zone” is a nonscientific term popularized twenty years ago by Dan Buettner, a National Geographic explorer who studied five geographic regions where many people live to be over ninety or 100. …
Let us get this straight: Enjoying life is amazing. You should do more of it. Every day, if you can. But if you are truly committed to living well, you also need to get comfortable with something most people avoid…
Let us get this straight: Enjoying life is amazing. You should do more of it. Every day, if you can. But if you are truly committed to living well, you also need to get comfortable with something most people avoid like mystery meat at a buffet: preparing for your death.
Not obsessing over it. Not fearing it. Just preparing, so your loved ones are not left trying to solve your digital, …
As doctors, we often tend to focus on solving the problem at hand. We identify the issue, make a diagnosis, and try to treat the condition to the best of our capabilities. And in this pursuit to achieve our textbook…
As doctors, we often tend to focus on solving the problem at hand. We identify the issue, make a diagnosis, and try to treat the condition to the best of our capabilities. And in this pursuit to achieve our textbook level of homeostasis, we often forget that it is the patient who requires us. As rightfully pointed out in the posters outside the palliative care center, sometimes we may encounter …
The first thing I remember is the sound of oxygen at night. It was my second week as a hospice nurse. I had just pulled up to a modest home on a cul-de-sac, the kind of place where wind chimes…
The first thing I remember is the sound of oxygen at night.
It was my second week as a hospice nurse. I had just pulled up to a modest home on a cul-de-sac, the kind of place where wind chimes echo off empty sidewalks. Inside, a man in his seventies was dying of end-stage pulmonary fibrosis. He was surrounded by family, but it was that soft hiss—steady and rhythmic, like an …
We've medicalized nearly everything in life—birth, aging, sleep, even boredom. Now, in the spirit of efficiency, we've begun medicalizing death itself. In his unsettling essay "The European way to die," French novelist Michel Houellebecq warns that the normalization of euthanasia…
We’ve medicalized nearly everything in life—birth, aging, sleep, even boredom. Now, in the spirit of efficiency, we’ve begun medicalizing death itself.
In his unsettling essay “The European way to die,” French novelist Michel Houellebecq warns that the normalization of euthanasia and assisted suicide is not a sign of progress but of profound cultural decay. I didn’t expect to find myself agreeing with him.
"This is Dr. Mohr." I answered a number I didn't recognize. "It's Irving," said the frantic voice. "He collapsed. The paramedics are working on him now." "They're doing compressions? Stop! Put the paramedic on the phone!" My father-in-law, Irving, the…
“This is Dr. Mohr.” I answered a number I didn’t recognize.
“It’s Irving,” said the frantic voice. “He collapsed. The paramedics are working on him now.”
“They’re doing compressions? Stop! Put the paramedic on the phone!”
My father-in-law, Irving, the stoic Danish-American Navy veteran, had been on hospice for 3 months. His POST (physician order for life sustaining treatment) form was on file with the hospice agency and his custodial care facility: DNR/DNI, …
Recently, researchers examined whether there had been any changes in the way terminal cancer patients died from 2014 to 2019, given the increased information available on hospice, palliative care, and advanced end-of-life planning (EOLP). They asked whether those who were…
Recently, researchers examined whether there had been any changes in the way terminal cancer patients died from 2014 to 2019, given the increased information available on hospice, palliative care, and advanced end-of-life planning (EOLP). They asked whether those who were terminal continued aggressive treatment until their demise. The authors anticipated a decrease in this, but found that the frequency of cancer patients who continued aggressive therapy had not declined. The …
"It is a sad state that fear of liability will oftentimes negate the moral choice made by a terminally ill patient." - Journal of Air Law and Commerce Background In August 2024, I gave a presentation, "You're suing me because…
“It is a sad state that fear of liability will oftentimes negate the moral choice made by a terminally ill patient.”
– Journal of Air Law and Commerce
Background
In August 2024, I gave a presentation, “You’re suing me because I kept your mom alive? Avoiding wrongful life lawsuits.” I discussed the consequences for medical staff when they disregard a valid DNR and revive a person, against their wishes. There are numerous nationwide …
It's not the easiest question to ask aloud—especially in medicine, where we pronounce death but rarely reflect on it. We chart it. Certify it. Explain it. But what does it mean to die? For most of us, the word carries…
It’s not the easiest question to ask aloud—especially in medicine, where we pronounce death but rarely reflect on it.
We chart it. Certify it. Explain it.
But what does it mean to die?
For most of us, the word carries a double weight. It means to stop biologically. To cease. To end.
But it also means to vanish. To be forgotten. To be no longer seen, needed, or named.
When I was a general surgery intern, I was doing my very early morning pre-rounds on a frail female patient in her late 70s with significant cardio- and peripheral vascular disease. She'd been in the hospital for weeks and wasted…
When I was a general surgery intern, I was doing my very early morning pre-rounds on a frail female patient in her late 70s with significant cardio- and peripheral vascular disease. She’d been in the hospital for weeks and wasted away to no more than 85-90 pounds. She was not able to get out of bed unassisted. I don’t even remember why she was in the hospital, but what I …
Join us for an inspiring conversation with Jordan Grumet, internal medicine physician and host of the Earn & Invest Podcast, as we explore insights from his groundbreaking book, The Purpose Code: How to Unlock Meaning, Maximize Happiness, and Leave a…
Join us for an inspiring conversation with Jordan Grumet, internal medicine physician and host of the Earn & Invest Podcast, as we explore insights from his groundbreaking book, The Purpose Code: How to Unlock Meaning, Maximize Happiness, and Leave a Lasting Legacy. Discover the surprising truths about purpose, how to overcome …
My parents were born on the same day, six years apart, Depression-era babies. My dad died on Christmas Eve, 2016. Nearly every Christmas season after that, for the next seven years, I hoped Mom would follow him. Was I wrong…
My parents were born on the same day, six years apart, Depression-era babies. My dad died on Christmas Eve, 2016. Nearly every Christmas season after that, for the next seven years, I hoped Mom would follow him.
Was I wrong to wish that?
Dad played Santa Claus for three decades, donning a suit that had belonged to his mother, along with her bearskin gloves and a set of sleigh bells. Eventually, he …
With Jimmy Carter's passing, many will reflect on his impact at home and abroad. Yet, one his most personal acts will also stand as one of his most enduring legacies. At 100, not only was our 39th president the longest-lived…
With Jimmy Carter’s passing, many will reflect on his impact at home and abroad. Yet, one his most personal acts will also stand as one of his most enduring legacies.
At 100, not only was our 39th president the longest-lived president, he was also to first to publicly elect hospice care, prioritizing the quality of his last days over simply being alive.
When he first enrolled two years ago, the family’s announcement …
Health care providers dedicate years to rigorous education and training to optimize medical care, aiming to heal and treat illness. However, historically, there has been a significant gap in training regarding the transition from a treatment-focused approach to focusing on…
Health care providers dedicate years to rigorous education and training to optimize medical care, aiming to heal and treat illness. However, historically, there has been a significant gap in training regarding the transition from a treatment-focused approach to focusing on providing comfort in the face of serious illness and death. This leaves health care professionals unprepared to navigate the complexities of end-of-life care. Despite their good intentions, health are providers …
Join us as we welcome psychiatrist Lewis Cohen to discuss his book, Winter's End: Dementia and Dying Well. In this episode, we explore the ethical dilemmas, legal challenges, and emotional impacts surrounding life-shortening options for dementia patients. Drawing from the…
Join us as we welcome psychiatrist Lewis Cohen to discuss his book, Winter’s End: Dementia and Dying Well. In this episode, we explore the ethical dilemmas, legal challenges, and emotional impacts surrounding life-shortening options for dementia patients. Drawing from the perspectives of over 100 experts, Lewis delves into the complexities of …
During a recent palliative conference, the discussion turned to the challenges of translating our work to the public and our colleagues. Despite the growth of our field and increasing access, there remains major confusion about palliative care and hospice. Much…
During a recent palliative conference, the discussion turned to the challenges of translating our work to the public and our colleagues. Despite the growth of our field and increasing access, there remains major confusion about palliative care and hospice. Much of the misunderstanding originates from within the medical profession. Having worked in the palliative care and hospice arena for nearly two decades, I have seen many examples of the confusion …
We had been meeting for a number of months when she posed the question. We met in person one time, but other than that single appointment, all of our meetings were virtual. She had metastatic cancer. She didn’t actually want…
We had been meeting for a number of months when she posed the question. We met in person one time, but other than that single appointment, all of our meetings were virtual. She had metastatic cancer. She didn’t actually want to know that her cancer had returned. The metastatic disease had been found when they couldn’t complete her colonoscopy and ordered a scan to see why. She helped me understand …
"Rejoin the natural cycle: to know that the last gesture you'll make will be gentle and beneficial just feels like the right thing to do." - Recompose founder Katrina Spade I love gardening and watching things grow, so I found…
“Rejoin the natural cycle: to know that the last gesture you’ll make will be gentle and beneficial just feels like the right thing to do.”
– Recompose founder Katrina Spade
I love gardening and watching things grow, so I found the idea of human composting an intriguing concept. For those who find cremation unconventional or even unsettling, the process of disposing of the remains of a deceased loved one has taken a …
Join us as we delve into the complex terrain of end-of-life care and the contentious debate surrounding assisted suicide legislation. Cardiologist Joseph E. Marine offers unique insights into the ethical, medical, and societal implications of this polarizing issue. From disparities…
Join us as we delve into the complex terrain of end-of-life care and the contentious debate surrounding assisted suicide legislation. Cardiologist Joseph E. Marine offers unique insights into the ethical, medical, and societal implications of this polarizing issue. From disparities in health care access to the importance of palliative care, Joseph …
I opened my internal medicine practice almost four decades ago to serve a growing urban community. I gravitated toward the underserved geriatric population as they were vulnerable patients and eventually moved into the bygone realm of house calls for home-bound…
I opened my internal medicine practice almost four decades ago to serve a growing urban community. I gravitated toward the underserved geriatric population as they were vulnerable patients and eventually moved into the bygone realm of house calls for home-bound seniors.
This enhanced my learning curve, as house calls are not taught in medical school or residency yet bridge the continuity gap between hospitalization and patients returning home after an acute …
