I had a patient in the ED who reminded me a lot of my grandfather, my Dada. I grew up with my Dada, listening to his stories and learning from his knowledge of the intricate workings of the world. He was a first-generation college student, science lover, world traveler, vice president of a large chemical engineering company and loving husband, father and grandfather.
When I was in high school, he also …
Death is inevitable. Talk about it.
In his bestselling book How Not to Die, physician Michael Greger described how his grandmother, diagnosed with advanced heart disease at 65, transformed her health and lived for many years after switching to a whole-food, plant-based diet.
It was a seminal event for Dr. Greger that inspired a career dedicated to promoting the impact of lifestyle behavior on health. As lifestyle medicine-certified clinicians practicing in a palliative medicine …
The surprising role for lifestyle medicine in palliative care
“COVID has brought us new challenges and a genuine opportunity to be part of the critical response to optimize the care we deliver not just to our patients but also to their families and caregivers. I am lucky, blessed to do this work every day and carry such a deep passion.
We are …
A deep passion for palliative medicine [PODCAST]
“Death would not be called bad, O people, if one knew how to truly die.”
— Nanak
Her funeral was yesterday, and there was a huge turn-out. She was 67 and never cussed or said a bad word about anyone. She was much-friended and well-loved. In late January 2022, she was diagnosed with stage-4 cancer in her lungs, which metastasized to her liver and bones. At first, some medico used the word …
A bad death: the importance of truth-telling at end-of-life
I had known AR for eight days before she passed away.
AR’s medical record was littered with phrases all too familiar in the field of medicine: she had “poor insight into the severity of her disease” and was “insisting on all resuscitation measures despite poor prognosis.” But quite frankly, I could not blame her. She had been diagnosed with metastatic gastric cancer, bilateral Kruckenberg tumors and additional metastases throughout her abdominal …
“If you don’t let us go home because of the vomiting, his time is running out … I don’t want him to be at a point where there is nothing else to do, and I don’t want him to go home at that point,” said J’s mom.
“Am I crazy to want to see this naturopathic doctor? He promised us he would cure our son of his cancer …”
“It is not …
Palliative care: Most doctors do not know how to talk to their patients
My mom has Alzheimer’s dementia and lives in memory care. During her February 4th, 2022 health visit, her chart reflected stage FAST 7A (a 7-step staging system for dementia). I am her patient advocate, durable power of attorney for health care (DPOA-HC) that was activated two years ago. I was clear with her care team from the beginning that my mother is a DNAR and, when she became hospice eligible, …
Does your patient advocate have access to stop the medicalized death train?
As a hospice and palliative care physician, grief is a familiar concept to me. It is most often discussed in the context of loss of life. However, grief at the root is simply profound and agonizing distress caused by loss — any loss. In hospice and palliative care, we train to recognize risk factors for complicated grief and to refer for early intervention. The pandemic has been the ideal breeding …
Complicated grief: the hidden pandemic in health care workers
Granny Rachel, my husband’s mother, was an old country soul. She was a simple lady who loved the Lord.
She accepted me with open arms when my own parents turned their backs on me.
Granny Rachel made the best sweet tea and the best homemade vegetable soup with cornbread and gave unconditional love to all.
She totaled two of her cars twice. Her son would check on her and found multiple candles lit …
How do we explain the end-of-life rally?
My gut churned, a burning rose into my chest as I read the email. It’s happening again repeated on a reel in my mind, followed by I need to leave this job. But I wasn’t quitting. I was triggered. It was years after I’d had the rug pulled out from under me at an institution where I’d spent decades working, but sometimes my nervous system sent me right back there.
I was a palliative …
A crushing blow in a workplace I loved
An excerpt from At Heaven’s Door: What Shared Journeys to the Afterlife Teach About Dying Well and Living Better.
What brings you here?
I ask this question of every person who steps through the door because they have come to talk about death—the most universal of all human experiences yet the most difficult to discuss.
In modern culture, we have an uneasy relationship …
What shared journeys to the afterlife teach about dying well and living better
I will tell you exactly
And only the facts.
You are trapped a little for a time
And unhappy
Then your face hollows and it has a death mask
As the soul withdraws from the body
And you look at me and tell me who you see
It is always someone,
Sitting there like me,
But on the other side of things
Waiting for you.
And suddenly you become a column of white light
And leave the body all at once
Going upward,
I …
For the last couple of decades, I was trained to save lives. I sat shoulder to shoulder with others who drilled this in me when I was green, sometimes even through humiliation. I learned to perceptively read patient cues, develop quick reflexes, and think on the spot in critical moments, wherever and whenever life was compromised. I always threw lifebuoys into the ocean when I was called into action. This …
It’s not an easy thing to unlearn how to save a life
It’s one of the last weeks in December. If it was any other year, I would have realized that Christmas is around the corner, the air would be filled with a different, radiant, joyful kind of energy, and most of us would be focused on all the lessons this year has taught us. Unfortunately, this year is not like any other year. The air feels dense and heavy. You can’t …
You can’t fix what is already broken
As rising fourth-year medical students, we talked about caring for dying patients with Dr. Angie Anderson (AA), a pediatric palliative care specialist. An abridged version of our conversation is transcribed below.
Lindsey Pileika (LP): Honored to speak with you, Dr. Anderson. I just wanted to preface our interview with experiences that I’m bringing to this conversation. During my third year, I was working on the pediatric hematology-oncology service, where we frequently …
A conversation on death and hope a pediatric palliative care physician
Physicians have gone toe-to-toe with death since the earliest days of the profession, even knowing that our efforts would often be futile. Over the past century, dramatic technological advances have nearly doubled the average American lifespan, and modern practitioners have a level of control over mortality previous generations could scarcely have imagined. But medicine has by no means conquered death. This puts health care providers in …
Improving end of life care from the start of training
If a family member or friend asked you to serve as his/her medical power of attorney, what would your answer be? Many people agree to assume this role without a second thought, but you should take some time to understand what your responsibilities as a medical power of attorney would be, why the person has chosen you to do this, and what potential complications and conflicts may arise. With that …
What to consider before becoming a medical power of attorney
In the KevinMD article, “Assisted suicide: a change of heart,” the author contends that there is salvation in suffering, but not everyone believes that is true. While I support the author’s ability to decide how she wants to die, I do not believe that her personal beliefs should dictate how I die.
I retired as an internist a few years ago because of declining health. I …
Medical aid in dying is not assisted suicide
In today’s increasingly technological, data-driven, depersonalized world of health care, I wonder if the concept of “a good death” is even possible. The COVID-19 pandemic, in particular, has caused me to reflect on this. What does it look like? How do you define it? As I did, a patient came to mind. He was a retired minister in his 80s. I had cared for his wife as well until she …
A physician’s work is hard. And it is sacred.
My medical school’s secondary application, like that of many other medical schools, asked me to describe a personal or professional challenge or conflict and to explain how I worked to resolve it. However, unlike other medical schools, my school specified that they did not want to hear about the MCAT or another academic challenge.
For this question, I wrote about a challenge that I have been facing for most of my …
I challenge you to discuss death
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