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 a surrogate consultant, people often ask me for advice on the best advance directive (AD) to cover their medical and end-of-life (EOL) wishes. Unfortunately, the answer is not that simple. An AD is a “legally recognized” document usually containing a living will spelling out your preferences and treatment options when you cannot speak for yourself. It also includes the designation of a health care surrogate/proxy to follow your wishes. …
Successfully navigating advance directives to choose your best one
For most care providers, having conversations about end of life comes with certain challenges. Most medical education prioritizes diagnosis and treatment of illness with the goal of extending life; therefore, it can be quite difficult to acknowledge when curing illness or prolonging life are no longer achievable goals. On top of that, it’s certainly not easy to witness the pain and sadness of families when their loved ones are nearing …
Why it’s important for physicians to talk about death
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
An excerpt from Grief Connects Us: A Neurosurgeon’s Lessons on Love, Loss, and Compassion.
Brené Brown describes the importance of allowing ourselves to be vulnerable and holds up the surgeon as an example of someone who is exempted from this by the technical nature of their work. Yet, as I have come to appreciate, it turns out no one gets a …
Emotional agility is an essential element for patients and practitioners
She was listless in bed with agonal breathing — only 63 years old.
Before stage 4 colon cancer claimed my mother, she chose to come home to her house … her bedroom, where she’d stare out her window at the dogwood trees that symbolized the blood of Jesus.
A once-vibrant Italian Catholic and mother of four, she was the perfect wife of an IBM executive. But it was all for show — …
Today is the day you’ll have to die
Canadians with serious or progressive chronic illness are feeling especially vulnerable during the COVID-19 pandemic. It has underscored how quickly circumstances can change.
Talking about a serious illness diagnosis and the impact on life expectancy is difficult.
Many Canadians are uncomfortable having these conversations, even though they know it is important.
Surveys have uncovered this paradox: while 93 percent of …
3 critical things health care providers should discuss in serious illness conversations
Some years ago, my husband and I sat with his mother at her kitchen table and went over advance care planning documents her doctor had given her. She was in her mid-70s then, living independently but managing several chronic health issues.
The documents included a living will, which specified the kind of care she wished to receive – or not receive – if she were unable to …
The ultimate in patient empowerment: advance care planning
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
As a third-year medical student finally in the clinical arena, I’ve seen much more real medicine in the last three months than the entirety of my life. I’ve learned that the ethical dilemmas and the difficult patients are not restricted to TV medical dramas—it’s real life. On a Saturday morning on my inpatient Internal Medicine rotation, I witnessed my first end-of-life conversation, and the moment burned itself into my mind. …
My first end-of-life conversation
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
Like most situations that physicians encounter in their work, end-of-life conversations are not easy and require preparation and training. Yet these patient discussions are among the most satisfying I’ve experienced in my career because they’ve made me feel that I’ve made a true difference, offering comfort and a certain level of control to patients and families who are enduring difficult decisions.
Throughout my years as a practicing internist, I’ve had dozens …
End-of-life conversations: Why physicians should embrace the responsibility
“To help the reader understand the issues better, I would like to relate some stories. A friend of mine was dying of pancreatic cancer. He had an implantable morphine pump and was on both hospice and palliative care. Still, he found that his suffering was unbearable and wanted to die sooner. Doctors told him that his only option to end his …
Medical aid in dying is not assisted suicide [PODCAST]
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I wrote my undergraduate thesis on death and dying. I read journal articles trying to understand what death meant and how it affected people. I spent hours reading books, both fiction and nonfiction, trying to understand if you can ever die a good death. I engaged in meaningful conversations with compassionate and astute physicians, nurses, and professors who experienced the death of their patients, both adults and children, time and …
You will be unprepared to face death
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
When I was training as a surgeon, I was pro assisted suicide. I believed it was a humane act of kindness and compassion. I imagined myself to be in the place of the other and at times felt if that was me, I’d rather be dead than live with that condition or this condition. I understand how easy it is to think and feel like this and not even question: …
Assisted suicide: a change of heart
An excerpt from Dying with Ease: A Compassionate Guide for Making Wiser End-of-Life Decisions. Used by permission of the publisher Rowman & Littlefield. All rights reserved.
In 2017, there were 2,813,503 deaths in the United States. About a quarter of Americans die of heart disease, some 22 …
Death is personal for this physician
Recently, a neighbor and friend of mine died. After her cancer was diagnosed as incurable, she was referred to hospice care, and family members traveled long distances to spend quality time with her during her last month of life.
Her neighbors in our condo building clamored for slots in her packed social calendar. Two days before her death, she held a socially distanced open house for people lined up six feet …
This is what a good death could be
I am no stranger to death. I have gently closed the eyelids of a woman dying from liver disease, blasted Led Zeppelin by request during a man’s last breath, and exchanged dog photos with an elderly gentleman on his final day. Although I cared for these patients deeply, our relationships were defined by illness. Ms. B was different. Healthy and curious, she had sat in my clinic countless times with …
When the best care is a comfortable death
Every time I visit my great grandmother, Tata, Atul Gawande’s Being Mortal floods my thoughts. Tata is 101 and developed severe dementia within the past two years. In 2019, she fell and fractured her hip. In the hospital, she recovered poorly. The physicians on her team offered hospice. My grandfather (her only son), declined fervently. Instead, he insisted on moving her back home to my aunt’s house, where my great …
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