Palliative Care

End-of-life decisions aren’t any easier for a doctor

Physician

December 9, 2016

As an internist and geriatrician, I deal with elderly patients all the time. We always end up talking about end-of-life issues:

“Should I be resuscitated if my heart stops and I stop breathing?”

“Do I want a feeding tube or gastrostomy tube if I stop eating and require nutrition?”

“Should I be kept alive on machines and for how long if there is no reasonable hope of recovery?”

“When should we refuse tests for …

Death is not the enemy. More physicians need to realize that.

Nancy Wang, MD, MPH

Physician

August 20, 2016

I knew it was bad when she couldn’t tell me her name. I watched her face fill with frustration as a word she had uttered countless times over eight decades somehow got lost between her brain and her lips.

It was 2 a.m. and I was on call as the surgical resident. I had been told that a patient with bladder cancer was being transferred from another hospital, and, as these …

The worst thing about being an internal medicine intern

Marc N. Katz, MD

Physician

July 31, 2016

The only thing I love more than complaining about being a doctor is actually being a doctor. Intern year sucks. There’s no way around it. I wake up at 5:15 a.m. to get to the floor at 6:00 a.m. and I rarely leave at 5:00 p.m. when my shift is scheduled to end assuming I’m not on call until 9:00 p.m.

I often feel my stomach growl at 9:00 a.m. and …

This is why hospice work is so fulfilling

Laura Patel, MD

Physician

July 22, 2016

I make my way down the aisle of the plane, squeezing past my fellow passengers and plop down in my assigned seat. Sitting next to me is a middle-aged woman with a kind smile. As the plane takes off, she begins making small talk: ”What do you do?”

I silently debate, do I adopt my travel persona or answer truthfully? Answering honestly will result in one of two things; either we …

Terminal dehydration: A gentle way to die?

Christopher Stookey, MD

Physician

October 7, 2015

My father suffered a massive stroke on a September night not long after his 83rd birthday. It left him conscious yet unable to talk and communicate, unable to swallow and almost completely paralyzed.

After numerous scans and other tests, his doctors determined that there was no chance of recovery. My father would never walk, talk, or swallow food again. With nothing more to do for him in the hospital, we — …

Caring for the dying patient is a rewarding challenge

Earl Stewart, Jr., MD

Physician

September 17, 2015

I walked silently into the pristinely decorated room of the hospice facility and was greeted by her family. She lay there, not particularly responsive to her surroundings under the pressure and influences of metastatic stomach cancer. The warmness and smiles on the faces of her family told me that at some point and somehow, in the midst of actively witnessing the transition of their mother, aunt, sister, and grandmother, they …

Slowly, slowly

Christy Duan

Physician

August 11, 2015

“What is the meaning of life?”

A perfectly reasonable question, albeit a strange one considering that I was in the third grade, it was recess time, and I was having a philosophical conversation about death with a grasshopper I had just caught.

Ever since I could remember, I was fascinated by death. But my life was characterized more by loss than by death. When I was three, there were no funeral processions …

Read more…

Slowly, slowly

Comfort may be the most important thing that physicians can provide

Amrapali Maitra

Physician

July 13, 2015

A hospital can be full of discomfort. My patients tell me that the food is unappetizing. The beds hurt their backs. The noise echoing through the hallways at night makes it impossible to sleep. And for those patients near the end of life, the treatments being offered may no longer be of benefit, causing more pain than good.

The answer to discomfort for those who are very ill is comfort care, …

End-of-life care: What I learned from a pet’s death

Abigail Schildcrout, MD

Physician

April 30, 2015

It has taken me almost two years to be able to write this. We said goodbye to our beloved dog in early May of 2013. I grieved for well over a year.

About a month-and-a-half prior to his death, we had a big medical scare with him. I wrote at that time about how dealing with a veterinary emergency can provide us with some insights and practice parallels to dealing with …

The last breath can be seen as a the passage into eternity

Kathryn A. Hughes, MD

Physician

March 24, 2015

Eonia I Mnimi (Eternal Memory)
– Greek Orthodox Funeral Blessing

“Have you ever seen anyone die before?” my cousin asked me, from across the bed.

“Sure I have, plenty of times,” I answered.

We were flanking her father, my uncle (really, my mother’s cousin, but extended Greek families are complicated; suffice it to say that our families are very close). He had just taken his last breath.

***

My uncle had been declining for several years with Lewy …

3 myths and 3 truths about hospice

Monica Williams-Murphy, MD

Physician

March 17, 2015

As I travel around speaking about preparing for peace at the end of life, I have found that there are three pervasive myths about hospice that might cause you to inadvertently rob yourself or your family of a peace-filled end-of-life experience.

So, I am taking on the job of myth-buster to clear the air. Here goes:

Myth #1: Hospice is a place. While hospice can be a place, it is primarily a service. …

Read more…

3 myths and 3 truths about hospice

The line between comfort care and murder

James C. Salwitz, MD

Physician

February 6, 2015

“So, I told the doctor at the nursing home that I loved my father more than anything. Dad was my friend and the most wonderful man I had ever known. I wanted everything for him. But, I said, Dad was sick, weak, confused, and he never wanted to live like that. The next morning he was dead. That was OK by me.”

I once participated in a panel discussion about hospice, …

I’m a palliative care doctor. This is what I do.

Andrew Thurston, MD

Physician

February 1, 2015

Some people who know what I do don’t really know what I do.

They picture me floating through the hospital extinguishing lives, blowing them out one by one like candles down an endless corridor. They think I practice euthanasia, that my presence alone hastens death — that I consume hope and happiness like a black hole, compressing it all into nothingness. Some call me the Grim Reaper, others the Death Doctor. …

We forget to ask patients what their goals are

Mitch Kaminski, MD

Physician

January 29, 2015

Mr. Dwyer isn’t my patient, but today I’m covering for my partner in our family practice office, so he’s been slipped into my schedule.

Reading his chart, I have an ominous feeling that this visit won’t be simple.

A tall, lanky man with an air of quiet dignity, Mr. Dwyer is eighty-eight. His legs are swollen, and merely talking makes him short of breath.

He suffers from both congestive heart failure and renal …

Stuart Scott and his fighting words

Christian Sinclair, MD

Physician

January 15, 2015

ESPN sportscaster Stuart Scott’s recent death has given the American public a chance to reflect on what it means to live with a cancer diagnosis. His speech at the ESPY awards in the summer of 2014 was widely hailed as an inspiration to people with cancer. Obviously, the Jimmy Valvano Award for Perseverance with the ties to cancer research (Jimmy V Foundation) and Scott’s public image as someone being …

Read more…

Stuart Scott and his fighting words

How to introduce palliative care to patients

Robert Centor, MD

Physician

December 15, 2014

Did I tell you that I was a big fan of palliative care? Palliative care started around 15 years ago at the VA where I worked. We saw the service evolve. We saw how the palliative care approach improved the quality of both life and death.

Many physicians have not yet accepted or at least understood palliative care. Many physicians use some palliative care principles and believe palliative care is superfluous. …

The 75 Plan: Thoughts on Ezekiel Emanuel’s palliative care article

James C. Salwitz, MD

Physician

November 6, 2014

shutterstock_137226314

When teaching about life near dying, it is hard to achieve open conversation. No matter what one says in a lecture hall or what brilliant writers publish on the terrible state of end-of-life care, change is painfully slow. While we blame evasion by doctors of challenging conversations, failure by patients to plan or denial by families which blocks open communication, the …

A twisted argument against end-of-life care

James C. Salwitz, MD

Physician

September 25, 2014

“All your patients will die. Maybe not today, but someday. The defining fact of life is that it ends. Only a fool would dedicate their career to fighting something that can never be beaten. Therefore, a doctor’s task cannot be to fight death. A doctor’s task is to heal when possible and prevent suffering always. Our calling is to support life. Fighting death may deprive patients of the opportunity to …

Deactivating a pacemaker: Is it euthanasia?

Eric Widera, MD

Conditions

September 18, 2014

“He’d feel okay about not replacing the pacemaker’s battery when it ran down, he said. But turning it off, he said, would be ‘too active.’ Later he would tell me that it would have been “like putting a pillow over your father’s head.”

These are the words of Katy Butler in her book Knocking on Heaven’s Door – The Path to a Better Way of Death in which she writes about her …

What is a gomer? And why should you know about it?

Admin

Video

September 12, 2014

Ever wonder what a “gomer” is? While certainly passé and unprofessional, does it shed light into the frustrations both doctors and patients have with end-of-life care? Emergency physician and author Brian Goldman explains the origins and use of such medical slang in his book, The Secret Language of Doctors.

What is a gomer? And why should you know about it?