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.
The last thing Jessica said to John, her fiancé of 10 years, was, “I love you” before he drove to work. Hours later, after suddenly experiencing a cardiac arrest at the office, he was in an ICU bed attached to a ventilator. He was pale and unresponsive, on multiple medications to artificially augment his blood pressure, hooked up to a machine that did the work of his kidneys, and cooled …
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The COVID-19 pandemic is changing end-of-life care. We’re not ready.
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 …
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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 …
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I challenge you to discuss death
Death. Mortality. End of Life. Something inevitable, yet rarely discussed and a source of intense discomfort for most. When mentioned, it is considered inauspicious and rude in many cultures. Death is an integral part of the workday for a critical care physician like me. But it was never a topic of discussion in medical school or training.
Death is inevitably encountered by every physician at some point and by every human. …
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Death is not giving up hope
Life may never be the same after COVID-19. With tens of thousands of Americans having succumbed to the coronavirus in the United States, some of us are considering our own mortality. Life insurance companies have plenty of new customers. Estate planning attorneys are busier than ever. Many of us are thinking about how our loved ones will be taken care of in the event of our own death.
Death is always …
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We need to learn to accept death in the United States
I’m a palliative care chaplain who provides spiritual support to patients with serious, life-changing, and for some, life-threatening, illnesses. A common story they tell is an illness, like a storm, blew them off their life’s map. They find themselves lost in the unfamiliar territory of sickness. The future, once certain and promising, is now uncertain and ominous. Plans they’d made are on hold, possibly canceled. The specter of death looms …
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Learning to cope with the pandemic from palliative care patients
Insurance companies require doctors to ask dozens of questions and click on carpal-tunnel inducing boxes during a yearly physical. However, none of those questions or boxes address one of the most important aspects of a person’s life, their death. So, as a family doctor, I encourage people to think about it, have “the conversation” with loved ones, and complete the paperwork.
I’m also married to a doctor, so the conversation is …
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COVID tells us to have “the conversation” now
I have cared for them both, husband and wife, now in their 80s, for almost 20 years. She is a retired nurse and him from his business. They are so typical of this “greatest generation”: tough, enduring, hard-working, deeply faithful, fervently independent, those characteristics that allowed them to survive the Great Depression, World War II, and the many challenges that come with life. They have seen their share of joy …
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The final words that are a precious reminder of why I went into medicine
The doom, gloom, and uncertainty surrounding the ongoing COVID-19 pandemic can be overwhelming, even for an emergency department physician such as myself. The heaviness of the situation largely stems from the deadly nature of the virus, our relatively minimal understanding of how it works, and our seeming inability to control the rapidly changing nature of our day-to-day lives.
TIME Ideas published an excellent piece by Drs. Jessica …
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COVID-19 is an opportunity to change the culture of death
When coronavirus exploded, my family was on vacation in Colorado. We played the news nonstop, and it was frightening. I’m a control freak, a planner, and thus my worries were nonstop. What were other hospitals doing to prepare as compared to my own? What were the plans to ration PPE? How was the morale at the place I’d been at almost daily for years?
I was angry, frustrated, and disappointed. Not …
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Cowardice in the face of coronavirus
The image of patients dying in the intensive care unit is changing. Over the phone, family members cry on the other end as I tell them that we are not allowing visitors due to “the coronavirus” at this time. They tell me, “but I help make his decisions for him.” These decisions now have to be made over the phone.
This is just what we have to do to keep society …
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Grieving the end of life experience from an ICU nurse
Being a medical student during your clinical years imparts a certain feeling of invincibility. For many of us, this is our first-time taking care of patients. Our history-taking and physical exam skills are being honed like superpowers. Our clinical knowledge is growing. We begin to take ownership of patients as our own.
With all but two clinical rotations left in my third year, and at the peak of my own feelings …
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7 reflections on grief and personal loss as told by a medical student
He was a logical man. A northeast Ohio man. Who worked all his life and worked hard. I can see it in his hands. They are entirely calloused with traces of grease impervious even to pumice soap.
A family man. His wife and sons and daughters are at bedside. And proud grandson, just a man, not dry-eyed, stands in the corner, in his college jacket, the spitting image of his bedridden …
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Proper endings like this feel right
Does care fall short or go higher when the patient is one of our own?
It depends on who you ask: We, the medical team, believe we try hard for everyone, but go the extra mile when it’s one of our own. Perhaps to family/outsiders, we’re not doing enough.
A recent case illustrates this phenomenon: a gifted physician colleague, a new diagnosis of advanced cancer. Needs control as part of a coping …
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We can’t deny death, even if it’s a colleague
We were told to wear masks before entering this patient’s ICU room. Entering his room, you could smell his rotting flesh. He was 92 years old.
His skin would slough off if you dared to bathe him.
His decubitus ulcers were raging with infection.
As long as I’ve been an ICU nurse, this was the worst — the smell, the neglect, the disrespect for this man.
He was VIP status.
I always had a problem …
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When a wife won’t let her husband die
It’s the winter of 1993. A cold, snowy day. Windy. A blizzard. The phone rings.
I’m not on call for my patients today — except for one. Daisy has been in my care since the early 1970s, and given the risk that she may suffer a serious downturn, I’ve instructed her nursing home to call me whenever necessary.
This is that call. Daisy, my dear lady, the old artist, is dying.
Throughout her …
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I had to be there for this patient’s last breath
Google is universally well known as a search and advertising company. Now Google is tapping into the $3.5 trillion health care market. To compete with the Apple Watch, Google acquired Fitbit, the wearable exercise, heart rate and sleep tracking device.
Data is king.
Voluntarily worn fitness tracking devices are one thing, but Google has entered the realm of the brave new world. A government inquiry has brought …
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Data mining, artificial intelligence, and angels of death
“Black life remains unexpected.”
I have been mulling over these words written by Ibram X. Kendi, in The Atlantic. This followed his piece exploring the “anniversary” of slavery in 2019. He experiences this 400-year marker both with hope and concern given the persistence of a split America: “Black death matters to racist America. Black life matters to African America.” He writes, “there may be no more consequential white …
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How race plays a role in palliative care
