shutterstock_33798526 The alarm clock’s blast brings hours of work, running from task to task, always pushing toward the next turn.  In moments of failure, the waves of complexity and anxiety batter and you question each stroke. Then you fly downhill, easy breeze in your face, as success urges you on.  After the finish, the parking lot empties, the lights go out, and ...

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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 ...

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shutterstock_139655147 A 57-year-old doctor I know is retiring to teach at a local junior college.  He is respected, enjoys practicing medicine and is beloved by his patients; therefore, I was surprised. While he is frustrated by the complexity of health insurance, tired by the long hours and angered by defensive medicine, the final straw is that he can not stand the world ...

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Not too long ago I suggested hospice to a patient who had progressive cancer, although she likely had months to live.  “I don’t think it is time,” she replied, “hospice is for morphine.” “That is not how I see hospice,” I replied, “I think hospice is about getting the best care and support, even if there is no real treatment for the disease.  It is about living well, maybe better. Even ...

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A friend of mine plays a mean game of poker.  She comes out ahead in Atlantic City, finishing near the top in hold ’em tournaments.  She is a poker savant. Not long ago I asked her secret to playing the game so well. “I learned to play cards when I was being trained to treat cancer.” “Oh,” I said, “the discipline, memorization, patience and statistics?” “No, that is when I learned not to ...

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The Institute of Medicine of the National Academies has released their long anticipated 500-page report, titled ,"Dying in America – Improving Quality and Honoring Individual Preferences near the End of Life." This is a critical addition to the ongoing conversation about health care in the United States and makes observations and conclusions, which we need to consider and understand.   They conclude, as has been said before, that we waste ...

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“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 ...

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August 17, 2010. Maris is a 57-year-old woman in excellent health.  She has not seen a doctor in years. Divorced, she lives by herself, but spends occasional evenings with her daughter and son-in-law.  A successful businesswoman, Maris gardens, serves on the board of a community theater and plays a mean game of bridge. It is 10:11 a.m. when Maris presents to the emergency room. Three hours earlier, her legs became wobbly while ...

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7:00 a.m. Lights on.   Coffee, black and a banana. Paperwork.  27 patient visits, 3 emergencies, 35 phone calls.  Lots of computer time. Some laughs and a few tears. Paperwork.  Last family meeting.  Coffee, black.   In between: Thursday. Was not completely successful in explaining to my frantic patient with the multi-page lab printout, how the problem was not that her tests were bad, but that the computer had used the wrong “normal” range ...

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What do eggs, roofing nails, men’s haircuts and plastic cups have in common? A bizarre fraternity ritual or my Saturday morning honey-do list?  Gasoline, copying paper and paperclips?  Shopping for a mobile accounting office?  Nope.  What these items share is that who ever makes them, wherever you buy them, they are essentially the same.  They are commodities. They do not vary significantly in construction or quality.  The only way to ...

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