I have tried to write a letter of thanks but don't know what to say or even how to begin. I don't know the persons I am writing to, but part of their loved one is literally now a part of me.It began with a phone call from my brother. "Jim, what the hell is Fuchs' Dystrophy anyway - do you have it too?"I racked my brain and tried to ...
Jim deMaine, MD
Our society expends huge sums on futile care
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for "feeling good", but he did hope that it would help him avoid illness. It was worrisome when he started with some belly cramping and noticed some blood streaks in his stools. It took about a month until he could be scheduled for a colonoscopy. The news was shocking. "There's a cancer ...
Is it ethical to prescribe a placebo for a patient?
Betty was complaining at an escalating rate. She'd been in her nursing home for four years and wasn't happy. She kept coming up with new symptoms like aching, fatigue, nervous stomach, tingling, dizziness, etc. Her daughter Nancy was getting daily calls from Betty and the staff at the nursing home. Multiple trips to the doctor for diagnostic tests had ensued: blood counts, liver functions, x-rays, thyroid function, plus many others. ...
Advance planning should be a public health issue
"Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my career as a pulmonary and critical care physician, and I have cared for thousands of dying patients. In many cases, both the patients and I knew that they were dying. ...
We are seeing more terminal patients being referred to hospice
At the University Hospital in Madison Wisconsin in 1938, a patient was dying from a very painful bone cancer which had produced fractures. The young interns knew that more morphine injections were needed but they feared they might be blamed for giving a lethal dose. So a tacit agreement was reached. Every hour or so,one of them would come into the patient's room and give a shot of morphine. This ...
Gallows humor is only a temporary release from a traumatic situation
Cheryl and Susan arrived at the hospital at 6:30 AM. As was their routine, they stopped for their Starbuck's latte and shared family stories as they walked toward the ICU. The two were well known pranksters but were widely respected for being top notch ICU nurses. The whole crew there was like a family. They went to baseball games, picnics, and vacations together. Today was like most other days. They ...
Medicine is slowly facing the issue of futile care
The voice on the phone is demanding, quavering, pleading; "Dr. deMaine you are going to be the attending critical care doctor when our mother is transferred to your hospital today. She needs to be taken off the respirator and allowed to die. We have been pleading with the doctors at the burn center, but they keep doing more procedures. We want her off life support as soon as she gets ...
Discussing end of life issues with a teenager
Marcie transitioned to my care when she turned sixteen. She felt too grown up now to be in the same waiting room with "kids" at the children's clinic. But she wasn't doing well.Her pediatrician had suspected the problem shortly after birth. She wasn't growing normally, had nasal congestion, and more respiratory infections than usual. A sweat chloride test was ordered which was positive. The diagnosis was cystic fibrosis (CF). The ...
The decision not to become a surgeon
Every medical student goes though a process of elimination when deciding what kind of doctor they want to become. We hear the old saying, "Internists know everything and do nothing; Surgeons know nothing and do everything; Psychiatrists know nothing and do nothing; Pathologists know everything and do everything but it's too late." We hear that pediatricians wear bow ties, are short, and love to laugh and play; that surgeons ...
The secret in caring for the patient is to care for the patient
Erik's wife had warned him many times, "Stay off ladders dear, leave it to someone younger." Erik though was a pretty spry 72 years old and had been cleaning the gutters for many years. He had a sturdy 25 foot extension ladder, had years of experience as an athlete, and wasn't about to slow down for no good reason.It was an unusually bright crisp November day in Seattle, when Erik ...
How a patient’s organs could live on and be life saving to a recipient
Sam was late and Ella was furious. "Now why isn't that man back by now? He knows it's time to leave for church."The hours began to pass and Ella became frightened. Sam had gone out for his usual two mile run and had simply disappeared. Ella called friends and neighbors but no one had seen him. Panic began to set in so Ella called 911 who connected her to the ...
The care was futile, and the patient’s wishes
"We have a patient on a ventilator here who is stable enough to transfer to your ICU, if that's OK with you."This call, coming from the transfer coordinator, is emblematic of an insurance generated "medical care" coverage issue. I am salaried under the patient's insurance carrier so the insurer wants this patient back under its wing as soon as possible.The community hospital has been keeping Stella Norris (not her real ...
