“Oh God!” she groaned, looking upward with tears flooding her cheeks, which were stretched into the shape of agony. Her chest heaved uncontrollably with grief. “I am so very sorry,” I whispered again while leaning in and stroking her hand. This is what death notification often looks like and feels like. We doctors should be masters of delivering some of the worst news that could ever be uttered; the worst news that ...

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By now you’ve surely heard that Medicare is going to pay doctors and other qualified health care providers for advance care planning with patients in 2016. Aren’t you excited? OK, so if you are not utterly thrilled or even if you are nonplussed about the whole issue, then let me give you a different perspective on why you should rush into your friendly local doctor’s office to make a living will and ...

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Medical school and medical training attempt to teach subjective humans how to think and practice medicine objectively. This may be one of the unique fallacies of modern medicine, but that’s a subject for a different blog. Nevertheless, even in the highly emotional field of emergency medicine I’m usually pretty chill. That is, until someone’s dying, and then all of my equanimity can go flying out the window, for better or worse. Such ...

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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. ...

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Early on in my career I called an Indian internist in the middle of the night to admit a patient to him. The patient was an 88-year-old female with advanced dementia, a terminal brain disease. She had aspiration pneumonia, which is often the final common pathway of this illness. She was in respiratory failure, in septic shock and was a “full code.” I can still recall our 4 a.m. conversation: “Hi, Dr. ...

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I live and work in the house medicine. You would think that those of us who have chosen this profession would actually know what dying looks like. Furthermore, one would hope that if the doctor could identify dying, he or she could share this with the patient and family (given that this is fairly significant medical information). I never cease to be amazed that most doctors cannot speak straightforwardly and compassionately about ...

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Most of the time I feel as though I am running in quicksand attempting to bring patients to a place of grace and dignity in dying. On occasion, there is someone who jerks me out of my quicksand and plants me squarely on stable shore and then proceeds to show me what grace and dignity in the face of death really look and feel like. Please meet Mr. Jefferson. Mr. Jefferson had long, lacy ...

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Mrs. Sandra Jackson knew that she was no Warren Buffet. She knew that she was no Bill Gates. Instead, Mrs. Jackson knew that she worked two jobs, 7 days a week to support her family. So, she hid her breast condition for a better time, another day. She would ask herself, which was more important: going to a doctor or buying her children dinner? For a true mother, the answer ...

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Many years ago when I was a “young” doctor, moonlighting in the ER of a tiny country town, I had an experience that challenged my training. You see, most young, new doctors often think their training and knowledge is superior to that of “old” doctors, which is often malarkey. A wise and sage old doctor in this tiny country town taught me an important lesson on where and how one ...

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Standing up from my computer terminal to go see another patient, I caught a glimpse of a small, spindly frail woman being rolled by paramedics into one of my shock and trauma rooms. Very calmly, I remarked, “That woman is dying.” The medical student who was rotating with me was unnerved that I would make such a pronouncement out of a mere casual observance, “Oh my goodness! How can you just say ...

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