I hoped that my feisty patient who prevailed over brain cancer would be spared another terminal diagnosis, but after two years in remission, her mammogram showed breast cancer. She agreed to surgery, but declined further chemotherapy. When the time comes, she asked, would I help her end her life? The End of Life Option Act goes into effect in California on June 9, 2016, joining a ...

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When asked during a recent ICU rotation if I was considering critical care as a subspecialty, I offended more than one person with my response: “No, I really don’t enjoy torturing old people.”  Granted, that unfiltered comment came at the end of a long and sleepless 28-hour shift, but the sentiment holds true. As doctors, we have a number of tools to assess quality of life in research.  We use fancy ...

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I remember my first death. He was my patient, a 59 year old who suffered an episode of asphyxiation. His story was tragic, a reminder of the frailty of human life. After choking on a food bolus at home, he had called 911. Unfortunately, he suffered a prolonged cardiac arrest that resulted in irreversible brain damage. He spent two weeks in the intensive care unit in hopes of a recovery, but the ...

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“Son, just let me die.” Those were the first words Mr. O. told me as I introduced myself. As a 75-year-old stage IV lung cancer patient with brain metastasis, Mr. O knew his time on this planet was limited -- the last place he wanted to be was in a hospital with a newly minted clinical student. Mr. O’s neighbor had found him unconscious on his porch earlier this morning, and ...

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Even as a child, I noticed that many people, especially my Depression-era grandmother, feared aging and the imminence of death. Death was no stranger to me growing up; I lost my then best friend, my Nano, and my uncle as a child, both traumatically. Yet, death was sad, but natural. Because of this, I never understood our society’s stigma against dying, something that I've struggled with even in medical school. In ...

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An excerpt from Wishes To Die For: A Caregiver's Guide to Advance Care Directives. The great poet Rumi ascribes, “I should be suspicious of what I want.” Like many others, as I become older I look forward to Medicare paying for health care expenses. Being enrolled in Medicare makes health care available, ...

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Sedated by Oxycodone, Ted slept despite the rhythmic ruckus of his breathing machine. He never felt quite rested in the hospital. While awake, his gaze often lingered on a snapshot that captured him in the past: full of laughter and radiant joy with his little granddaughter, Tara. The grandfather in the photo -- muscular, mischievous -- barely resembled the emaciated elder in the bed who silently mouthed short answers to ...

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What if you woke up tomorrow and learned that your grandmother had been kidnapped overnight by a couple of strangers, thrown in a white van, and taken to a distant warehouse where she spent the subsequent forty-five minutes being tortured before finally succumbing to her death? Where she was repeatedly beaten in the chest, where a tube was shoved down her throat, where she was tasered with high voltage, where a ...

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The affection families express for their dying loved ones can take many forms.  Recently, I saw a spry 91-year-old Spanish-speaking gentleman with lung cancer which had consumed the better part of his right lung.  He had a large family with many doting daughters.  In his neighborhood, he was popular and well respected.   He, according his family, had "many girlfriends."  His lung cancer was no doubt a result of a ...

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"It's those pain medicines you are giving her.  She’s very sensitive to them.  I think that’s why she’s confused -- she is doped up." Two months after receiving her diagnosis Mrs. M signed up for hospice.  At our first visit, she was suffering and visibly uncomfortable.  Her skin appeared excoriated from weeks of scratching.  She was confused, restless, and racked by pain. Mrs. M had metastatic liver cancer resulting from underlying cirrhosis.  ...

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