I knew it was bad when she couldn’t tell me her name. I watched her face fill with frustration as a word she had uttered countless times over eight decades somehow got lost between her brain and her lips. It was 2 a.m. and I was on call as the surgical resident. I had been told that a patient with bladder cancer was being transferred from another hospital, and, as these ...

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During the first few days that my mother spent in hospice, I silently sat by her bed watching her chest rise and fall, listening to her moan, counting her doses of Ativan, Tylenol, and Morphine, and tallying the days she’d been without food and water. On day five of my vigil, I asked her nurse, “How long can Mom live like this? She hasn’t opened her eyes or eaten or had ...

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Ruth was a spry, but frail 98-year-old woman who was stiff and sore following the 6-hour drive from California to Arizona. She had suffered a recent wrist injury and was not recovering well after spending three weeks in a rehabilitation center. She was in the midst of upheaval and discontent -- in the throes of relocated to an assisted-living residence closer to her son. The facility’s coordinator had begun to ...

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The only thing I love more than complaining about being a doctor is actually being a doctor. Intern year sucks. There’s no way around it. I wake up at 5:15 a.m. to get to the floor at 6:00 a.m. and I rarely leave at 5:00 p.m. when my shift is scheduled to end assuming I’m not on call until 9:00 p.m. I often feel my stomach growl at 9:00 a.m. and ...

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They said, "Do everything." She knew something was wrong. And by the time she was 85 she had forgotten the names of her children, the town she raised them in, even the name of her deceased husband. In her 70s she was diagnosed with Alzheimer's. Still coherent, she talked to her physician about becoming a DNR: do not resuscitate. She did not want to live on a machine that would breathe ...

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I make my way down the aisle of the plane, squeezing past my fellow passengers and plop down in my assigned seat.  Sitting next to me is a middle-aged woman with a kind smile. As the plane takes off, she begins making small talk: ”What do you do?” I silently debate, do I adopt my travel persona or answer truthfully?  Answering honestly will result in one of two things; either we ...

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I slipped and fell. My hip fractured, surgery would make it better. But it didn't. My body was too weak to fight. I couldn't cough and deep breathe; I stayed in bed. I had nausea and vomiting. I couldn't breathe. I became weaker and weaker, until my family noticed. The medics rushed me into the ER. My blood pressure was 62/34. For how long? The ER nurses and doctors tried ...

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Physicians are accustomed to seeing patients at the end of their lives.  It is difficult to let families know they may lose their loved one.  Clinicians are often accepting of patients DNR orders before family members are ready.  This story is about a time where the health care team was ill-prepared, yet a parent made the difficult decision to discontinue intervention.  It taught me an unforgettable lesson. During the first ICU ...

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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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