Draping a shroud of 30's Depression on any dust bowl child can thicken the skin, so my 88-year-old patient learned to be fiercely independent with a “talk to the hand” attitude, and “don’t get in my way” personality.  Even after her husband passed away, she remained autonomous traveling and golfing in her social circuit. Living life as a smoker was always a threat to her health, and this year became a ...

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Somewhere along the way I learned to believe that if a declaration is written down on physical paper and signed, it carries with it an almost magical certainty of follow-through: it can be framed, cited, stored in a safe, and, if need be, brandished in a court of law. This is an interesting idea in the realm of advance directives. Well-intentioned advance directives The goal of an advance directive is to protect ...

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shutterstock_150470876 I became a doctor because I was excited by the idea of helping people every day. Following a lifelong fascination with science, I found myself in medical school, surrounded by bright classmates. We bonded over late night study sessions at the library and kegs of beer after each exam. As all medical students do, we memorized the 640 skeletal muscles that ...

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When a terminally ill but mentally competent patient wishes to die, should a physician be allowed to bring about such wish? The California legislature is considering that question, and physicians will soon be asked to weigh in on it. Until recently, so-called “physician-assisted dying” (PAD) garnered little support among doctors. Currently, however, enthusiasm in its favor is growing. What are the reasons given to justify this emerging practice? Do they ...

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It has taken me almost two years to be able to write this. We said goodbye to our beloved dog in early May of 2013. I grieved for well over a year. About a month-and-a-half prior to his death, we had a big medical scare with him. I wrote at that time about how dealing with a veterinary emergency can provide us with some insights and practice parallels to dealing with ...

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The theater darkens; children stop laughing, adults sit forward in their chairs. Framed by a single light in the center of the stage, he stands; tuxedo, white shirt, black tie. He stares into the silent crowd, slowly turning his head, lips touched with the slightest, smallest, cruelest of smiles. His gaze fixes upon you; he is just feet away. His hand rises to the brim of his tall hat and ...

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“Good morning baby,” she said to me each morning I when I came into her room. Ms. K was an educated woman in her early 50s with three children. She loved drinking tea in the morning. She also had a very advanced case of lobular carcinoma of the breast that had extended into her abdomen. A cluster of cancer cells was obstructing her small intestine, causing her to have nausea, vomiting, ...

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Count no man happy till his end is known.  - Herodotus This was true in ancient Greece 2,500 years ago. It is even more true today -- aggressive end-of-life hospital care, the lack of sufficient palliative care, and unduly restrictive assisted suicide laws make it impossible for most people to die with dignity. There is no worse death than a hospital death. Dying well means dying at home. This requires preparation and preparation ...

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“Nobody does this …” Dr. D said as a greeting as he walked in holding the 700-word letter I had sent him some weeks before my periodic physical examination. Half the letter addressed six issues that had arisen during the year and a half since my last physical. I thought, nearing age 62, that it’d be both efficient and prudent to provide my GP an update on my health experiences. Half ...

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Americans are waking up to the fact that the $170 billion that Medicare spends on the last six months of life is not helping us die well. Instead, the way we die today tends to be protracted, undignified, and painful. Sarah Palin’s “death panel” debacle temporarily stifled all discussion on the subject, but the silence has been broken by dialogue inspired by the Institute of Medicine’s recent report, Dying in ...

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