“J.T.” is 92 and clearly a soul who lives to the beat of a different drummer. She has no children and her closest relative is a niece who she despises. Despite this the niece oversees her care, sending in a full time aide and her personnel assistant to run the household. J.T. will not come to the office for a visit. If I call and make an appointment to see ...
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The unexamined life is not worth living.
–Plato
There are obstacles to dignity at the end of life. Disease inflicted pain and debilitation, cost and confusion, poor planning and fear, all aggravated by our societal ignorance regarding dying, result in unneeded suffering and isolation. In addition, it occurs to me that a hindrance to control and quality is that we are overwhelmed by the pressure of our day-to-day lives. In other words, ...
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I write a lot about end of life conversations that go well or have unexpectedly positive outcomes. But to be fair and balanced, you should also hear about the ones that don't go so well, lest you be led to believe that I have magical powers over my patients and their families.
Here are two of my attempted end of life map conversations that did not go over so well. In fact, ...
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1. FDA Wants Cancer Warnings on Tanning Beds. Indoor tanning beds must must carry prominent warning labels indicating that children younger than 18 should not use them and that people who do use them need regular cancer screening.
2. Religion Powers End-of-Life Care. Terminal cancer patients with strong religious support were more likely to receive invasive treatments ...
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Watching my grandfather pass away changed my life. It wasn’t sudden and it shouldn’t have been unexpected. Yet it seemed unnatural, mysterious, and incredibly uncomfortable. I can still remember receiving the phone call from the hospital, my mother letting out a distraught cry that my grandfather was no more. My initial reaction was shock and confusion: I just couldn’t understand what had happened. Looking back, he had been under intensive ...
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It had all been so easy when Jim was still around. Lisa's ex-husband had many shortcomings, but being a critical care specialist sure came in handy. Any time her mom or dad had a health crisis, he was right there in the middle of it: advocating, interpreting, breaking down the complexities into easily digestible morsels of information. But then Lisa's father died, and the emotional and physical stress brought the unstable union ...
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We are frequently reminded by the General Accounting Office and CMS that a great proportion of Medicare health costs are incurred in the last three months of a patient’s life. Health care policy experts have tried to reduce these costs by encouraging end of life planning. Living wills, health care directives and the availability of hospice and palliative services will not put a dent in these costs because of human ...
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When I attended the Association of Health Care Journalists (AHCJ) conference in Boston recently, discussion swirled on the topics of unsustainable costs of care, doctors’ incentives under traditional payment models to order more tests and treatments, and the struggles of patients’ family members to avoid unwanted care at the end of life. That Sunday night, I was back at my day job (so to speak) in ...
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During morning rounds on my sub-internship, we always spoke softly about TG. There was never any good news. The 56-year-old writer’s lifelong battle with substance abuse was coming to an end – her heart, liver, and kidney were slowly failing. But TG’s devoted husband was in denial. And behind the scenes, we were struggling, too. The patient needed pain control, symptom management, and psychiatric support among other things. At this ...
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The metaphor we use, almost universally, to describe the experience of illness is that of warfare. Someone diagnosed with cancer is said to be “battling” cancer (as if the diagnosis itself implies a fight). Family members often say that their hospitalized loved one is a “fighter” who “will never give up” or surrender. Doctors refer to the most potent antibiotics as “big guns” that are prescribed to “kill the bugs” ...
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