"Why don't you talk loud enough for the whole damn hospital to hear you?" I've just greeted my eighty-four-year-old grandmother, and now this irascible voice has erupted from behind the curtain that separates us from whoever is sharing Grandma's room. The nursing assistant whfo showed me in glares across the curtain at the other inhabitant. "You shut up," she tells the person firmly, "or I'll smack you with a bedpan." Then, she leaves us ...

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At first, you'll question reality. You will hear your own words, but they'll sound foreign — apart from you. The ground will still reassuringly push back against your toes when you walk out of the room, but you will wonder if they are your feet. Like in a movie, you will negotiate the world convincingly. Yet, you are an actor playing a part. It is not the real you. Be assured ...

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An excerpt from Life after the Diagnosis: Expert Advice on Living Well with Serious Illness for Patients and Caregivers. Serious illness doesn’t discriminate; it strikes patients of all ethnic and cultural ...

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I am working hospitalist right now. On Friday, a man in his 80s was admitted with difficulty breathing. He had a complicated history, including a heart attack at age 35 with all the subsequent sequela of heart disease. He had an abnormal heart rhythm and was taking a blood thinner for stroke prevention. In addition, he had scarring of his lungs (cause unknown). He was transferred to us from another hospital. ...

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When I was a practicing attorney, my colleagues and I would sit around at lunch, arguing about whose sandwich was better. Alone in our world of books and “right and wrong,” (as in “I’m right, and you’re wrong”), we spent hours creating problems to solve so we could make money. Lawyers -- like many professionals -- form their own little bubble, but unlike say, IT guys or architects, our bubble ...

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There was a lot about that place I didn't want to see or hear. The buzzing and whirring of ventilators; the loud call bells; near-dead patients; nurses running around with IV pumps and tubes dangling along behind them; the heart-stopping "Code Blue" warning; or the electrical sizzle of a patient getting shocked as someone screams, "All clear!" I didn't want to do it. Just a few days before, I had buried my mom. First ...

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STAT_Logo Propelled in part by the unalloyed hopes I cultivated in medical school, I got through my internal medicine residency training largely free of questions about medicine’s limitations. Ailing strangers entered my life in the hospital and I helped them leave nearly restored to health. This was exactly the kind of physician I expected to be. That changed when I ...

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The news was bad. Mimi, a woman in her early 80s, had been undergoing treatment for lymphoma. Her husband was being treated for bladder cancer. Recently, she developed chest pain, and a biopsy showed that she had developed a secondary tumor of the pleura, the space around one of her lungs. Her oncology team’s mission was to share this bad news. Mimi’s case was far from unique. Each year in the ...

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I waited intently as the board members rearranged in their seats and look up expectantly. Silence. I wasn't going to let it be that easy. I repeated myself and paused again. This time a few tentative answers flutter up to the podium. Hospice? Comfort care? End of life? Giving up? Now this is something I could work with. I cleared my throat and smile broadly. Palliative care is a philosophy. I can't help but ...

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Alfred is 95 years old, and sits quietly in his wheelchair, rocking back and forth.  His strength is gone, and his veins and tendons bulge through fair, translucent skin, stretched over muscles of long lost size and use.  His greatest foe is gravity, which holds his lithe, bird-like form in the chair enough to cause sores on his hips, but only barely.  It looks as if he might float away. He remembers little, but ...

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