Not too long ago I suggested hospice to a patient who had progressive cancer, although she likely had months to live.  “I don’t think it is time,” she replied, “hospice is for morphine.” “That is not how I see hospice,” I replied, “I think hospice is about getting the best care and support, even if there is no real treatment for the disease.  It is about living well, maybe better. Even ...

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He had called the other day to update me up on his condition.  He did not sound upset, but resolute.  "They offered me peritoneal dialysis," he said, "but I decided against it and figured I'd just let nature take its course.  The hospice people are so wonderful -- I've got things all set here at home, but I have two questions.  What should I do about my warfarin?  You know, ...

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We’re born into our bodies, and we take that for granted. Our first job is to take a breath, something we’ll hopefully do many millions of times and never think about.  That first breath changes everything: Our blood starts to flow through our heart and lungs in a different way and for the first time we taste a new world. Before we’re born, all our needs are met via an artery and ...

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As a family doctor, I had the privilege of sitting down at the hospital recently with Mr. M, a longstanding patient of mine, and his family. Mr. M is a college-educated engineer, struggling near the end of his life with end-stage kidney disease, dialysis, severe congestive heart failure and crippling COPD. And he was pretty down about it. In the hospital, a critical care physician, a pulmonologist, a nephrologist, and a cardiologist ...

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The Institute of Medicine of the National Academies has released their long anticipated 500-page report, titled ,"Dying in America – Improving Quality and Honoring Individual Preferences near the End of Life." This is a critical addition to the ongoing conversation about health care in the United States and makes observations and conclusions, which we need to consider and understand.   They conclude, as has been said before, that we waste ...

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Where is compassionate end of life care for the elderly patient? When my 82-year-old uncle had a heart attack in the kitchen of his home, I was on the next plane to the East Coast. No one knew how long his brain had been deprived of oxygen before he’d been resuscitated. As I stood next to his bed in the hospital’s ICU, I feared that my uncle would not make it. I ...

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A palliative care dilemma on the first day of the job It was my first day at my new job, practicing a new specialty. Having spent fourteen years as an ICU physician -- including a four-year pulmonary/critical-care fellowship in this very hospital -- I had just completed a palliative care fellowship. Now I was the hospital's palliative care consult attending. When I set eyes on the patient in room 1407, my first thought ...

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“All your patients will die. Maybe not today, but someday.  The defining fact of life is that it ends.  Only a fool would dedicate their career to fighting something that can never be beaten.  Therefore, a doctor’s task cannot be to fight death.  A doctor’s task is to heal when possible and prevent suffering always. Our calling is to support life. Fighting death may deprive patients of the opportunity to ...

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She was nearing the end of a long and interesting life. Her birth was announced on the party line in her rural community’s first telephone system. Her death, which would come soon, would be shared on Facebook and via cell phone. She had graduated with a degree in home economics from the University of Minnesota in 1938 and had worked for a meat packing company during and after World War ...

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We speak of everyday decisions in terms of cost-benefit analyses. Many of our patients can’t afford a healthy meal, let alone a hefty hospital bill, thus making cost awareness increasingly relevant. But on the day that I met Mr. R., it wasn’t the financial aspects of his care that concerned me. I was thinking about the patient, his family, and two roads diverged in a hospital ward. I was thinking ...

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