I never realized the true meaning of palliative care amidst the harried practice of emergency medicine. The pressure being placed on me to do more often becomes the same expectation I place on patients to receive more treatment. Gloria, the wife of my patient with terminal mesothelioma, shed a light on palliative care for me with the insightful words, “We know that there is no cure -- we just want to ...

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Poor bored government. So much time on their hands; so little real work that needs to get done, all they can do is micromanage poor physicians like me to death. Well, they can try. For its first forty-five years, Medicare was (in)famous for the very narrow limits on things it covered. It would pay for medical care when you were sick or injured, and that was basically it. No preventive care. ...

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On September 12, 2015, the California Legislature passed a controversial bill legalizing physician-assisted suicide. California would become the fifth state to allow doctors to prescribe lethal medication to terminally ill patients who request it, after Oregon, Washington, Vermont and Montana. During the debate over the passage of the bill, everybody weighed in: patient’s rights advocates, dying patients and their advocates, religious groups. The one group that I didn’t hear about ...

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What do I need to know as I age?  While scientists ponder the questions of water existing on Mars and if it can essentially sustain life, my duty it to assess if there is life left in Oliver -- a nursing home patient transferred to the ER. Oliver was not oxygenating well but appeared to be resting comfortably. Reportedly, Oliver had fallen that day and EMS discovered a sizeable bruise ...

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It is a pattern oft repeated in a lifetime: You go to the doctor’s office, get a prescription, and go home. You go to the urgent clinic, get care, and go home. You go the hospital, get better, and go home. But some people are very surprised when they go to inpatient hospice, are stabilized and told to go home. Inpatient hospice could be within a hospital, nursing home, or a dedicated hospice facility. The ...

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“Doctor, I am ready to die.” I knew her from a few years back. This patient of mine. I am a hospitalist and the patients in my care come and go, making it difficult to really form relationships like the ones primary care physicians have with their panel of patients. But this patient was different.  I saw her once many years ago when she was gravely ill, and we managed to pull her ...

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The extraordinary pain of many people around you is unaddressed, and the scale of that unmet need would shock you if you saw it. Compartments of privacy separate you from the experience of your neighbors and even your own families. I understand that you have been unaware as well as hopeful that our medical system will either fix the problems or, at least, soothe the pain. It does neither consistently. ...

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On a September night not long after his 83rd birthday, my father suffered a massive stroke.  It left him conscious yet unable to talk and communicate, unable to swallow, and almost completely paralyzed. After numerous scans and other tests, his doctors determined that there was no chance for recovery.  My father would never walk, talk, or swallow food again.  With nothing more to do for him in the hospital, we -- ...

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Do you truly understand advance directives?  With the help of Green Day, emergency physician Michael Barton seeks to educate with this fantastic video.

While sitting one evening with my terminally ill elderly mother, she again asked me to help her end her suffering.  This time it was, “Could you just go get the hammer and hit me in the head?” Her previous requests had included "Son, you are a doctor, can’t you do something to help me with this?”  And then, “They treat animals better than this.” On previous occasions, I had to remind ...

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