Sedated by Oxycodone, Ted slept despite the rhythmic ruckus of his breathing machine. He never felt quite rested in the hospital. While awake, his gaze often lingered on a snapshot that captured him in the past: full of laughter and radiant joy with his little granddaughter, Tara. The grandfather in the photo -- muscular, mischievous -- barely resembled the emaciated elder in the bed who silently mouthed short answers to ...

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What if you woke up tomorrow and learned that your grandmother had been kidnapped overnight by a couple of strangers, thrown in a white van, and taken to a distant warehouse where she spent the subsequent forty-five minutes being tortured before finally succumbing to her death? Where she was repeatedly beaten in the chest, where a tube was shoved down her throat, where she was tasered with high voltage, where a ...

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The affection families express for their dying loved ones can take many forms.  Recently, I saw a spry 91-year-old Spanish-speaking gentleman with lung cancer which had consumed the better part of his right lung.  He had a large family with many doting daughters.  In his neighborhood, he was popular and well respected.   He, according his family, had "many girlfriends."  His lung cancer was no doubt a result of a ...

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"It's those pain medicines you are giving her.  She’s very sensitive to them.  I think that’s why she’s confused -- she is doped up." Two months after receiving her diagnosis Mrs. M signed up for hospice.  At our first visit, she was suffering and visibly uncomfortable.  Her skin appeared excoriated from weeks of scratching.  She was confused, restless, and racked by pain. Mrs. M had metastatic liver cancer resulting from underlying cirrhosis.  ...

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“Oh God!” she groaned, looking upward with tears flooding her cheeks, which were stretched into the shape of agony. Her chest heaved uncontrollably with grief. “I am so very sorry,” I whispered again while leaning in and stroking her hand. This is what death notification often looks like and feels like. We doctors should be masters of delivering some of the worst news that could ever be uttered; the worst news that ...

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As I sat in my hospice interdisciplinary group meeting, reviewing the many patients who have died in the past two weeks as well as our new patients, there was a slight break in the discussion. Being ever the multitasker, I clicked on a New York Times article I had been meaning to read and scanned the first two sentences:  “When my husband died from cancer last March at age 37, ...

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Thomas Hobbes described life as pitifully “nasty, brutish, and short.” Thanks to the free market and the state, life is no longer a Hobbesian nightmare. But death has become nasty, brutish, and long. Surgeon and writer, Atul Gawande, explores the medicalization of ageing and death in Being Mortal. Gawande points to a glaring deficiency in medical education. Taught to save lives and fight death, doctors don’t bow out gracefully and ...

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By now you’ve surely heard that Medicare is going to pay doctors and other qualified health care providers for advance care planning with patients in 2016. Aren’t you excited? OK, so if you are not utterly thrilled or even if you are nonplussed about the whole issue, then let me give you a different perspective on why you should rush into your friendly local doctor’s office to make a living will and ...

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asco-logo She had been a patient for several years, and I still remember meeting her that first time: Her breast cancer was stage IV at diagnosis, already established in her bones; she was scared; she was in pain. Surgery was taken off the table, and she was referred for medical therapy. We had discussed prognosis, the incurableness of her cancer, ...

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This New Year is the appropriate time to make a resolution: the occasion to link advance care planning with a spiritual legacy.  People all have deep-seated values and determinations of what they are willing to pay for, live for and die for, but few actually document these for caregivers or posterity. Beginning in 2016, Medicare will begin to reimburse physicians for end-of-life counseling. However, throwing taxpayer dollars at no-win situations is ...

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