I had a most surprising visit with a patient last week; she came to say goodbye, because she was dying. The surprise was that while she does have a terminal illness, she is not actively dying; I would put her prognosis at four to eight months. She was bidding me adieu, because I had referred her to hospice.
There is confusion about the role of the primary doctor, when a patient ...
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I was recently speaking to the clinical leaders of a mid-sized hospital, and a senior administrator posed the question, “should we require our doctors and nurses to get flu shots?” The answer, I said, is yes, and it isn’t just to prevent the flu. It’s to get into the habit of making our folks do the right thing when it comes to patient safety.
Preventing the flu is very important. In ...
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It's Friday afternoon and I check the day's schedule. A name jumps out at me and I groan a little and worry -- what am I going to say to someone I've treated for twenty years, who's my age and just been admitted to hospice care? If this is goodbye, how do I as a physician, who is more than an acquaintance but not quite a friend, handle this appointment?
All ...
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Here is a little appreciated fact: Patients cannot order medical care; they can only accept or refuse it. Only a doctor can order medical treatment. In an extreme medical situation, the doctor can offer CPR, but it is the patient’s job to accept or reject. Any patient can refuse CPR. This refusal is known as Do Not Resuscitate or DNR, and for obvious reasons needs to be made ahead of ...
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He used to be a boxer.
Those days were long-gone, though.
Now he was a shell of his former self.
The hands that formerly knocked opponents to the mat were now contracted and full of arthritis. Dementia had taken away his ability to tell the stories about his career. Metastatic lung cancer ravaged his body. Multiple bed sores ate away at his sacrum and ...
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The Institute of Medicine’s Rosenthal Lecture this past December addressed pop culture images of death with an eye toward understanding how “attitudes towards the end of life inform and shape our cultural repertoire” and helping “overcome the emotional obstacles that inhibit us” from dealing properly with the end of life, said IOM president Dr. Harvey Fineberg. The panelists were Dr. Kathleen Foley, a neurologist and palliative care specialist; Jay Clayton, ...
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Seven months ago, in Carbondale, Colorado, staff at the skilled nursing facility where my mother had resided for over a year recommended that she be placed on hospice. My mother has severe advanced dementia and can no longer walk, speak, feed herself or recognize her family members.
As much as I know about hospice care for cancer patients here in San Diego, I knew nothing about hospice care in Carbondale for ...
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Please raise your hand if you are not going to die.
If you haven’t found the fountain of youth and we haven’t perfected anti-aging technology, then you my friend are going to die. But you are not alone, so am I, and so is your mother and your father and your brothers and sisters and even little Johnny down the street.
Now that I have reminded you of your own mortality. Does ...
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Hospitals are busy places to work. The work is fast paced, and never seems to stop. For most physicians, the work ends when the work is done, or until you fall over, whichever comes first. So as a consultant, when I am seeing a patient wherein there is no longer anything that I am contributing to a patient’s care it’s routine that a physician would “sign off” the case, meaning ...
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A grandfather-father-husband-salesman-cook-gardener-hiker-gentleman, adored by many, is struck down by cancer. His disease is particularly horrible, spreading quickly though his body causing damage not only to bone and organ, but to sinew and nerve. He suffers terrible pain for weeks, relieved poorly with inadequate doses of inferior medications, thrashing in misery witnessed by his kin, always at the bedside, ages seven to seventy. Finally, uncomfortable and agitated until the end, he ...
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-Eric Topol, MD, author of The Creative Destruction of Medicine
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