It is in our nature to lie.  Falsehood is one of the most creative things we do and the most remarkable of the human arts. We construct castles from ether and support their ephemeral walls on a foundation of accepted truths, which themselves are wisps of previous lies. The more we live within lies, the greater the challenge and more the harm. We pay a heavy price for fabrication.  What happens ...

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We never know how high we are Till we are called to rise. -Emily Dickinson It could be suggested that the “good death” is falsely named in the field of thanatology and in the popular press.  It implies an ideal state, one which of course we cannot have.  Never agonize over ideals when the problem is as urgent as death.  Perhaps it should be renamed “the good-enough death,” one that is ...

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New Jersey is considering following four other states in legalizing physician-assisted suicide. The Death with Dignity Act would allow people with less than six months to live to receive a prescription for a fatal cocktail and then to commit suicide at the time of their choosing in the privacy of home. Recently, I had the opportunity to participate in a debate on the merits of the proposed law.  While I oppose this ...

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As physicians, we bear witness to the health and life events that unfold for our patients. We diagnose and treat diseases. We watch as our patients find partners and celebrate as they bring new life to their families. Yet when the challenge becomes great for our patients, our role must change. We must do more than bear witness. We must shepherd. When I first began seeing John as a patient, he ...

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For reasons I confess I don't quite understand, zombies are in these days. They populate blockbuster movies, TV shows, and even commercials. There are the classic, grisly, menacing variety, and even some new-age variants that seem almost cuddly, in a creepy sort of way. But whatever explains the fascination with zombies, they seem to belong to that same taxonomic category of interest as purple cows of silly poem fame: People ...

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Many years ago when I was a “young” doctor, moonlighting in the ER of a tiny country town, I had an experience that challenged my training. You see, most young, new doctors often think their training and knowledge is superior to that of “old” doctors, which is often malarkey. A wise and sage old doctor in this tiny country town taught me an important lesson on where and how one ...

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"Did you sell the business yet?" I marvel at my patient Jack: despite his breathlessness, he's somehow managed to greet his wife Sara with a complete sentence. Given his condition, it's truly amazing. Most of his lung function has been devastated by his forty-year, pack-a-day smoking habit; the rest has been demolished by cancer. The easy, automatic breathing he once took for granted is just a memory. He can't even lie down ...

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In his beautifully written, recently published novel “And the Mountains Echoed,” Khaled Hosseini presents a series of stories in which individuals are faced with near-impossible choices. Impossible choices permeate Khaled Hosseni's latest novel. Studies show many doctors struggle to help their patients through their most difficult choices. As difficult as the decisions in the book seem, it turns out the worst possible ...

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Advanced dementia is a terminal illness needing palliative care. Unfortunately, there is a great divide between this statement of the world as it should be, and the current reality of the world as it is.  Rates of pain and shortness of breath are high for patients with advance dementia.  Patients with advanced dementia often reside in nursing homes, and few nursing homes offer specialized palliative care services. And, as we can see from an ...

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Earlier this month, a candid and powerful personal essay was published by Jessica Rice, a thirtysomething woman with terminal cancer. An emerging theme of Jessica’s piece was the importance of frank conversation between physician and patient, and I was curious what a provider -- someone who has difficult conversations on an almost daily basis -- would think of this patient’s story and perspective. Thoracic oncologist Kavitha Jennifer Ramchandran, MD, read the piece ...

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