Other than taxes, the only other certainty in life is death. People don’t like to pay taxes or think about dying. But on April 16th, National Healthcare Decisions Day (NHDD) reminds people to complete their advance directives. Like a passport, an advance directive permits an individual to proceed from one world to another with an easy stamp of approval. Without the proper paperwork, patients at the end of life are ...

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At 69, Bob appeared to be a broken man. He left the hospital the day before and returned to the emergency department (ED) because he wasn’t “acting right.” Bob became upset when a second injection to his abdomen burned, and family members were angry that the discharge instructions did not explain this. After four years of receiving treatment for metastatic colon cancer, Bob had reached the breaking point of persecution, but ...

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I overheard a colleague admit an 84-year-old woman to the hospital from the emergency department for a sizable mass in her uterus -- no doubt, cancerous. I pictured a frail woman who’d been suffering for a while and was afraid to tell anyone about it, fearing the worst.  Like most, she preferred to ignore it rather than have others tell her what to do. Having fallen ill, she risked losing ...

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Ruth was a spry, but frail 98-year-old woman who was stiff and sore following the 6-hour drive from California to Arizona. She had suffered a recent wrist injury and was not recovering well after spending three weeks in a rehabilitation center. She was in the midst of upheaval and discontent -- in the throes of relocated to an assisted-living residence closer to her son. The facility’s coordinator had begun to ...

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John was an 88-year-old ranch owner who struck gold when he sold his homestead in Wyoming. His golden years in Arizona were spent struggling with back pain and caring for his 80-year-old niece with dementia. He ran out of pain medication and presented to the ER for another “handout” of hydrocodone. He admitted that life was taking its toll, and he was beside himself from aging. Was it time to ...

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Dad had taken a turn for the worse, but my family was not ready to give up on him and consider end-of-life care. Nevertheless, choices had to be made. Would Dad be allowed to pass while in assisted living or have his life prolonged in a skilled-nursing facility? What kind of a doctor am I? When perceiving that a patient is dying, what type of physician neglects to intervene and ...

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An excerpt from Wishes To Die For: A Caregiver's Guide to Advance Care Directives. The great poet Rumi ascribes, “I should be suspicious of what I want.” Like many others, as I become older I look forward to Medicare paying for health care expenses. Being enrolled in Medicare makes health care available, ...

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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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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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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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