Like most situations that physicians encounter in their work, end-of-life conversations are not easy and require preparation and training. Yet these patient discussions are among the most satisfying I’ve experienced in my career because they’ve made me feel that I’ve made a true difference, offering comfort and a certain level of control to patients and families who are enduring difficult decisions. Throughout my years as a practicing internist, I’ve had dozens ...

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"Holding space means being physically, mentally, and emotionally present for someone. It means putting your focus on someone to support them as they feel their feelings. An important aspect of holding space is managing judgment while you are present. Like when you tell a patient that they have stage IV pancreatic cancer and that it is nonsurgical and even with the best ...

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"To help the reader understand the issues better, I would like to relate some stories. A friend of mine was dying of pancreatic cancer. He had an implantable morphine pump and was on both hospice and palliative care. Still, he found that his suffering was unbearable and wanted to die sooner. Doctors told him that his only option to end his ...

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I wrote my undergraduate thesis on death and dying. I read journal articles trying to understand what death meant and how it affected people. I spent hours reading books, both fiction and nonfiction, trying to understand if you can ever die a good death. I engaged in meaningful conversations with compassionate and astute physicians, nurses, and professors who experienced the death of their patients, both adults and children, time and ...

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In the KevinMD article, "Assisted suicide: a change of heart," the author contends that there is salvation in suffering, but not everyone believes that is true. While I support the author's ability to decide how she wants to die, I do not believe that her personal beliefs should dictate how I die. I retired as an internist a few years ago because of declining health. I ...

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When I was training as a surgeon, I was pro assisted suicide. I believed it was a humane act of kindness and compassion. I imagined myself to be in the place of the other and at times felt if that was me, I’d rather be dead than live with that condition or this condition.  I understand how easy it is to think and feel like this and not even question: ...

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An excerpt from Dying with Ease: A Compassionate Guide for Making Wiser End-of-Life Decisions. Used by permission of the publisher Rowman & Littlefield. All rights reserved. In 2017, there were 2,813,503 deaths in the United States. About a quarter of Americans die of heart disease, some 22 ...

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Recently, a neighbor and friend of mine died. After her cancer was diagnosed as incurable, she was referred to hospice care, and family members traveled long distances to spend quality time with her during her last month of life. Her neighbors in our condo building clamored for slots in her packed social calendar. Two days before her death, she held a socially distanced open house for people lined up six feet ...

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"As a runner, my pulse rests around fifty, but the ICU team had worried when it dipped to thirty-five, and my blood pressure hovered around ninety over fifty. Understandably, bags of saline were hung, and steroids were added. My headache improved, but my ankles disappeared, and I was often short of breath. Upon discharge, I went into full diuresis mode and ...

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I am no stranger to death. I have gently closed the eyelids of a woman dying from liver disease, blasted Led Zeppelin by request during a man's last breath, and exchanged dog photos with an elderly gentleman on his final day. Although I cared for these patients deeply, our relationships were defined by illness. Ms. B was different. Healthy and curious, she had sat in my clinic countless times with ...

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Every time I visit my great grandmother, Tata, Atul Gawande’s Being Mortal floods my thoughts. Tata is 101 and developed severe dementia within the past two years. In 2019, she fell and fractured her hip. In the hospital, she recovered poorly. The physicians on her team offered hospice. My grandfather (her only son), declined fervently. Instead, he insisted on moving her back home to my aunt’s house, where my great ...

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The last thing Jessica said to John, her fiancé of 10 years, was, “I love you” before he drove to work. Hours later, after suddenly experiencing a cardiac arrest at the office, he was in an ICU bed attached to a ventilator. He was pale and unresponsive, on multiple medications to artificially augment his blood pressure, hooked up to a machine that did the work of his kidneys, and cooled ...

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 In today’s increasingly technological, data-driven, depersonalized world of health care, I wonder if the concept of “a good death” is even possible. The COVID-19 pandemic, in particular, has caused me to reflect on this. What does it look like? How do you define it? As I did, a patient came to mind. He was a retired minister in his 80s. I had cared for his wife as well ...

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"We are health care workers. We are doctors, advanced care practitioners, nurses, pharmacists, social workers, and so much more. We are on the frontlines. We are our parents’ children, and we are parents to our young children. For the first time, we are at an extremely high risk of being quarantined by the same beast we are trying to conquer. We ...

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"It seems as though the looming reality for many of us is that we will have patients who need ventilators, and none will be available. It seems like we might benefit from remembering that we can still succeed in practicing medicine by being present with those suffering before us, even when we know we cannot cure them of disease. In a more ...

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My medical school’s secondary application, like that of many other medical schools, asked me to describe a personal or professional challenge or conflict and to explain how I worked to resolve it. However, unlike other medical schools, my school specified that they did not want to hear about the MCAT or another academic challenge. For this question, I wrote about a challenge that I have been facing for most of my ...

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  "Faced with the prospect of not being able to provide all COVID-19 patients with the life support that they may need, physicians and nurses are working in conditions that have been described as 'hell.' How are providers to cope with the trauma they are experiencing in New York and Italy, and presumably other nations as well? How are they to cope with ...

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Death. Mortality. End of Life. Something inevitable, yet rarely discussed and a source of intense discomfort for most. When mentioned, it is considered inauspicious and rude in many cultures. Death is an integral part of the workday for a critical care physician like me. But it was never a topic of discussion in medical school or training. Death is inevitably encountered by every physician at some point and by every human. ...

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Life may never be the same after COVID-19.  With tens of thousands of Americans having succumbed to the coronavirus in the United States, some of us are considering our own mortality.  Life insurance companies have plenty of new customers.  Estate planning attorneys are busier than ever.  Many of us are thinking about how our loved ones will be taken care of in the event of our own death. Death is always ...

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I'm a palliative care chaplain who provides spiritual support to patients with serious, life-changing, and for some, life-threatening, illnesses. A common story they tell is an illness, like a storm, blew them off their life's map.  They find themselves lost in the unfamiliar territory of sickness. The future, once certain and promising, is now uncertain and ominous. Plans they'd made are on hold, possibly canceled. The specter of death looms ...

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