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What happens when your deepest religious convictions collide with a patient suffering from metastatic cancer and no miracle in sight? Medical student Jonah Rocheeld shares the raw tension between …
Why I would never compromise on withdrawing care until I saw it firsthand [PODCAST]
They tell us doctors
to practice self-care,
as if grief were a muscle
that loosens with stretching.
But no one teaches
how to set down
a conversation about dying
and pick up
the rhythm of living.
At the end of the work day,
the questions still echo,
How much time do I have?
What would you do, doc?
The charts are closed,
but the questions remain open.
Burnout does not arrive
as flames.
It seeps,
through the small cracks
between hope and reality,
between doing everything possible
and knowing we have …
A physician’s poem on burnout and end-of-life care
Every physician recognizes the serpent and the staff. It appears on hospital logos, medical schools, and ambulance doors, so familiar that few of us stop to ask what it actually means.
Many assume the symbol of medicine is the caduceus: two snakes, wings, and a staff. It is not. That emblem belonged to Hermes, the Greek god of commerce, negotiation, and speed. Its twin serpents represent exchange and trade, apt for …
The serpent and the staff: the ancient origins of the medical symbol
Advance directives pale in comparison to the real-time medical decisions caregivers make every day, whether to encourage medication, contact a specialist, call 911, or continue treatment for a loved one. National Healthcare Decisions Day (NHDD), observed each year on April 16, encourages individuals to complete an advance directive. But when the true day of reckoning arrives, when death seems imminent, disfigurement is likely, or mental capacity is lost, this document …
Caregiver end-of-life decisions: Moving beyond advance directives
Every clinician has encountered this moment. A patient leans forward and says, “But doctor, I was fine yesterday.” The statement carries confusion, frustration, and sometimes quiet alarm. It also reveals an assumption deeply embedded in both medical culture and human cognition, that stability should look like consistency.
In clinical medicine, predictability is often mistaken for stability. We feel reassured when symptoms follow familiar patterns. Patients feel encouraged when treatments produce repeatable …
Why symptom variability in chronic illness is not failure
On the morning of May 19, 2024, my 74-year-old mother was struggling to breathe at her home in Bastrop, Texas. I called 911, an ambulance arrived, and my mother was transported to a hospital.
What followed was a devastating series of miscommunications and ignored directives that led to unnecessary suffering for her and profound trauma for our family.
A clear directive
My mother’s end-of-life wishes had been clear for a long time: She …
Ignored DNR hospital policy: a family’s tragic end-of-life story
If life is what we make it, then the end of life can be understood as a spiritual journey rather than a medical pursuit. We demedicalize dying by distancing ourselves from practices that use hope as consent (prolonging life through reflexive hospitalizations, procedures, or antibiotics that offer little dignity to those already living with serious illness).
Every medical decision poses a fundamental question: Is this the beginning of the end, or …
Demedicalize dying: Why end-of-life care needs a spiritual reset
At two o’clock in the morning, the emergency department doors open to a familiar story. A middle-aged man arrives with massive gastrointestinal bleeding, severe jaundice, and advanced cirrhosis from decades of alcohol use. He has no insurance, no primary care provider, no stable home, and no ongoing addiction treatment. The next 10 days bring mechanical ventilation, endoscopic procedures, dialysis, and intensive care. The total bill will exceed $100,000, nearly all …
End-of-life care cost substance use: When compassion meets economic reality
In the first episode of The Pitt season 2, Dr. Robby reveals he’s taking a three-month sabbatical, his last shift before heading to a UNESCO World Heritage Site in Canada. For a primetime medical drama to feature a physician stepping away for three months signals something important: Sabbaticals are entering the cultural conversation about how doctors survive in modern medicine.
But here’s what the show doesn’t tell you: Most physicians can’t …
Why every physician needs a sabbatical (and how to take one)
After years of leading palliative medicine departments, as a Fellow of the American Academy of Hospice and Palliative Medicine, I’ve had countless conversations that start the same way. A colleague in the hallway says, “Oh, palliative care—that’s so important. You all are so nice.” Or a hospital administrator tells me, “We wish we could give you more, but resources are tight right now.” Or my personal favorite: “Palliative care is …
What is palliative medicine and why is it so misunderstood?
In July, I wrote about the importance of end-of-life planning (EOL). Shortly after, I read a study that examined physicians’ EOL plans with advanced cancer and Alzheimer’s disease (stage unspecified). The study encompassed nations with different forms of aid in dying, from the U.S., where a terminal coma is the only option most states allow, to Belgium, where physician-assisted dying (PAD) and euthanasia are available. Although the term suicide …
Physicians’ end-of-life choices: a surprising study
This is a work of fiction.
I directed Mrs. Powell to sit and make herself comfortable. She lowered herself into the chair at the round table in the lobby of my office slowly, her frail, 90-year-old frame eventually settling into it.
“How’s your health, Mrs. Powell?” I asked. This is how I approached most conversations in which a client asked if they could meet suddenly. Usually, it meant they had gotten some …
How end-of-life planning can be a gift
I live across the street from a funeral home. Each day as I see the cars begin to line up and the people in dark clothes gather to say goodbye, I can’t help but wonder about the stories inside. Who were they coming to honor? What kind of life had just ended? So, most mornings, before I check my email or the hospital census, I read the obituaries.
As a child, …
A doctor’s ritual: Reading obituaries
For the past century, physicians have practiced within the framework of materialism: the belief that everything real can be measured, and everything measurable is real. But that worldview has been quietly eroded by physics itself. In the double-slit experiment, particles behave as waves of probability until observed, at which point they collapse into definite form. Later variations (such as Wheeler’s delayed-choice experiments) demonstrated that observation seems to determine not only …
The role of meaning in modern medicine
For nearly a decade, almost every time my husband, Teddy, went into the hospital, they asked if he had an advance directive. And he did: It was notarized and given to any doctor he saw and any hospital he visited, including the one he died in.
But on the last day of Teddy’s life, the interventions he received were explicitly against his wishes as documented in his advance directive: no resuscitation, …
Advance directives not honored: a wife’s story
“Health-care professionals are increasingly demoralised by pressure to prioritise their employers’ financial goals over patients’ needs and professional norms, as space for good work in a bad system narrows.” This statement from an October 2025 Lancet article spoke directly to my experience.
By all quantifiable metrics, I was successful. I’d just been promoted to associate professor in the number-one-ranked department in the country for my specialty. I had a rewarding leadership …
Reclaiming physician agency in a broken system
AI is rolling out in medicine faster than most of us can process. Ambient scribes documenting visits. Clinical decision support algorithms. Automated prior authorizations. The promises are compelling: reduced clerical burden, more face-time with patients, less burnout.
I wanted this. As a palliative care doctor and director of physician well-being at my institution, I’ve spent years watching colleagues drown in documentation and burn out from relentless task loads. When AI tools …
The human cost of health care automation
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Physician executive Joseph Pepe discusses his article, “A doctor’s guide to preparing for your death.” He shares practical and compassionate advice on planning for life’s inevitable end, from organizing essential documents and …
How to prepare for your death [PODCAST]
Extreme longevity
People claim they want to live to be 100, yet is that a good thing? How you get there may make all the difference. Here’s my take on Blue Zones and the prospect of living to 100. “Blue Zone” is a nonscientific term popularized twenty years ago by Dan Buettner, a National Geographic explorer who studied five geographic regions where many people live to be over ninety or 100. …
Who wants to live to be a hundred?
Let us get this straight: Enjoying life is amazing. You should do more of it. Every day, if you can. But if you are truly committed to living well, you also need to get comfortable with something most people avoid like mystery meat at a buffet: preparing for your death.
Not obsessing over it. Not fearing it. Just preparing, so your loved ones are not left trying to solve your digital, …
A doctor’s guide to preparing for your death
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