

It’s tempting to put these all-important conversations off but the consequences can be dire
Quick ReadIt’s tempting to put these all-important conversations off but the consequences can be dire
It’s tempting to put these all-important conversations off but the consequences can be dire
It’s 9.15am. The medical team is full of energy and caffeine. We have patients to see, some of whom are on the road to recovery, others who have already been recognised as dying, and some who have uncertain futures. There are three new patients whose condition could worsen at any time. Given their frailty I believe cardiopulmonary resuscitation (CPR) would be futile. It is now my job to start a discussion about their future care. Three conversations. I take a deep breath.
The trainee doctors are attentive and still learning how to do this. I complete my assessment for the first patient, pause, then open the discussion. My version is not perfect, and it varies. If it does not vary then it shows I am just repeating some learned lines – an impression that is important to avoid.
Image via Flickr Some rights reserved by NIHClinicalCenter
Lethal Plans: When Seniors Turn To Suicide In Long-Term CareApril 10, 2019 |
A six-month investigation by KHN and PBS NewsHour finds that older Americans are quietly killing themselves in nursing homes, assisted living centers and adult care homes
A six-month investigation by KHN and PBS NewsHour finds that older Americans are quietly killing themselves in nursing homes, assisted living centers and adult care homes
When Larry Anders moved into the Bay at Burlington nursing home in late 2017, he wasn’t supposed to be there long. At 77, the stoic Wisconsin machinist had just endured the death of his wife of 51 years and a grim new diagnosis: throat cancer, stage 4.
His son and daughter expected him to stay two weeks, tops, before going home to begin chemotherapy. From the start, they were alarmed by the lack of care at the center, where, they said, staff seemed indifferent, if not incompetent — failing to check on him promptly, handing pills to a man who couldn’t swallow.
Anders never mentioned suicide to his children, who camped out day and night by his bedside to monitor his care.
But two days after Christmas, alone in his nursing home room, Anders killed himself. He didn’t leave a note.
…continue reading ‘Lethal Plans: When Seniors Turn To Suicide In Long-Term Care’
Image via Picryl
What Cancer Takes AwayApril 8, 2019 |
Anne Boyer writes, “When I got sick, I warned my friends: Don’t try to make me stop thinking about death.”
Anne Boyer writes, “When I got sick, I warned my friends: Don’t try to make me stop thinking about death.”
Before I got sick, I’d been making plans for a place for public weeping, hoping to install in major cities a temple where anyone who needed it could get together to cry in good company and with the proper equipment. It would be a precisely imagined architecture of sadness: gargoyles made of night sweat, moldings made of longest minutes, support beams made of I-can’t-go-on-I-must-go-on.
When planning the temple, I remembered the existence of people who hate those they call crybabies, and how they might respond with rage to a place full of distraught strangers—a place that exposed suffering as what is shared. It would have been something tremendous to offer those sufferers the exquisite comforts of stately marble troughs in which to collectivize their tears. But I never did this.
Later, when I was sick, I was on a chemotherapy drug with a side effect of endless crying, tears dripping without agency from my eyes no matter what I was feeling or where I was. For months, my body’s sadness disregarded my mind’s attempts to convince me that I was O.K. I cried every minute, whether I was sad or not, my self a mobile, embarrassed monument of tears. I didn’t need to build the temple for weeping, then, having been one. I’ve just always hated it when anyone suffers alone.
…continue reading ‘What Cancer Takes Away’
thumb image via The New Yorker – illustration by Bianca Bagnarelli
How Physicians Should and Shouldn’t Talk With Dying PatientsMarch 13, 2019 |
Hospitals should require patients to give explicit informed consent before physicians are authorized to discuss life-and-death matters with them offsite via technology
Hospitals should require patients to give explicit informed consent before physicians are authorized to discuss life-and-death matters with them offsite via technology
By Evan Selinger with Arthur Caplan
On March 3, 78-year-old Ernest Quintana was admitted to Kaiser Permanente Medical Center’s emergency department in Fremont, California. Quintana was suffering from lung disease; it was the third time he had been admitted to the hospital in 15 days. As his granddaughter Annalisia Wilharm stood by his bedside, a machine on wheels with an attached digital screen rolled into Quintana’s room. A live-streaming image of a doctor in a remote location appeared on the screen to tell the pair that Quintana didn’t have long to live.
While Quintana’s family “knew he was dying of chronic lung disease,” they weren’t expecting him to die imminently and in the hospital. While repeating aloud what the remote physician was saying to her hard-of-hearing grandfather, Wilharm had to be corrected. She suggested the next step might be “going to hospice at home,” but the physician told them he didn’t think Quintana would make it that far. He died in the hospital the next day.
Quintana’s family was justifiably horrified by how this news — the worst medical update any family could receive — was conveyed. His daughter Catherine Quintana told news outlets, “I don’t want this to happen to anyone else. It just shouldn’t happen.” People expressed outrage on social media, calling the exchange not just underwhelming but unbearably cruel. Doctors chimed in, bemoaning the fact that they are given little time to talk to patients about anything, even a death sentence.
…continue reading ‘How Physicians Should and Shouldn’t Talk With Dying Patients’
Image via Facebook – Julianne Spangler
At Death’s Door, Shedding Light On How To LiveNovember 8, 2018 |
Nothing so alters a person as learning you have a terminal illness
Nothing so alters a person as learning you have a terminal illness
Ronni Bennett, who writes a popular blog about aging, discovered that recently when she heard that cancer had metastasized to her lungs and her peritoneum (a membrane that lines the cavity of the abdomen).
There is no cure for your condition, Bennett was told by doctors, who estimated she might have six to eight months of good health before symptoms began to appear.
Right then and there, this 77-year-old resolved to start doing things differently — something many people might be inclined to do in a similar situation.
…continue reading ‘At Death’s Door, Shedding Light On How To Live’
Nursing Homes Are Pushing the Dying Into Pricey RehabOctober 10, 2018 |
Elderly residents given intensive therapy in the last weeks of life jumped 65 percent, a study shows, raising questions about financial incentives
Elderly residents given intensive therapy in the last weeks of life jumped 65 percent, a study shows, raising questions about financial incentives
Nursing home residents are increasingly spending time in rehabilitation treatment during the last days of their lives, subjected to potentially unnecessary therapy that reaps significant financial benefits for cash-strapped facilities, a study shows.
The proportion of nursing home residents who received “ultrahigh intensity” rehabilitation increased by 65 percent from October 2012 to April 2016, according to research published this month by the University of Rochester. Medicare defines “very high” therapy as almost nine hours per week, and “ultrahigh” therapy as more than 12 hours per week. Some residents were found to have been treated with the highest concentration of rehabilitation during their last week of life.
…continue reading ‘Nursing Homes Are Pushing the Dying Into Pricey Rehab’
A Plan to Keep Dying Patients’ Drugs From Fueling AddictionOctober 9, 2018 |
The opioids bill that passed Congress includes a measure to let hospice workers destroy unneeded medications
The opioids bill that passed Congress includes a measure to let hospice workers destroy unneeded medications
Hospice workers will be allowed to destroy patients’ unneeded opioids, reducing the risk that families misuse them, according to one little-noticed provision in the bipartisan opioids bill headed to President Donald Trump’s desk for his likely signature.
The bill would empower hospice staff to destroy opioid medications that are expired, no longer needed by the patient because of a change in treatment, or left over after the patient dies.
A spokesperson for Massachusetts Senator Elizabeth Warren, one of the Democrats who pushed for this provision to be included in the overall opioid package that the Senate passed Wednesday, said the idea was sparked by Kaiser Health News’ reporting.
…continue reading ‘A Plan to Keep Dying Patients’ Drugs From Fueling Addiction’
Image via Flickr License Some rights reserved by NIAID
Dead Man’s Son Sues Cryonics Lab for Only Freezing Dad’s HeadSeptember 11, 2018 |
A man is suing a cryonics firm for allegedly not respecting his late father’s wishes—or contract—to have his entire body cryogenically preserved. Instead, the firm severed and stored the man’s head, sending his cremated remains to his son
A man is suing a cryonics firm for allegedly not respecting his late father’s wishes—or contract—to have his entire body cryogenically preserved. Instead, the firm severed and stored the man’s head, sending his cremated remains to his son
The firm in question is Alcor Life Extension Foundation, the first and largest business of its kind. The Arizona-based organization cools down recently deceased individuals in the hopes of bringing them back in the future. Laurence Pilgeram, a scientist long involved in the cryonics community, was Alcor’s 135th patient, and is the subject of the aforementioned lawsuit.
According to a complaint filed against Alcor by Dr. Pilgeram’s son, Kurt Pilgeram, “Alcor has intentionally caused severe emotional distress to Kurt when they cremated his father’s remains and had them shipped to his house in a box without notice. Furthermore, Alcor committed fraud against Kurt when they promised him that his father’s whole body would be preserved and then cut off his head.”
…continue reading ‘Dead Man’s Son Sues Cryonics Lab for Only Freezing Dad’s Head’
Image: By Lab of Ralf Reski (http://en.wikipedia.org/wiki/Ralf_Reski) – International Moss Stock Center (http://en.wikipedia.org/wiki/International_Moss_Stock_Center), CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=10375772