

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
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
Family MedicineMarch 5, 2019 |
James Marcus writes about how, at the end of his life, his father went from doctor to patient, from scientist to subject
James Marcus writes about how, at the end of his life, his father went from doctor to patient, from scientist to subject
We like the heart to behave—no skipped beats, no atrial flutter, just the regular, precious, plodding cadence. For this we will sacrifice much. The medicine my father began taking for his irregular heartbeat, in 2014, could have turned his skin gray, or caused him to grow breasts, or collected in tiny granular deposits behind his eyes, so that everything he looked at would have had a blue halo. None of this happened to him. Instead, he was cold all the time.
Inside my parents’ house, a century-old structure north of New York City whose thin walls testified to the golden age of cheap petroleum, he took to wearing a heavy tweed overcoat. He wore it when he watched television, or napped on the sofa, or read through old copies of the Times which he kept in the basement. He wore it at meals, also donning gloves and a hat. He peeled off the overcoat only when he went to sleep, under several blankets and a stout covering my parents called Milty the Quilty. Of course, they could have turned up the heat. But old habits of thrift got in the way, as did the psychological complexities of a long marriage. My mother had wanted to move decades ago, my father had run out the clock in his typically charming and infuriating manner, and now remaining in the chilly house was punishment for him, not for her.
…continue reading ‘Family Medicine’
Thumb image via The New Yorker – Illustration by Tallulah Fontaine
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’
Any day spent in a hospital emergency department shows how the illusion that we are in control of our lives can be shattered by the laws of nature, which can catastrophically change everything, unexpectedly rendering us helpless, damaged or dead
Any day spent in a hospital emergency department shows how the illusion that we are in control of our lives can be shattered by the laws of nature, which can catastrophically change everything, unexpectedly rendering us helpless, damaged or dead
The suddenly-ill are rescued by modern technological interventions whenever possible; it is assumed to be in the patients’ best interests to survive and recover. But the interventions may result in very little, if any, quality of life and instead only prevent “natural dying”. This is a new problem, born of technological progress. Where does it leave us?
This summer, after considering the case of a man known only as “Mr Y”, the UK supreme court clarified that judges need not be consulted if a clinical team and a patient’s family agree – after careful discussion following best practice and legal guidelines – that it’s not in the best interests of a patient with a prolonged disorder of consciousness to continue artificial hydration and nutrition. It is permissible to withdraw this treatment and allow their dying to proceed naturally. …
…continue reading ‘How our lives end must no longer be a taboo subject’
The AMA Has Long Opposed Assisted SuicideJune 11, 2018 |
Is that about to change?
Is that about to change?
During his three decades as an emergency-room doctor, Bob Uslander had never written a prescription for a lethal dose of medication. But then he shifted to geriatric and palliative care, and in 2016, a patient suffering from the neurodegenerative disease amyotrophic lateral sclerosis (ALS) wanted to use California’s new physician-assisted death law.
Uslander was apprehensive. Until then, he had always viewed death as a failure.
“I didn’t really know what it would be like to be with somebody who had made the choice and was taking this medication,” he recalled recently. “I didn’t know if they would just gently fall asleep or if they would be gasping or struggling.”
…continue reading ‘the AMA has long opposed assisted suicide’