end of life decision making

What Do You Want Your Life to Look Like?

Sarah Stumbar June 3, 2022 16 Comments

In the first months of medical school, we’re taught that patient autonomy should be one of a physician’s guiding tenets. The doctor provides diagnoses, prognoses and treatment plans, but ultimately it’s up to patients to make decisions about their own care.

As a family doctor, I often tell patients: “Only you can know what the right decision is for you. I’m here to provide information and recommendations and then to support your decision.”

But over the past year, as my father’s memory deteriorated and

When Worlds Collide

Cynthia Stock March 4, 2022 5 Comments

Malcolm sat in the ICU bed, propped up on pillows to ease his breathing. At seventy-five, he had suffered respiratory complications after open-heart surgery. He’d been on a ventilator for several weeks before gradually being weaned from it.

Malcolm’s blue golf cap hid a bald pate surrounded by a fringe of silver hair. He always seemed to be smiling, comfortable with himself and what life had thrown his way. His smile had grown even warmer

The Fight of His Life

Julie Kallikkadan Thomas September 3, 2021 10 Comments

During the early months of the COVID pandemic, the Utah medical school where I teach asked me to facilitate a small group of first-year students in Layers of Medicine—a course that covers what you might call the “messy” side of medicine, including end-of-life discussions.

Just after the course started, my dad was diagnosed with pancreatic cancer. All at once, I felt my personal and professional responsibilities intersect, unexpectedly and powerfully.

Watching Cricket With My Dad

Govind Krishnan January 8, 2021 6 Comments

“Nothing in life is certain except death and taxes!” my dad often crows.

This phrase takes me back to my boyhood, watching the Cricket World Cup matches with him. Time and again, I would pray fervently for an Indian win, but watch in increasing desperation as India threw away an insurmountable lead and snatched defeat from the jaws of victory.

Decision

Greg Mahr August 28, 2020 13 Comments

B546 wants to die
eight years after they saved her.
Cervical-cord injuries are cruel.
For Maria it was a gunshot,
but it could have been a car wreck, a fall,
or a drunken misstep off a roof.
The reasons seemed to matter; now they don’t.
Thirty-two, alone, paralyzed, on a vent,
she mouths “no” to the antibiotics, the heart meds.
“I want to die,” she shouts

Deadlock

Zachary Reese August 17, 2018 7 Comments

Zachary Reese ~

“Does a rock float on water?” I asked the haggard woman lying in the ICU bed.

I was an intern, in the first rotation of my medical residency, and Mrs. Jones had been my ICU team’s patient for the past week. Over that time, she’d looked more and more uncomfortable, constantly gesturing for her breathing tube to be removed.

Mrs. Jones tried to form words in response to

Comfort Care

Sarah Buttrey April 29, 2017 No Comments

When a year ago he arrived at the clinic, he was a hard-working man with neck pain, there with his expectant wife and their adoring toddler. No one had anticipated a tumor.

Family Summons

Amy Cowan January 6, 2017 9 Comments

Amy Cowan

Startled out of sleep, I reflexively reach for my beeping pager. For a split second, I lie poised between wakefulness and terror in the pitch-dark resident call room, not sure where I am or what happened. I resolve to sleep with the lights on from now on.

I dial the call-back number.

“Pod A,” a caffeinated voice chirps. It’s Candice, one of the nurses.

“Hi. Amy here, returning a

Knowing When to Let Go

Deb Skolnik January 2, 2017 1 Comment

I will never forget being told that my mother’s treatment options were pretty much over. A COPD/atrial fibrillation sufferer, she had been intubated and spent time in the ICU, then rehab and then home for a few days. She was very vehement about not wanting to spend life on a ventilator. And she documented this in a living will.

At Day’s End

Marc Tumerman November 18, 2016 14 Comments

Marc Tumerman

This is a story of two deaths. That these patients’ stories intersected on the same morning, in the same building, in two adjacent rooms, has left me thinking about them now that the day is almost done.

I was surprised to see Mrs. Stevens’ name on my schedule today. She came to the office last week, and I felt sure that she’d be too weak for another visit. But I was glad

Race in the Advance Directives Conversation

Henry Schneiderman July 29, 2016 2 Comments

Much of my work as a Palliative Care physician involves conversations with patients and their families for whom the medical outlook is bleak: to help them receive the treatment they want, not more and not less. Such discussions are best held in tandem with the primary medical team and with the nurse. Many times, both attending doctors and housestaff have said, “But it’s so much harder to get a DNR (Do Not Resuscitate Order)

Last Stand

E. Wesley Ely July 24, 2015 23 Comments

E. Wesley Ely

The first time I saw Jessa, she lay crumpled in the ICU bed, paralyzed, expressionless and unable to speak. A military veteran, she had fought in Desert Storm, but she now was facing a deadlier and more inexorable foe: amyotrophic lateral sclerosis (ALS), aka Lou Gehrig’s disease.

This disease causes progressive loss of muscle control, and Jessa was unable to speak, eat or breathe on her own. Her only means

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