Home
/
end of life decision...
/
Page 2

Tag: end of life decision making

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 she’d made it, as I’ve become quite fond of her.

She’s seventy, and dying of metastatic lung cancer. She’s a lifelong smoker, but at this point I’m not worried about cause and effect, accountability and responsibility. None of that changes what I must do now as her physician.

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) with African-American families.”

My experience differs.

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 of communicating was through small facial movements–opening and closing her eyes or mouth, raising her eyebrows.

A dozen people made up her ICU team: three interns, three residents, a pharmacist, a nurse, a respiratory therapist, a social worker, a hospital chaplain and myself–the lead physician, or intensivist.

Surprise Ending

Ellen Kolton March 27, 2015 9 Comments

Ellen Kolton

“He’s just expired,” said the nurse as I approached Ray’s room in the large inner-city hospital where I work as a patient advocate. “And his wife has just arrived. Why don’t you go in?”

I found Natalie bent over Ray’s body. His hollow cheek was drenched with her tears.

“I’m so sor–“

“I told him yesterday to talk to Jesus,” Natalie interrupted, speaking quickly. “I told him if the two of them decided it was time for him to go, then it was okay with me. I guess they had their talk,” she said, glancing at Ray as though expecting an answer.

Casting Out Demons

Jef Gamblee December 26, 2014 14 Comments

Jef Gamblee

As I stand beside the bed in Mr. Jerome’s living room, his pit bull puppy sniffs the body bag lying on a stretcher nearby. His cat curls up on the bedside shelf.

“That dog gonna be a problem?” asks Jude, one of the crematory guys.

“She might get underfoot,” says the neighbor, whose name I can’t remember. “But she’s a lover, not a fighter.”

Jude and Chuck are here to pick up Mr. Jerome, who died of prostate cancer today. His body lies on the bed–the wasted husk of a once lively, athletic man who had taught history in a New Jersey middle school.

I’m a hospice chaplain; Mr. Jerome was my client. I’d known him for about six

A Doctor’s Dilemma

Jessica Zitter September 12, 2014 12 Comments

Jessica Zitter

It was my first day at my new job, practicing a new specialty. Having spent fourteen years as an ICU physician–including a four-year pulmonary/critical-care fellowship in this very hospital–I had just completed a palliative-care fellowship. Now I was the hospital’s palliative-care consult attending.

When I set eyes on the patient in room 1407, my first thought was: THIS LADY NEEDS TO BE INTUBATED–STAT!

The only trouble was that my job was to ease this patient’s passing, not to prolong her life.

The team had told me that Mrs. Zelnick, an eighty-two-year-old widow, was dying from pneumonia and didn’t want to be put on life support.

The Pros and Cons of Living with a Terminal Illness

Ellen Diamond May 9, 2014 8 Comments

Ellen Diamond

Before I retired in 2000, I worked in a state agency as a peer counselor, or more formally, an employee assistance program (EAP) coordinator. The “coordinator” part was there because my job description wasn’t actually to do counseling; it was to assess the problem and refer the client for help.

But of course both of those processes involved counseling. We just couldn’t call it that.

In 1986, shortly after I’d begun the job, I was separately visited by two employees with HIV/AIDS. Treatments such as the antiviral drugs used so successfully today were nearly a decade away, and a diagnosis of HIV meant almost certain death. These clients were understandably upset and frightened, but they each made it clear to me that they

Consult

Daniel Becker May 2, 2014 7 Comments

Daniel Becker

Once the tube is out it takes her a minute to turn blue and relax. Another minute to lose her pulse. I learned as a student to feel the difference between the pulse in my fingers and the pulse at the patient’s wrist. Or thought I learned. When you listen for a heart to stop you start to hear heart sounds that might not be there. Like waking up at night thinking you heard something then listening to the dark to be sure, not quite convinced either way. Weak sounds, S1 and S2, valves closing. Slow and slower, regular then irregular, then almost nothing…then who knows? The monitor is off in her room but on at the nursing station. One screen shows every heart

Saving Grampa

Alia Moore April 25, 2014 9 Comments

Alia Moore

You were supposed to die of cardiac arrest as you circled toward home plate. Or of a brain aneurysm in the summer during one of your countless hikes through the mountains.

You weren’t supposed to die here. Not in a hospital bed, inhabiting this fragile new body, with an oxygen tube in your nose and tumors in your lungs.

Two days before you left us, I traveled home to visit you. I’d last seen you six months before, shortly after your eighty-eighth birthday. You were a lifelong athlete and adventurer, but you seemed just a little less spry than I remembered.

The Couple Next Door

Kelly McCutcheon Adams January 31, 2014 12 Comments

Kelly McCutcheon Adams

In 2005, my husband and I bought a small farmhouse in northern New England next door to Tom and Sally.

They were in their early seventies, married nearly fifty years, with a large family. Tom’s grandfather had built a farmhouse in 1900 on the family’s small pig farm. In the 1970s, Tom and Sally had parceled off the land and built a modern house for themselves, a stone’s throw from the old farmhouse that eventually became ours.

Eleventh Hour

K.D. Hayes January 3, 2014 16 Comments

K.D. Hayes

Uncle Walt died this morning. Finally.

I say “finally” because I believed this day would come four months ago, when he had emergency bypass surgery.

At the time, I didn’t believe Walt would live; he was an ailing, seventy-seven-year-old man with severe pulmonary disease. When his heart started to hurt one Friday, his doctors told him, “With bypass surgery, you might live. Without it, you’ll be dead before the weekend is over.”

Walt’s oldest daughter and my parents, who were with him, told me about the doctors’ recommendations.

As a retired paramedic, I’d seen this scenario before–often enough to have a strong opinion, and my own advance directives.

Return of the Hero

Peg Ackerman May 24, 2013 1 Comment

Peg Ackerman

Blanched by anemia, Mary rested quietly in the hospital bed. Her pallor made her barely visible amid the bleached bed linens–she seemed a mere shock of white hair against the pillowcase.

Age ninety-three, she’d visited the hospital a half-dozen times in as many months, shuttling between nursing home and hospital as many elders unwittingly do in their last year of life. She may have preferred to stay put, but no one knew for sure: as a person with dementia, she was presumably unable to speak for herself.

I was a palliative-care nurse practitioner in the hospital. Until about two decades ago, whenever someone neared the end of life the details of care were discussed with his or her doctor; nowadays, that intimate discussion often

fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

Tag: end of life decision making

At Day’s End

Race in the Advance Directives Conversation

Last Stand

Surprise Ending

Casting Out Demons

A Doctor’s Dilemma

The Pros and Cons of Living with a Terminal Illness

Consult

Saving Grampa

The Couple Next Door

Eleventh Hour

Return of the Hero

fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

Tag: end of life decision making

Start typing and press enter to search