Category Archives: Mapping Out the End of Life

To understand where you are on the pathway of life, you need a map.

I was at the end of a long shift. I had already seen too many patients to have any common sense left and it felt as though there were no remaining neurons firing in any agreeable pattern in my brain. And here came my last patient. I peeked into her room before I showed my own face. She was 78 years old with long gray curls piled way atop her head. Her chest seemingly rose and fell too rapidly for comfort. The sounds of bubbles in her airway were audible even outside of the room.

“Uh oh,” I thought…fate has saved the toughest patient for last. Tough because at first glance I could already tell that I would need to have an end-of-life planning conversation with this little lady. She was already triggering my mental screening tool: Would I be surprised if this patient died within the next year?
The answer was a resounding “no.”

I pulled back the curtain.

“Hi Toots!” She called out to greet me as I made my way into her room. (This was a first…and I liked it!)

This spunky little lady was in the ER for shortness of breath. Again.

As we talked it became clear that she had entered her end-of-life pathway. The last six months she had multiple hospitalizations for pneumonia. She now only routinely walked to the restroom or to the dinner table. She was beginning sleep a lot and there was about 20 lbs. weight-loss.

Despite my fatigue it was my duty to have “the conversation” with this patient and her husband, regardless of the physical and mental energy costs to myself.

So I took a deep, tired, ragged breath and started my usual condensed ED-goals of care conversation:

“Do you have a living will?”

Her husband quickly responded, “What’s a living will?”

Secretly, in the recesses of my imagination, I slapped my forehead, yelled out “Oh brother!” and rolled my eyes. As I sat motionless, fake-smiling at the gentleman, I hoped that none of my true sentiments had shone through in my facial expressions or demeanor.

Before I could continue my spiel with this fake-smiling expression plastered on my face the husband asked, “Does that mean that we ask about her wishes?”

Oh wow!

Suddenly I felt as refreshed as after a good nights sleep! “Why yes!” I gushed to
him, my fake-smile now genuine and deep.

“Well, let’s just ask her then,” he said turning to her as my smile turned to an expression of near-astonishment. This had never happened before.

“Honey,” he leaned over her bed rail, “This nice doctor wants to know your wishes like whether or not you want life support and things like that.” He looked toward me as he spoke to her searching my face for confirmation.

Boy, did he get it! I was shaking my head vigorously, “YES!”

Her response?

“Well, I don’t want all of that. You see, I only want to die once.” She said impishly.

We all burst into laughter.

She apparently took this as her cue. So, she continued, “I mean who in their right mind would want to die twice? Right?”

(She began to remind me of Joan Rivers on stage.)

She kept going…”Why break my ribs just so I can come back to do it all over again? And who came up with that plan anyway, doctor ?!?”

#LOL #ROFL were understatements!

Observing my uncontrolled laughter she said, “At least you’ve got a sense of humor kid. But let’s get on with this admission, I’m hungry….”

So, we did.

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Lesson 1- Things are not always as they first appear. Sometimes we are pleasantly surprised.

Lesson 2- Fatigue is no excuse for skipping what could be the most important healthcare planning conversation in a patient’s whole life.

Lesson 3- Always find a reason to smile or laugh with your patients (even if it’s a choice :) )

I have a very wise nurse-friend, we call her “Coop.” I have always thought that she double-dipped from the fountain of compassion. This paper, which she wrote for a Nursing 403 class, proves my suspicions true and gives us all a clue on how to become more like her. This lesson is applicable to ALL of us who care for and serve others, not just those called to nursing: Continue reading

“To every thing there is a season…”

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I am highly tied to the earth. Living purposefully on a lonesome mountain (more like a hill), I almost feel like a participant in the season’s changes.

Within the cycles of nature I also witness the cycles of humanity, even the cycles of our personal lives. Trees change their shrouds just as time traces itself upon our faces and the hairs of our heads. Imagining winter, just like imagining my own demise, gives me a breathless appreciation for the present- for the deepening red of the leaf and for the smell of my child’s curly hair. Viewing the natural world and viewing our own lives with the end in mind awakens a deep reverence for the very act of living itself, and the opportunity to do so.

I have found that when we are not observant of the cycles of nature and the natural cycles of the human life, we become unseated at some deep level. Something feels awry.

Once I saw an old man, in the deep winter of his life. Despite his physical appearance- that of old, dead wood- he was receiving aggressive chemotherapy in desperate attempts to recover just a little bit of spring, a touch of summer, or at least a smidge of late fall. I grieved for him. Something was awry.

We cannot supplant the seasons and love them at the same time. We must learn to love and respect the seasons of our lives and to be one with them- only then can we know of their gifts.

Monica Williams-Murphy, MD

 

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“If you don’t want to deal with death and dying, then you need to quit medicine now and become an accountant…because this is what we have signed up for and we’ve got to do a better job at it.”  Continue reading

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I love hospitalists, they are some of my favorite people. Like me, they come into the hospital and work their butts off for 10-12 hours with very little food or water. We are essentially kinfolk, and we take care of the same patients.

Because we are comrades, I make sure to meet and greet with hospitalists each time I see them. (Some of us even hug!)

One of my favorite hospitalist was in the ER today when I arrived, and somehow (of course) we got on the subject of advanced directives. He told me that his own living will says that when he cannot wipe his own ass, then doesn’t want to be kept alive by any medical interventions. (Excuse his “French”)

We both laughed knowingly.

He said that when he shared his living will with his wife, she freaked out. In her distress, she asked, “Don’t you love me? Don’t you love the children?”

He said, “Of course I do, however my definition of life meaning means being able to actually live.”

Pensively, I remarked, “We’ve seen too much haven’t we?”

We both nodded in agreement. Then, we both smiled and he admitted my next patient-an hundred-year-old man who could no longer wipe his own ass.

Recent articles suggest that doctors typically do not want aggressive measures for themselves at the end of their own lives.

And why is that? It’s because we’ve seen too much haven’t we?

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(photo credit: www.mdsalaries.com)

#YOLO and #YODO! by Monica Williams-Murphy, MD

Saturday, 16 Aug 2014 16:50

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I recently got back from an exciting vacation which included zip-lining and whitewater rafting. Repeatedly during this trip, my oldest daughter and I would encourage each other with the trendy term “#YOLO“-“you only live once,”  before we did something that felt  risky but adventurous. (No offense to my Hindu and Buddhist friends who might prefer another acronym such as “you only live as many times as you need to get it right”! #yolamtayntgir (Sorry…not terribly catchy guys!) Continue reading

The following image is a picture taken by Dr. Kevin Jackson. The quality of the photo has variations in clarity and color as it is a commemorative plaque hanging within the halls of the hospital in which Dr. Thoroughman practiced medicine. The engraving speaks for itself.

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Father's Day- Tim and Darcy

The name of my book is “Bitter and Sweet, A Family’s Journey with Cancer.” Here is a brief summary. In April of 2010, my husband Tim began to have some strange sensations in his side. On May 7, we found ourselves facing stage IV gallbladder cancer rather than a simple gallbladder removal as planned. Five months and one week later, my husband died. Those five months were the most difficult and horrifying time of our lives. It was also an extremely beautiful time for us. We found ourselves using the phrase “bitter and sweet” so often during those five months, that it was an obvious title choice. What follows is the short version of our story…

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Our lives had been full of paradoxes. How do you fight for your life and yet accept mortality at the same time? How do you maintain optimism, which is necessary for health, and prepare for your death and get your affairs in order? How do you understand God’s love and compassion, and yet experience cancer and suffering? Continue reading