Category Archives: Medical Decision Making

If one were to plot a person’s life on a number line, then death would be nothing more than an infinitesimally thin point, nothing more than a nanosecond demarcation from one state of being to another state of being. So why is it that some of us fight death with our last full measure while others embrace it like a new born baby? Continue reading

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I sat in silence wrestling with myself, shifting in my seat, as my husband drove down the road. He pointed out some beautiful fall foliage. I looked at the trees but could not appreciate the scenery due to my turmoil. All I could think about was how uncomfortable I was with my father’s hospital discharge plan and how fractured end of life healthcare planning is in some states (specifically, states without a POLST form), states such as mine, Alabama. Since becoming active in advocating for better end of life healthcare planning, I have been a supporter of the POLST for lots of obvious reasons- but most basically, it ensures that the medical system obeys the wishes of the patient or the acting healthcare proxy. I have known abstractly how important such a document is for my patients. But now, a new personal knowledge is dawning for me—I now know firsthand how the LACK of a POLST or POLST-like document actually LIMITS healthcare options for those who are near the end of life! Continue reading

We never know how high we are

Till we are called to rise.

                                                            Emily Dickinson

It could be suggested that the “good death” is falsely named in the field of thanatology and in the popular press.  It implies an ideal state, one which of course, we cannot have.  Never agonize over ideals when the problem is as urgent as death.  Perhaps it should be renamed “the good-enough death,” one that is sufficient and satisfactory to both the dying person and the caregiver.  It is the best that can be achieved at that time, in that place, by those people, with that problem, in their particular situation.  Maya Angelou was right to say, “You did then what you knew how to do, and when you know better, you will do better.”   Death and dying are extremely personal. Continue reading

(Editor’s Note: Dr. Kella’s story reflects my own personal journey as an Emergency Physician. All conscientious healthcare providers eventually come to a patient who transforms the way they practice. The lesson in Dr. Kella’s story is especially important for those of us who practice in the Emergency Department, where we set the expectations for our patients and families, and we set the course of care with the therapies that we initiate (or not).  It is within our power to change the destinies of those whom we serve, to relieve and prevent their suffering, instead of allowing and creating more.- Monica Williams-Murphy, MD)

Dr Vipul Kella, Vice-Chairman of Emergency Medicine, So. Maryland Hospital

Dr Vipul Kella, Vice-Chairman of Emergency Medicine, So. Maryland Hospital

When I graduated residency and started my first job, I walked around the ED confidently, chest slightly pumped up at all times. I knew I was well-trained. If there was a sick patient, I was going to resuscitate them. If there was an impossible central line that was needed – I was going to get it. Difficult intubation? No problem. There was no procedure that was too difficult for me. Continue reading

 

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Listen in as we discuss: personal stories of dying loved ones, why you should not show up to the ER without an advance directive, reasons that Americans avoid conversations about death, how the Declaration of Independence is relevant to end of life discussions, how to have a “good death”….and much, much more…

Listen here–Blog Talk Radio Interview by Audrey Pellicano, New York Death Cafe Hostess and Grief Specialist

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“Great show! Thank you both very much for sharing such powerful and needed information and for getting it into a book that is not only personal but offers so much practical information.
Let’s keep the conversation going!”
Audrey Pellicano R.N.,M.S.  CEO Wise Widow Grief Recovery Specialist  audrey@wisewidow.com | www.wisewidow.com

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Many years ago when I was a “young” doctor, moonlighting in the ER of a tiny country town, I had an experience that challenged my training. You see, most “young”, “new” doctors often think their training and knowledge is superior to that of “old” doctors…which is often…malarkey! A wise and sage “old” doctor in this tiny country town taught me an important lesson on where and how one should die. Continue reading