Category Archives: Begining with the End in Mind

To the extent it is possible, we should plan out, organize and groom the end of life for all of its gifts.

I pulled the stifling surgical mask off my face as I left my last patient’s room. I had just finished suturing a complicated facial laceration and was bone-tired from the evening. Glancing at the clock, I saw that mercifully, my shift was over.

Collapsing into my chair to finish up my charting, I was slightly annoyed when my nurse held a clip-board in front of my face, “Here is your next patient.”

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When dying should not be an emergency

Wednesday, 31 Oct 2012 20:12

If you are 15 years old and you are walking to school and are hit by a car and you are dying, this is an emergency.

If you are 85 years old and you are out doing your morning walk and are hit by a car and are dying, this is an emergency.

An unexpected dying at any age is an emergency.

In contrast, there are many people dying of advanced chronic and terminal illnesses whose dying should really NOT be an emergency. Yet these poor people come to the Emergency Department for help because they do not know two very important things: Continue reading

My Public Service Announcement

Thursday, 18 Oct 2012 17:12

In an alternate universe, I would get on TV and as a public service announcement

I would say: “If you are very elderly or terminally Ill please don’t come to my ER To die, please instead choose to die in the safety and comfort of your own home.” Continue reading

I have decided that if I am going to continually encourage my very elderly and terminally ill patients to decline artificial life support measures at the end of the road, and instead, choose a “good death,” then I need to be able to explain and provide this “better” alternative more effectively.

So, I thought it time to revisit an article published in 2006, analyzing factors that define the concept of a “good death.” The author, Karen Kehl, MS, RN, ACHPN, gathered forty-two articles from diverse sources including medical, nursing, patient perspectives and sociological literature, and extracted concepts most frequently mentioned as contributing to the creation of a good death. Continue reading