Category Archives: Uncategorized

Medicare End-of-Life Care Planning has been another victim of the partisan hostility that permeates Washington D.C. During the 2009 Affordable Care Act / “Obamacare” debacle, the “death panel” card was somewhat successfully played by those seeking to derail the massive expansion of government intervention, regulation, and delivery of health care. Conservatives were mortified by the proposed expansion of Medicaid to tens of millions of additional recipients. Democrats felt they were taking moral steps further down the “Medicare for All” path.

The Obama Administration and the Democrat Congressional leaders, seeking to provide medical care/insurance to almost all American’s, ramrodded the legislation through the House and Senate, with late-night sessions and contorting legislative rules of the Congress to do so. On the other hand, the GOP vilified and demagogued aspects of the proposed legislation while theorizing it was the end of the country as we know it. (Neglecting to mention that the country has already set up a system, that taxes ALL wage earners and the self-employed, to pay for a medical system which covers everyone 65 and over. When you throw in Federal workers and the military, it seems that Uncle Sam already provides medical care/insurance to most of us.) Continue reading

The sage doctor who stood at the bedside as I held my dying grandmother said, “We seem to die one organ at a time.” I, however, have come to believe that we are too focused on the failing of the organs to rightly perceive the dying of the person.

Death comes in many different ways, in many different packages. Sometimes it arrives wrapped thoughtlessly in advanced dementia, other times the package is stained red with the blood of exsanguination. Usually, these packages are wrapped in a fashion that, for the careful observer, indicates the content. On occasion, the package arrives and is not recognized even by the most astute among us. Continue reading

Consider this…

Tuesday, 03 Apr 2012 02:58

You have been together for years. Shared good times and bad, played together, lounged together. The memories seem innumerable and your love complete.

But, you never thought you would ever see her this sick, see her in this condition.  You walk into the room and catch your breath at the sight of her…her hair unkempt, her mouth opened slightly, dried saliva crusting on her lips.

You hold her wasting frame, crying.  She lets out a small and unfamiliar sound as if in pain.

A deep agony overtakes you as you notice bedsores developing over her right hip, open raw flesh stuck to fresh sheets.  You ask for a dressing to be applied. Continue reading

First, what the heck is a POLST anyway? “POLST” is an acronym for “Physician Orders for Life-Sustaining Treatment”. This is a paradigm shifting legal document that may be adopted on a state-by-state basis and which is transforming end-of-life care. How? By taking information only formerly found in your living will and putting it into a legal medical document, which is signed by your physician—this order will be “obeyed” in any medical scenario in which you find yourself.

To make it very clear how important this tool is, let me tell you about a family who could have really appreciated a POLST, but whose state had not yet adopted one: Continue reading

I had just arrived to a mid-afternoon shift in the ER when I was called emergently into the room of an unresponsive 94 year old fellow. The paramedics told me that they thought he had either a bleeding stroke or an infection in his blood stream because he was so comatose.
Eyeballing my new patient as the paramedics gave report, he appeared as many of my patients do who are near to death- he was reclined on the bed with shallow breathing, mouth relaxed and  wide open, with eyes gently closed. His medical documents from the assisted living facility, where he resided, read like a medical text book for most of the extremely aged: dementia, diabetes, chronic urinary tract infections, prostate cancer. But, what was NOT listed in his paperwork was ANY kind of advanced directive…NADA, nothing, no mention of end-of-life wishes documented anywhere although he was clearly at or near the end of his life.
I moved forward to rest my hand on his chest and bent down near his ear to speak to him. I didn’t expect any response when I said rather loudly, “Mr Green?” yet, his eyes fluttered open, much to the shock of the paramedics who said that during transport he didn’t rouse at all. He even turned his head to look at me…I was relieved. Continue reading

This past week a lovely 80 year-old lady came in to the ER with her husband who was himself a Christian minister. My patient, the wife, came in for fatigue and a variety of other symptoms. As we chatted she raised her eyebrows and smilingly said, “I really didn’t want to come in. I just thought all of this was old age. I’m 80 you know and we don’t live forever.”

I smiled back, “You are very wise, but there are still some things that we could find today that we could treat, which would help give you better quality of life. You are right that we don’t live forever, but we can help you feel the best you can for as long as you can.” Continue reading

Whose Dying Is It Anyway?

Monday, 13 Feb 2012 21:51

Many times a patient arrives to the Emergency Department and it becomes very clear that he or she is beginning to die. What is not always so clear is whose needs we are trying to meet, the one who is dying or one of the family member’s.

***

“Dr. Murphy,” my nurse called out, “This man who just arrived from dialysis doesn’t look so well, would you please come to room 35?”

“Sure,” I always knew that Nancy had good judgment and when she was worried about a patient, this meant that I needed to be worried as well.

Entering room 35, I tilted my head to be aligned with my patient’s. Mr. Joe Brock was a 79-year-old man who had just been sent to the ER from a dialysis clinic. His 3 hour long dialysis session had been cut short because his blood pressure had dropped and he began to act rather lethargic. As I looked into his face which was resting at an angle on his collar bone, he shifted his eyes to look into mine, but that’s all that he did. Mr. Brock didn’t have anything to say. When I asked him his name or where he was, he just looked at me. When I asked him to squeeze my hand or wiggle his toes, he simply stopped looking at me. Continue reading

I have a friend who has always seemed wary about death. When her father was dying, she had a hard time with it. Now, her mother is elderly and sick. Her mother’s primary care doctor has tried to talk to my friend about the inevitable. She didn’t want to discuss it.

One day in the hall at work, she asked me about the book and told me that she thought she needed to read it–thought that it would help. Apparently, it did.

Not too long afterward, a friend of hers came into the ER and was my patient. She was very ill with the complications of a cancer, but was seeking aggressive treatment. We had her admitted to the ICU where she stayed for a few days until the doctors said, “There is nothing more we can do to treat your cancer, but we can make you comfortable…” (I was very proud of those doctors to be able to say those words, to turn her toward comfort-focused medicine). The last I heard, she was in a regular hospital bed wearing an oxygen face mask, and she was comfortable. Continue reading

Recently, I had the privilege of caring for a dying patient and her daughter who was suffering and afraid because no doctor had given her guidance on what to expect.

Allow me to share this patient story with you:

“Dr. Murphy, you have an 85 year-old female and her daughter in room 12. The patient was just discharged from the hospital back to the nursing home. The family had decided to sign Do Not Resuscitate orders and to start hospice tomorrow, but the nursing home would not take her because the patient was wearing a full oxygen mask… apparently that level of respiratory management is against their policy. So, the nursing home made the ambulance bring this lady back to the hospital.” Continue reading

Below, I have compiled a list of 10 reasons why it’s wrong for me to do chest compressions on your 90 year-old grandmother. Please share this list with everyone you know…

1- CPR is ineffective in the very old and very frail.

2 – I will break all of her ribs.

If all of her ribs are broken but her heart is actually restarted, she will most likely be on full life support. And:

3- She will likely die within a few days anyway… or, if she lives longer:

4- She will probably never get off of life support — her family will have to decide whether or not to remove the machine(s), or

5- If in the very, very rare event that she regains consciousness, enough to feel that all of her ribs are broken, she would wish that she were dead, or

6- She would die of the complications of the multiple rib fractures anyway.

Other reasons why it is wrong to perform CPR on your 90 year-old granny: Continue reading

A mother prepares for birth. Couples prepare for marriage. We should all also
prepare for our final and possibly most profound life event, death. Does dying
deserve any less attention? I will say it probably deserves more.  This is why:

If death is the final act of living, the closing line to the script of the story of our lives; then it should be planned for with great care. Do not work on living a wonderful life and then, allow your dying to be haphazard.  Your whole end-of-living era should be devoted to creating physical comfort, emotional healing, and spiritual closure. Your story, the final lines of your life, should end like a great play—with resolution, reunion, and redress.  These generally do not occur accidentally, but require foresight, action, and yes, planning. Thus, your end-of-life planning should begin long before. But even more, if you address these issues now, you will find more peace even in your present phase of living.

Continue reading