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
(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)
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
Last week, I wrote about the concept of a “good death” and how it can be created. If there is meaning and utility in comparing and contrasting ideas, then this week I should identify what might constitute a “bad death” and suggest ways to avoid this Please prepare yourself, the “yuck” factor is, at times, fairly high in this discussion.
I will begin by begging you to avoid a bad death at all costs. I have seen too many and can assure you that this is not the path that you should allow yourself, or any one to take. You should plan to avoid a bad death with just as much motivation as you plan to create a good death for yourself and those whom you love and care for. 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