QUESTION: How can a little, frail 82 year old lady with advanced dementia have this written in her chart:
I live and work in the house medicine. You would think that those of us who have chosen this profession would actually know what dying looks like. Furthermore, one would hope that if the doctor could identify dying, he or she could share this with the patient and family (given that this is fairly significant medical information!). Continue reading
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
Standing up from my computer terminal to go see another patient, I caught a glimpse of a small, spindly frail woman being rolled by paramedics into one of my shock and trauma rooms.
Very calmly, I remarked, “That woman is dying.”
The medical student who was rotating with me was unnerved that I would make such a pronouncement out of a mere casual observance, “Oh my goodness! How can you just say that?” Continue reading
Let me tell you about my dear landlady, Sue, as she prepared to die a natural and family supported death last week: Continue reading
I write a lot about end of life conversations that go well or have unexpectedly positive outcomes. But to be fair and balanced, you should also hear about the ones that don’t go so well, lest you be led to believe that I have magical powers over my patients and their families.
Here are two of my attempted “end of life map” conversations that did not go over so well. In fact, these conversations left me speechless… Continue reading
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
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
The names of things often greatly affect our perception. In End-Of-Life lexicon, there is a movement underway to change the name of the medical order DNR (Do Not Resuscitate) to AND (Allow Natural Death). No change in the medical reality of what occurs, but a radical change in our emotional reaction to the each term:
from “DNR”— “they withholding a medical intervention” (evoking negative feelings)
to “AND“– “they are giving care that allows death to occur naturally.”
I certainly feel more comforted and assured by the latter, positive wording, although both phrases constitute the same medical pathway.
Now, I am ready to take this a step further, I would like to rename the “Full Code” pathway for those who are in the final stages of a terminal illness or at the end of a long life: instead of offering “Artificial Life Support” to these patients, I will be offering “Artificial Death Extension.”
Yikes! Who in their right mind would want that? Or even say such? Now before you think that I’m an insensitive brute let me explain: Continue reading
I have been an ICU and ER nurse for 16 years and during this time I have seen very few, if any patients or family members that have been “prepared” to die. I have seen a lot of miracles that have kept people alive, but never have viewed a death as a miracle, until the case of “Mrs. Elizabeth”.
I am often described as a sassy, confident, lip-gloss wearing trauma nurse who does not mind “telling it like it is” or stating my opinion. When I am doing my job critical or not, I am very focused and serious and feel that I have to hold back my emotions to provide the best care for my patient. This said, my co-workers are shocked when I get upset over a patient or when I become gentle and sweet because I am moved by a patient experience. Continue reading