(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
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
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
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