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The Man Who Died Well


One of my favorite patients died last week.

My reaction to this was not quite what you would think: I smiled.  No, I didn’t smile because of his death; I smiled because of his life.  I smiled because I got to be a part of that life.  His death wasn’t his tragic end, it was the exclamation point to his life.

I am around a lot of death – it’s one of the things that makes being a doctor different from other jobs.  My goal with all of my patients is to keep them healthy, to relieve their pain, and to do my best to keep them alive.  Ultimately, though, it’s a losing battle; 100% of them will eventually die.  That’s why I don’t like statistics about how many people who die due to inadequate doctoring.  Our job is to resist an irresistible force.  We are standing up to the hurricane, the avalanche, the flood. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Why Is It Taboo For Doctors To Discuss Death With Patients?

Back in the day when I was a newspaper reporter I completed a biomedical ethics fellowship at the University of Virginia Medical Center in Charlottesville, VA. In addition to sitting in on the hospital’s bioethics committee discussions, I spent much of the week shadowing a nurse in the ICU.

They called her the Death Nurse because her job was to intervene with doctors, nurses, patients and families when the time came for a patient to move from the ICU to hospice. While her title was Supportive Care, she flat out told her me her job was to help people die; not actively, but from behind the scenes by helping patients and those caring for them understand when the time had come to move from curative care to supportive care (email me if you’d like a copy of the article I wrote about her). Read more »

*This blog post was originally published at Debra Gordon on Medical Writing (and other medical topics of interest)*

Saving Billions On End-Of-Life Care: Another Mirage?

“We can no longer afford an overall health care system in which the thought is more is always better, because it’s not.”  – Peter Orszag

Could anyone disagree? Not really.  Which ought to be the first clue that it’s a meaningless truism.  I mean, of course more isn’t always better.

But this hasn’t stopped this truism from becoming one of the most popular refrains in health care reform.  Most of the time this is directed at one area:  end-of-life care. Read more »

*This blog post was originally published at See First Blog*

When Your Significant Other Overrides Your Living Will

He knew she was angry with him.

“Whenever I come to see her, I reach out and take her hand, but she looks away.”

Husband and wife for well over 50 years, they had been through a lot.  They met in another country in another time, and to hear him tell it, it almost seemed fated that they’d end up together.  Since then, they’d moved many times, raised a family, supported each other through myriad illnesses.  They were growing old together.

Unfortunately, “growing old together” doesn’t always work out like we hope it will.  Diseases and illnesses ravage our bodies; dementia ravages our brains.  She’d long ago given up on their little garden in the backyard.  It was her favorite hobby, but she couldn’t manage it anymore. Read more »

*This blog post was originally published at code blog - tales of a nurse*

When Should A Physician Help A Patient Die?

Here’s an interesting case.  A young woman drinks antifreeze to commit suicide, writes a note saying she does not want any medical treatment and calls an ambulance so she can die peacefully with the help of medical support.

I read a lot on  Happy Hospitalist about a patient’s right to demand what ever care they feel is necessary to keep them alive and the duty of the physician to provide whatever care the patient feels they require, no matter how costly or how miniscule the benefit.  Readers like to say it’s not a physician’s obligation to make quality of life decisions for the patient.

So let’s analyze this situation.  Does a  patient have the right to demand medical care and the services of physicians to let them die without pain?  Does a patient have the right to demand a physician order morphine and ativan to keep a depressed but physically intact patient comfortable as they slip away in a horrible antifreeze death under the care of medical personel? Read more »

*This blog post was originally published at A Happy Hospitalist*

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