End-of-Life Care
lborkowski | December 27, 2011While we're on vacation, we're re-posting content from earlier in the year. This post was originally published on April 27, 2011.
By Liz Borkowski
Last week, Andrew Sullivan noted that a large proportion of healthcare costs are for the last days and hours of patients' lives and made the following proposal:
If everyone aged 40 or over simply made sure we appointed someone to be our power-of-attorney and instructed that person not to prolong our lives by extraordinary measures if we lost consciousness in a long, fatal illness or simply old age, then we'd immediately make a dent in some way on…
cmonforton | November 14, 2011She's a hospice nurse. When I tell people her occupation, I typically receive a response like this: "She must be a very special person. I could never work in a place where people go to die." Hospice is a "place," and equating hospice to death, are just two of the misperceptions that hospice care providers and proponents are constantly working to dispel. Providing correct information that hospice is a philosophy of care (not a place) takes on special importance in November because it is National Hospice and Palliative Care month.
Data from 2010 indicates that more than 68% of hospice…
lborkowski | April 27, 2011Last week, Andrew Sullivan noted that a large proportion of healthcare costs are for the last days and hours of patients' lives and made the following proposal:
If everyone aged 40 or over simply made sure we appointed someone to be our power-of-attorney and instructed that person not to prolong our lives by extraordinary measures if we lost consciousness in a long, fatal illness or simply old age, then we'd immediately make a dent in some way on future healthcare costs.
He goes on to note that this would be entirely voluntary, and suggests "an easily reached website that makes such a legal…
lborkowski | August 5, 2010If you haven't already, go read Atul Gawande's New Yorker article "Letting Go." As a surgeon, Gawande knows how doctors tend to death with terminally ill patients, both because of their training and their ordinary human tendencies. As a writer, he knows how to weave together personal stories and explanations into a seamless portrait of our medical system's dysfunctional approach to death. Here's one of his snapshots:
Recently, while seeing a patient in an intensive-care unit at my hospital, I stopped to talk with the critical-care physician on duty, someone I'd known since college. "I'm…
signout | November 14, 2008I've been away from the blog for a while, working on fellowship applications and riding the wave of the ICU. Thank you for your patience, as ever.
As you might remember from my days as an intern, I used to love the ICU. That love is no longer: doing procedures to people whose fate is inevitable isn't as much fun as it used to be, and I feel powerless in the face of a culture that doesn't exactly embrace the avoidance of unnecessary intervention.
This most recent time in the ICU, I worked with an intern who seemed to me less eager than some to take on the burden of her responsibility. About…
signout | September 15, 2007I spent the afternoon today in the office of Dr. Leaky, a neurologist who takes care of people with movement disorders. One of the patients we saw was a man in his late fifties with amytrophic lateral sclerosis (ALS, otherwise known as Lou Gehrig's disease). ALS is a devastating illness that slowly drains muscle strength until a person is unable to feed themselves, bathe themselves, or even breathe for themselves. The course of the illness varies, but affected people usually die of respiratory failure within five years of the diagnosis.
This patient had been seeing Dr. Leaky for a year, ever…
signout | April 2, 2007Not half an hour ago, post-call after an exhausting night in our cardiac care unit, I stopped in at the residency program office to pick up my mail. At the top of the stack was an envelope with a familiar name in the return address--the name of a man I had taken care of while on a general medicine rotation a few weeks ago. Inside was my first thank-you note from a patient, written in a tender, newsy tone by an old man whose diagnosis I can't for the life of me remember.
It comes at a strange time. After my short time on the cardiac care service, I have become more dubious than ever before…
signout | March 8, 2007"I'm a 70-year old basket case," he said.
He was right. He'd been admitted a month before for workup of what was thought to be a relapse of a malignant melanoma--an aggressive cancer. His chart told a story of overwhelming chronic anxiety and depression dominating his adult life and resulting in a near-total inability to care for himself. His mental illness featured prominently in his hospitalization; most mornings, when I scanned his chart, there were notes from the nursing staff about him crying out in the night, and notes from the chaplaincy service about the previous day's existential…
signout | January 28, 2007Back in October, I admitted a patient to the general medicine service with a three-week history of abdominal pain and progressively yellowing eyes. She was a large, pleasant, quiet black woman who was almost always accompanied by her husband, a broad man with laughing eyes and a white beard who wore an old-fashioned train engineer's cap. Her history was suspicious for pancreatic cancer, as was the flurry of radiologic studies and biopsies that followed her admission.
On a Saturday morning shortly before I finished the rotation, I had a long conversation with the patient and her husband.…
signout | January 13, 2007I just finished a rotation in pediatric hematology and oncology, where almost all of the kids I was taking care of had cancer. Most had leukemia or lymphoma with prognoses that were varying degrees of good. A few had other, highly curable solid tumors. Only one kid--a boy I've written about here twice before--had a bad cancer. But boy, was it bad.
His tumor, called a neuroblastoma, is a cancer of the sympathetic nervous system. Its prognosis can vary significantly with the age of the patient it affects and with characteristics of the tumor itself. This boy's problems had started at the age of…
signout | October 28, 2006The other night, I started writing about one of the things I hate about the NICU, which is that no one there talks about death. I didn't finish it, so I didn't post it, thinking I'd get to it the next night.
The following morning, instead of our usual attending rounds, we had a "debriefing," which is basically a meeting of everyone in the NICU involved in the care of a patient who has died. As these things often are, it was a lovely example of the support that people can show for each other at moments when they question their own actions and motives. But beyond that, the session helped me…