PALLIATIVE CARE BLOG

PALLIATIVE CARE BLOG

PALLIATIVE CARE BLOG


  • Pulling The Rug- Can it go gently?

    Jul 20, 2021 by Tristen Dinkel, BSN, RN, CPN, CNRN
    39 weeks of a pregnancy in which we were riding the rollercoaster of will she or won’t she... survive. Is she big enough? Did she grow enough lung tissue? Is there too much fluid? The rollercoaster ride took its final drop when I got the call just days before delivery that they have a genetic diagnosis, and we need to come in the office. My husband was at work. As we had been told of all the possibilities from the 20-week mark, I thought was strong enough to hear whatever they could tell me that day on my own. .So I picked up my rug and trekked into my doctor's office.
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  • How Does One Suffer “Gladly” Exactly?

    Jul 13, 2021 by F. Amos Bailey, MD
    I have roots in the Deep South of our country. We are known for our cuisine, hospitality, poverty, racism, pride, arrogance, and ignorance, and… our accents. There is also a great and continuing fount of Southern Literature with many writers I could recommend to you, such as William Faulkner, Maya Angelou, Reynolds Price, and many more.
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  • Happy 4th of July!

    Jul 6, 2021
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  • Breaking Up is Hard to Do: Coping with Organizational Trauma

    Jun 29, 2021 by Melissa C Palmer, LCSW, ACHP-SW, APHSW-C, JD
    Let’s admit it. This past year has been a bear. Between the COVID pandemic, forest fires burning across the West, and political nonsense causing polarization, we are lucky if we have survived relatively unscathed. Healthcare workers are the wounded warriors who keep pushing through and persevering. During 2020, healthcare and other organizations have been battered by the frequent changes made to accommodate the safety and welfare of our patients while making difficult choices about financial resources that impact workers’ daily lives.
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  • Time-Limited Offer/Time-Limited Trial

    Jun 22, 2021 by F. Amos Bailey, MD
    Whenever I hear the term “Time-Limited Trial”, I think for a moment about a Time Limited Offer and the pressure this term suggests making a purchase while supplies last. It always feels a little bit like a shady salesperson pitch.
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  • Dying with Dignity?

    Jun 15, 2021 by Jean Abbott, MD
    Discussion about “aid in dying” (AID) has re-emerged recently with Diane Rehm’s book and documentary on PBS (“When my Time Comes”), and the Katie Engelhart book “Inevitable”. And, just in time, this week an acquaintance called me to ask about a friend who wants “Death with Dignity.” The phrase makes me wince (just as much as “physician assisted suicide”, I think). I liked the more profound discussion of the role of Aid in Dying by Dr. Lonny Shavelson in a recent “lunch conversation” as part of the Completed Life Initiative series. (https://vimeo.com/534607128) Shavelson is Chair of the Board of Directors of the American Clinicians Academy on Medical Aid in Dying. In his presentation, he challenges the false dichotomy between a miserable or a merciful death too often implied by proponents of AID, and their “usurping” of the term “dignity”. As he points out, “dignity” language linked to AID is deceptive and wrong, even if it may be useful to galvanize the public to adopt state laws that allow physicians to write prescriptions for terminally ill patients. There are many paths to dignity as we die, many ways to maintain self-respect, and to move into our death in ways which accept and gracefully face our ending. None are perfect and none is clearly “better.”
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  • Is There Any Value in Advance Care Planning?

    Jun 8, 2021 by Jean Abbott, MD
    I have found the discussions within my community to elicit rich conversations about what matters to people as they approach the end of their lives. Likewise, the ethics consults I am part of are complex and thoughtful. Two contrasting dilemmas are seen pretty regularly. There is the distraught family in the waiting room with little insight into what mom, critical in the ICU, would want as she struggles on a ventilator, near the end of life. There is also the family who holds in their hands documents written 5 years before which say their father would want “everything” done to prolong his life. Sometimes it feels like “I don’t know” versus the “I know too much.”
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  • Finding Peace

    Jun 1, 2021 by Erin Vipler, MD, FACP
    I slowly sipped my coffee as I sat down at the desk and logged in to the computer. It was a Sunday morning and I was on my last day in a long stretch of shifts. It was the middle of winter and the census was heavy, full of patients with respiratory infections, congestive heart failure, the usual. I’ll admit I was planning to round quickly and get home. My family was arriving in town later that day and I still needed to clean the house and buy groceries. I opened the chart of a 33-year-old man admitted overnight and was immediately struck by his diagnosis: acute respiratory failure, history of metastatic lung cancer. And only 33 years old. As I read on, I learned that he was diagnosed 2 months ago when he had a cough that just wouldn’t resolve. At the time of his diagnosis, it had already spread to innumerable additional sites. His prognosis was extremely grim, but he was still doing everything he could to “fight” it – chemotherapy, radiation, a feeding tube.
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  • Living above the line: Creating a sense of Belonging

    May 25, 2021 by Melissa C Palmer, LCSW, ACHP-SW, APHSW-C, JD
    I wanted to share a powerful commencement ceremony speech by my dear friend, Dimple Dhabalia. Dimple reminds me of how I want to strive to live my life every day. Although she is not working in healthcare, her message of choosing to “live above the line” inspires me to be a role model for acceptance and kindness in the world.
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  • Delirium is Deadly

    May 18, 2021 by F. Amos Bailey, MD
    Recently I visited a patient who was recovering from major surgery. She was terrified. Apparently, all night she had thought someone was trying to kill her. She was concerned that the staff might poison her and was reluctant to take her medicine.
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  • Bleeding: Ever Heard of Amicar?

    May 11, 2021 by F. Amos Bailey, MD
    Blood and bleeding are scary and overwhelming. There is a reason that blood features prominently in horror movies. Now imagine that it is you bleeding, or someone you know and love, that you are caring for. The bleeding starts and you are helpless to stop it.
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  • May the Force Be With You

    May 4, 2021 by Nancy Robertson, DNP
    She looked at me incredulously. “What do you mean you use intuition to lead difficult conversations?”, she gasped. Her response pulled me up short. I forgot that I was mentoring a nurse practitioner student who was currently living in the world of academia. She was shoving as many facts, guidelines, and protocols into her head as she could manage. And if she couldn’t immediately recall necessary algorithms, she had apps on her phone she could quickly consult. She had come to learn that decisions to any patient dilemma are found in expert informed, evidence-based guidelines outside of herself.
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  • Survivorship: What Now?

    Apr 27, 2021 by Melissa C Palmer, LCSW, ACHP-SW, APHSW-C, JD
    A clean bill of health. The cancer is gone. Next check up in a year. Your transplant surgery is a success. These are the words all people living with cancer or transplant long to hear. The new goal is getting back to “normal”. The thing is, most of the time, returning to the way things were before diagnosis is not an option. After the initial euphoria of realizing “I beat cancer!” or “I got the transplant!”, survivors have to re-learn how to live and adapt to the fantastic and not so great aspects of life after a serious illness.
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  • Pediatric Palliative Care for the Uninitiated

    Apr 20, 2021 by Michelle Moon, DO
    If a child has a lifespan limiting condition, treatment options diminish over time and life gets even more complicated. Sometimes, parents have to make what seems like impossible decisions. The answers can usually be found by following the child’s lead -- but what does this mean?
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  • Pediatric Palliative Care for the Uninitiated

    Apr 13, 2021 by Michelle Moon, DO
    Eighty percent of children receiving palliative care depend on some sort of medical technology, so one major role of pediatric palliative care providers is to help guide decisions around these devices. To do this, it’s important to know the real-life implications of devices like feeding tubes and tracheostomy. This video explores this, and some of the things that influence parents’ decisions.
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  • Pediatric Palliative Care for the Uninitiated

    Apr 6, 2021 by Michelle Moon, DO
    Minimizing regret is one of the holy grails of parenting a child with a lifespan limiting illness. We need to know that we’ve been the best parent possible – but what does that mean?
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  • Pediatric Palliative Care for the Uninitiated

    Mar 30, 2021 by Michelle Moon, DO
    During my daughter’s hospitalizations for respiratory failure, her heart rate was routinely in the 120’s and 130’s. Her medical team told me that it was an indication of how sick she was, and that the heart rate itself did not need to be treated. They had to remind me of this again and again, because the non-pediatrician in me wanted to push beta blockers.
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  • Pediatric Palliative Care for the Uninitiated

    Mar 23, 2021 by Michelle Moon, DO
    It is the rare -- like, unicorn rare -- physician who feels completely comfortable with both pediatric and adult medicine. Most of us figure out early on which camp we’re in and have no need (or desire) to cross over.
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  • Palliative Care and Trauma-Informed Care

    Mar 16, 2021 by Melissa C Palmer, LCSW, ACHP-SW, APHSW-C, JD
    Traumatic events affect us on a psychological and physical, cellular level. During widespread disasters like the pandemic, patients and healthcare providers cope best when they have interventions based on both crisis and ongoing psychosocial needs. Palliative care community specialists are primed to be able to provide the type of transdisciplinary interventions that are closely aligned to trauma-informed care.
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  • Most of the Developing World Cannot Purchase/Afford COVID-19 vaccinations

    Mar 9, 2021 by F. Amos Bailey, MD
    This situation is: Unjust and unwise A Global Vaccination Plan Possible​ Two pokes or one jab Protects me and you and you From COVID’s dread​
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