While rounding in the hospital, I met Joel. Joel had a complicated illness that required a prolonged period of time on mechanical ventilation which had led to him living with a trach – you know, that tube coming out of his throat that is used to hook to the breathing machine.
Jennifer Temel’s article in the NEJM was published 9 years ago and has now been cited in over 5000 subsequent articles. Temel and colleagues reported the findings of their rather simply designed Randomized Control Trial (RCT) of palliative care for Stage IV Non-Small Cell Lung Cancer. 150 people referred were randomly assigned to a Palliative Care (PC) consult or could have a PRN referral if the patient/family or provider desired.
Why do people who are enrolled in home hospice go to the Emergency Room or hospital? This is a question that I have thought about for a long time. Home hospice is a great service that can help most people at EOL stay at home if that is their preference. But…
Ms. Griffiths was the doyen of her local Methodist Church. Always a smile, a compliment, asking after family, a basket with freshly baked bread. Today I hardly recognized her. Her hair was dirty and uncombed, the bed was unmade and she was crying out when the nurse tried to help her; she was terrified. This was delirium, again. We were having a run with this being the third case this week.
Have you read Sam Shem’s The House of God? I am not sure I would recommend it but…. you should know about this book. Many hospitals were started by and are still supported by religious communities so I recognized the reference. After all, the charity hospital in New Orleans was locally known as Hotel-Dieu, House of God.
The University of Colorado School of Medicine has been approved to begin offering a first-in-the-nation non-residential fellowship program as a way to meet the need for trained physician specialists in hospice and palliative medicine.
I am extremely grateful that I chose to do the Hospice/Palliative Care rotation. Throughout this month, I have learned much more than I anticipated, and it definitely wasn’t all about medicine. I learned more about families, how crucial the moment of the deliverance of bad news is, how much pain can affect a patient’s experience, and how difficult discussions surrounding death and dying are than I did about specific aspects of medicine.
I just heard that a dear friend was diagnosed with cancer. We had dinner together less than 2 months ago and now he was in the hospital, having surgery followed by chemotherapy. I am shocked and can’t imagine how my friend is feeling.
Last week another person with chronic Hepatitis C and hepatocellular carcinoma was seen by the Palliative Care team. There was a lot of discussion of new treatments, such as tumor infusion therapy, surgery if it got smaller….. a new chemo trial? There was also much sadness, regret, stigma and grief.
Jessica Zitter has gotten to be one of my favorite end-of-life writers. Watch her great video called “Extreme Measures”! She also writes some New York Times essays that I use in our Palliative Care program. She wrestles with issues of justice and the use of technology at the end of life – since she faces such ethical dilemmas daily in her dual roles as a Critical Care doc and palliative care specialist. In June she wrote an essay called “The Never-Ending Mistreatment of Black Patients.” She asks the uncomfortable question: At the end of life, do African-Americans get too much medical care?
As a healthcare provider I am asked to weigh in on pain management by both patients and family members. Usually it is to treat a bad sprain or other recreational injury from hiking, skiing or some other fun Colorado outdoor sport. Or it could be because of some surgery, maybe to repair an injury.
I am of two minds. As a hospice doctor I visited a lot of people at home. I loved making home visits! The familiar smells of home cooking, the loved but “eclectic” collections of furniture that did not have to be pre-distressed because it was distressed. The home environment wrapping a dying person into the fold of every day family life. But I also grew up poor and know what inadequate housing looks like; what living on the edge means on a daily survival basis.
“The Warden wants to talk with you!” I don’t get a phone call from the Warden of the Penitentiary very often. “What could this possibly be about?” I picked up the phone.
“I get to decide if a prisoner has a DNR order – not you.” A cold, low voice announced.
My church recently celebrated the nonagenarians within the congregation—lovingly deemed the VIPs, Very Inspiring Persons—and I was amazed to learn that we have twenty members ninety years old and above! They were each asked to stand while one of the ministers shared brief excerpts from their life stories. I recognized several of them from their involvements around the church, and had no idea that they had reached the esteemed status of nonagenarian.
For more than twenty years I had in late winter or early spring read and re-read a collection of Walt Whitman poems. A few years ago, we moved to Colorado, and I couldn’t find my copy. I thought it had been lost on our way and hoped that whoever might find it would read and be moved by the words of this great lyric poet.
Food….there is so much food in our society but many don’t have enough. Hangrey , the smash up of hungry and angry. The idea being that we often get grumpy and angry when we don’t have enough food to eat. Unlike the commercial this is featured in I would recommend some fruit instead of a candy bar.
I just completed a week on the inpatient palliative care consult service. Here at University of Colorado, like any medical center, we see lots of people living with serious illness. Still, at least 75% of the patients I saw last week are still on a Statin?! When I asked their primary teams they pointed out they were following the guideline.