MD Anderson Cancer Center has changed its branding to scratch the word Cancer out of their name.
I don’t begrudge them. They have done amazing work as have many others with developing treatments for cancers that once routinely killed. However, Cancer still Sucks and will lurk in almost all of our lives as either someone living with cancer or a family or friend with the disease.
I had been seeing Tricia for about a year. She had been referred to me for ITP, Immune Thrombocytopenia, (a low platelet count) back in the mid-1990’s. In the history I elicited that she was sexually active and had unprotected sex with several partners over the last few years. Her platelets were low but not dangerously so. I recommended no immediate treatment but rather that we should do some workup. That included an HIV test.
I was able to visit Cuba just after this country opened its borders to the United States in 2016. I remember being so excited about not the typical things many Americans would be — smoking cigars or drinking mojitos — but rather being able to have a first-hand introduction to one of the best healthcare delivery systems in the world. I’m was not traveling alone. On this journey, I have the honor of traveling with six other adventurous women led by Dr. Joan O’Connell, Health Economist and Professor at the School of Public Health.
I’m jealous! All around me I hear people speaking in different languages. They graciously switch to English but I wish I spoke another language fluently. My Spanish allows me to greet someone, ask if they have pain and what number it is, but that is about it. I commit to improve my Spanish but really never make progress.
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.