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more on Hope a very moving article is in this Sunday’s NYTimes- How Cancer Changes Hope It’s written by Kate Bowler, who was recently diagnosed with metastatic cancer.  She is 35 yrs old. Most apropos to this blog is this paragraph: “I was confident that hope had its uses, but I began to think ofRead more

When talking with patients/families about end of life issues, there’s a BIG difference between talking about some future eventuality versus discussing that same outcome when it has now turned into reality. And our friend HOPE, has a lot to do with it. a Patient Mr B is 67 yrs old with multiple co-morbidities including heart failure,Read more

One of the most challenging conversations providers can have with patients/families, revolves around making decisions when none of the options are particularly good.  And when the patient/family says:  “we will do whatever the doctor thinks is best”– that is a challenge. How does that jive with ‘shared decision making’? And how can a doctor even determineRead more

Palliative care support is not just for patients with incurable disease.  But too many providers, patients, and the general population conflate a referral to palliative medicine with impending death. And because of this, patients are often not referred to us until or unless they are imminently dying. This frustrates the palliative medicine community because ofRead more

a Patient Baby girl G was born 4 weeks premature with severe brain anomalies.  Prenatal testing had alerted her doctors and her parents to this reality, and her parents were counseled that she would likely die soon after her birth.  They were devastated, but their strong religious beliefs kept them hoping for a miracle.  ImmediatelyRead more

sometimes recognition does come to those who are the most deserving. During my time as a reconstructive surgeon, I had the privilege of taking my skills to rural areas around the world and serve people with limited access to health care services.  The Democratic Republic of Congo was one of the places I worked.  AndRead more

But first, you must understand what it is you are asking I’ve written several posts about the importance of discussions centering on how a patient wants to live during the time they have left (the ‘goals’ discussion) rather than concentrating on what they want when they are dying (the ‘code status’ conversation).  But for practical purposes,Read more

In my most recent posts, I’ve stressed that providers need to remain cognizant of the fact that conversations about shifting code status to DNaR, or transitioning to comfort focused care, are essentially asking patients/families to say it’s ok for them or their loved one to die. And that can be too much for people. So,Read more

Continuing the theme from the last post… a Patient Mr G, 63 yr old, has a long history of ischemic heart disease.  Unfortunately, due to Mr G’s coronary artery anatomy, neither coronary artery stenting or bypass surgery offered potential benefit, so medical management was his only treatment option.   As expected with this condition, he hasRead more

It can be challenging caring for patients with serious illnesses. Health care providers typically think of themselves as ‘fixers’, so when a patient has an illness that can no longer be ‘fixed’, it can cause distress.  I’ve seen very caring providers become frustrated by patients/families that continue to ‘want everything’, when from the provider’s perspectiveRead more