#Palliative medicine

[palliativepoetry]

All the world's a stage

By William Shakespeare

(from As You Like It, spoken by Jaques)

                                      All the world’s a stage,

And all the men and women merely players;

They have their exits and their entrances;

And one man in his time plays many parts,

His acts being seven ages. At first the infant,

Mewling and puking in the nurse’s arms;

And then the whining school-boy, with his satchel

And shining morning face, creeping like snail

Unwillingly to school. And then the lover,

Sighing like furnace, with a woeful ballad

Made to his mistress’ eyebrow. Then a soldier,

Full of strange oaths, and bearded like the pard,

Jealous in honour, sudden and quick in quarrel,

Seeking the bubble reputation

Even in the cannon’s mouth. And then the justice,

In fair round belly with good capon lin’d,

With eyes severe and beard of formal cut,

Full of wise saws and modern instances;

And so he plays his part. The sixth age shifts

Into the lean and slipper’d pantaloon,

With spectacles on nose and pouch on side;

His youthful hose, well sav’d, a world too wide

For his shrunk shank; and his big manly voice,

Turning again toward childish treble, pipes

And whistles in his sound. Last scene of all,

That ends this strange eventful history,

Is second childishness and mere oblivion;

Sans teeth, sans eyes, sans taste, sans everything.

[dreamy-conceit]

When you get sicker, it's clear to us that your time is getting short. What do you want that time to look like? Would you be willing to risk spending your very last days hooked up to machines to buy you a bit more time? Or would you like to prioritise peace and comfort while your illness runs its natural course? Because with a serious illness, CPR won't change if you die, but it can change how you die.

— Matthew Tyler, MD, 'How I talk to patients about CPR' (TikTok, 11 October 2024).

Dr Tyler is board certified in internal medicine and hospice & palliative medicine, and runs How To Train Your Doctor.

[stemlyns]

Podcast - Paediatric Palliative Care in the ED

This post accompanies the podcast 'Paediatric Palliative Care' recorded live at the Premier Conference 2024. Learn how you can best help children with life limiting illness and their families if they need your care in the Emergency Department.

Working in the emergency department (ED) is always challenging, but caring for children with life-limiting conditions adds an extra layer of complexity and emotion. In this podcast, Dr Timothy Warlow, a consultant in Paediatric Palliative Medicine at University Hospitals Southampton & Naomi House & Jacksplace Hospices, shares some top tips for how we can best care for these children and their…

[balajihospital]

Balaji Hospital | Radiology Specialists for Imaging Services

Balaji Hospital's Radiologist providing advanced imaging services for accurate diagnosis & treatment planning, utilizing advanced technology & techniques

[nerdgirlnarrates]

Recently I was talking to another med student and shared that before my grandmother died, her heart failure had gotten so bad that her doctors couldn’t effectively diurese her and she ended up needing several thoracenteses. The other med student suggested that these procedures were too aggressive and my grandmother’s doctors should have let her die instead. And I’m confused, because these procedures were very much palliative in nature: it is painful to have a pleural effusion preventing you from breathing well. She needed surgery to address the valve issues causing her heart failure, but she was not a good candidate for surgery, so she had already foregone curative measures. Also, my grandmother did not want to die of a pleural effusion. I’m not saying her quality of life was good--it wasn’t--but she didn’t want to essentially drown to death. And I’m kind of upset at the notion that her doctors should have forced her to die that way. That’s not humanity, peace, or dignity in death. Maybe I’m misunderstanding something, but the conversation has left me unhappy.

[grendelsmom]

Doing research for hours without a break isn't good for me. My mind is so mushy that I just spend five minutes completely in awe of the word Implementationsempfehlungen before I remembered that that's just a basic compound noun

[somuchtostudysolittletime]

23/7/23 // 12.37

Some quick pretty diagrams about vomiting before I go off to camp. Very excited for a few days away but not excited for how tired I will be by the end of it!

[quilavastudy]

Still thinking about that time I went to the city council to give my notice of marriage, and the registrar looked through my details and said 'oh! I recognise your name from death certificates!' 💀

[meggettes]

my mom died a year ago

[girlhorse]

I dont hate these clients theyre usually nice but i do get frustrated when it seems they dont really understand that their animals are BAD about being handled. lol

[intrainingdoc]

New on in-House, a captivating piece exploring the interconnectivity of dance and non-verbal communication in the ICU. The piece is authored by The Aseemkala Initiative - a group of brilliant activists presenting diverse dance-based narrative medicine.

https://in-housestaff.org/chinnamastas-do-not-resuscitate-order-using-classical-indian-dance-to-improve-intensive-care-unit-non-verbal-communication-2057

[palliativepoetry]

I hope death is like

being carried to your bedroom

when you were a child

& fell asleep on the couch

during a family party.

I hope you can hear the laughter

from the next room

[howling-medic]

If your doctor, in almost any setting hasn’t asked you for your goal with your care, then tell them without prompting. They should ask, but everyone gets in a hurry (it’s not an excuse, just a very unfortunate reality) with the case load every specialty in every setting is balancing - in patient & out patient, ER to primary care to cardiology to oncology to nephrology and every else in between. They’re human. They forget. The good ones anyways. The bad ones, and there are bad doctors in every specialty, don’t care.

Advocate for yourself. Call healthcare professionals out. Don’t get steamrolled. Don’t get pressured into doing things you don’t want.

A doctor discovers an important question patients should be asked

This patient isn’t usually mine, but today I’m covering for my partner in our family-practice office, so he has been slipped into my schedule.

Reading his chart, I have an ominous feeling that this visit won’t be simple.

A tall, lanky man with an air of quiet dignity, he is 88. His legs are swollen, and merely talking makes him short of breath.

He suffers from both congestive heart failure and renal failure. It’s a medical Catch-22: When one condition is treated and gets better, the other condition gets worse. His past year has been an endless cycle of medication adjustments carried out by dueling specialists and punctuated by emergency-room visits and hospitalizations.

Hemodialysis would break the medical stalemate, but my patient flatly refuses it. Given his frail health, and the discomfort and inconvenience involved, I can’t blame him.

Now his cardiologist has referred him back to us, his primary-care providers. Why send him here and not to the ER? I wonder fleetingly.

With us is his daughter, who has driven from Philadelphia, an hour away. She seems dutiful but wary, awaiting the clinical wisdom of yet another doctor.

After 30 years of practice, I know that I can’t possibly solve this man’s medical conundrum.

A cardiologist and a nephrologist haven’t been able to help him, I reflect,so how can I? I’m a family doctor, not a magician. I can send him back to the ER, and they’ll admit him to the hospital. But that will just continue the cycle… .

Still, my first instinct is to do something to improve the functioning of his heart and kidneys. I start mulling over the possibilities, knowing all the while that it’s useless to try.

Then I remember a visiting palliative-care physician’s words about caring for the fragile elderly: “We forget to ask patients what they want from their care. What are their goals?”

I pause, then look this frail, dignified man in the eye.

“What are your goals for your care?” I ask. “How can I help you?”

The patient’s desire

My intuition tells me that he, like many patients in their 80s, harbors a fund of hard-won wisdom.

He won’t ask me to fix his kidneys or his heart, I think. He’ll say something noble and poignant: “I’d like to see my great-granddaughter get married next spring,” or “Help me to live long enough so that my wife and I can celebrate our 60th wedding anniversary.”

His daughter, looking tense, also faces her father and waits.

“I would like to be able to walk without falling,” he says. “Falling is horrible.”

This catches me off guard.

That’s all?

But it makes perfect sense. With challenging medical conditions commanding his caregivers’ attention, something as simple as walking is easily overlooked.

A wonderful geriatric nurse practitioner’s words come to mind: “Our goal for younger people is to help them live long and healthy lives; our goal for older patients should be to maximize their function.”

Suddenly I feel that I may be able to help, after all.

“We can order physical therapy — and there’s no need to admit you to the hospital for that,” I suggest, unsure of how this will go over.

He smiles. His daughter sighs with relief.

“He really wants to stay at home,” she says matter-of-factly.

As new as our doctor-patient relationship is, I feel emboldened to tackle the big, unspoken question looming over us.

“I know that you’ve decided against dialysis, and I can understand your decision,” I say. “And with your heart failure getting worse, your health is unlikely to improve.”

He nods.

“We have services designed to help keep you comfortable for whatever time you have left,” I venture. “And you could stay at home.”

Again, his daughter looks relieved. And he seems … well … surprisingly fine with the plan.

I call our hospice service, arranging for a nurse to visit him later today to set up physical therapy and to begin plans to help him to stay comfortable — at home.

Back home

Although I never see him again, over the next few months I sign the order forms faxed by his hospice nurses. I speak once with his granddaughter. It’s somewhat hard on his wife to have him die at home, she says, but he’s adamant that he wants to stay there.

A faxed request for sublingual morphine (used in the terminal stages of dying) prompts me to call to check up on him.

The nurse confirms that he is near death.

I feel a twinge of misgiving: Is his family happy with the process that I set in place? Does our one brief encounter qualify me to be his primary-care provider? Should I visit them all at home?

Two days later, and two months after we first met, I fill out his death certificate.

Looking back, I reflect: He didn’t go back to the hospital, he had no more falls, and he died at home, which is what he wanted. But I wonder if his wife felt the same.

Several months later, a new name appears on my patient schedule: It’s his wife.

“My family all thought I should see you,” she explains.

She, too, is in her late 80s and frail, but independent and mentally sharp. Yes, she is grieving the loss of her husband, and she’s lost some weight. No, she isn’t depressed. Her husband died peacefully at home, and it felt like the right thing for everyone.

“He liked you,” she says.

She’s suffering from fatigue and anemia. About a year ago, a hematologist diagnosed her with myelodysplasia (a bone marrow failure, often terminal). But six months back, she stopped going for medical care.

I ask why.

“They were just doing more and more tests,” she says. “And I wasn’t getting any better.”

Now I know what to do. I look her in the eye and ask:

“What are your goals for your care, and how can I help you?”

-Mitch Kaminski

Source

[balajihospital]

Balaji Hospital | Specialized Care Infectious Disease Experts

Balaji Hospital's Infectious Disease Specialist showcases specialized physicians managing & treating various infectious diseases using diagnostic techniques

[pwrn51]

Palliative Care Insights from Dr. Jared Rubenstein

  Today’s guest is Dr. Jared Rubenstein, a Pediatric Palliative Care Physician and Medical Educator at Baylor College of Medicine and Texas Children’s Hospital in Houston, Texas. In this insightful interview, Dr. Rubenstein shares how he became interested in Palliative Care, explaining what it involves and addressing the biases that exist toward it, even among medical professionals. As a…

[tjerra14]

bad news week evidently isn't over yet, my mother's dog likely has cancer, it turns out