Tag Archives: end-of-life

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Stephanie Hinton is a medical student in the Class of 2019 at Queen's University

 

It’s August 17th. My grandmother died today. She never made it to palliative care. Instead, she was kept in the corner of a hospital room surrounded by empty walls and a window looking out over a parking lot. She was confined to her bed, barely conscious, and at the mercy of those with little experience in end-of-life care because she had not quite been deemed “palliative.” I sat by her bedside for 12 hours a day, 3 days in a row, leaving only to sleep. I watched her grimace in pain and counted down the hours to the next dose of pain medication. It would finally come — four hours late and barely offering the relief she was looking for. We waited for a doctor to come check on her and answer our questions. We were told they didn’t know where the doctor was or when the doctor was coming, or — my personal favourite — “Doctor’s don’t need to keep you informed of every care decision.”

She had been refused IV hydration and kept NPO, and her vitals were never checked. When they were finally checked, she was saturating dangerously below 90%. On August 17th at 8:00 am, we received a call telling us she would be moved to palliative care. At 8:15 am, we got a call telling us she had died. She was alone. We had been given empty promises the night before that she “might pull through,” and we were unable to stay the night. We were given the “privilege” of seeing her 45 minutes after she had passed, the “privilege” of calling family members to ask them if they would like to come and say their final goodbyes. We had the “privilege” of sitting by her bedside and waiting for family to arrive long after she had transitioned between life and death, doctors and nurses nowhere in sight to offer the support we desperately needed. We sat with a dreadful feeling, wondering how we could have better advocated for her and knowing she was not given the dignified death she deserved. This feeling would linger and creep up months after her death. ...continue reading

Serena Arora is a medical student in the Class of 2019 at McMaster University

 

I love puzzles.

I love looking at the picture on the box, seeing what the completed version will look like and then pouring out all the little pieces — knowing that, somehow, they all come together to create something.

In some ways, practicing medicine is like doing a puzzle. It’s complex, intersecting, and incredibly rewarding when done right. At the same time, medicine is fractured into a thousand different components.  As physicians, we look at our patients and we piece them apart into organs and body systems and tissues. We rip the details we think are important from the fabric of their narrative to focus on specific complaints. We take their words and distill them into our jargon, often so much so that their original story would be unrecognizable. Medicine is often an act of reductionism.

If medicine is a puzzle, then palliative care is like the picture on the box. ...continue reading

Beatrice Preti is an Internal Medicine Resident (R2) at Queen's University

 

 

 

The list is long, but I know your name
Each day before, its spot was the same
Second from the top, the second room on the right
The one with three windows and a broken bathroom light

But today something’s different; the list I have’s bare
I looked for your name, but it wasn’t there
Something has happened, and, in my heart, I know
That though I fought to keep you here, you found a way to go ...continue reading

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 is a medical student in the Class of 2018 at the University of Alberta

 

In healthcare, we sometimes hear the saying, “I went home thinking about that patient.” I thought I knew what this meant until I met Winnie.

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It was a foggy Tuesday and the humidity hung thick in the air. On my first day as an elective student in Palliative Care, I was apprehensive as I exited the elevator onto the hospital unit where I would be spending the next two weeks. Soon after my orientation, I was asked to go meet my first patient. Winnie came to us with pain and shortness of breath due to an advanced lung cancer. We worried that Winnie’s hospital bed would become her death bed. ...continue reading

, MD, CMD serves as the medical director and an Associate Professor for the Division of Aging, in the Department of Family Medicine for the Carolinas Healthcare System, Charlotte, North Carolina

 

The (IOM), a non-profit institution which provides objective analysis and recommendations to address problems related to medical care in the United States, issued the 2014 report . The IOM report proposed changes to U.S. policy and payment systems to increase access to palliative care services, improve quality of care, and improve patient and family satisfaction with care at the end of life.

The release of the IOM report was regarded by many U.S. healthcare professionals as a significant step forward in identifying gaps in the delivery of care for seriously ill and terminally ill patients. Specific recommendations were outlined as a “call to action” to improve end-of-life care. Hospice and palliative care physicians, in particular, . ...continue reading

Marianne Dees is a family physician and academic researcher at Radboud University Medical Centre in the Netherlands

 

Let's take a look at .

The case of Mr. Jones

Mr. Jones, aged 88, was referred to the hospital for the fourth time that year with dyspnoea. He was diagnosed with pneumonia. His medical history mentioned myocardial infarction, chronic heart failure, and a pacemaker. Two years earlier he had made a written will with a non-resuscitation and non-intensive care statement. The next day he became progressively dyspnoeic and developed kidney failure. He was transferred to the ICU ...continue reading

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is a news journalist for the CMAJ

I found out my grandpa had a stroke on Thursday night. He was doing work in the backyard where he collapsed; my nanny found him 40 minutes later and called an ambulance. Too much time had passed. This was his second stroke, the first occurred 10 years ago just moments before he was due to depart on a cruise ship to Alaska. Emergency crews attended to him right away and his recovery was almost seamless.

This time it was different. My family told me to stay put in Ottawa for the night, but in the morning my brother called and told me I should come right away. It took about four and a half hours to reach the hospital in Mississauga where my grandpa, who I affectionately named Pa as a toddler, lay with tubes and patches attached to his body. When my mum told Pa that I had arrived, he opened his steel blue eyes for a moment with a look mixed with confusion and – I hoped – even acknowledgement. Then his eyes shut, and I never saw them again.

...continue reading

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is Deputy Editor at CMAJ

 

Today is a momentous day for physicians in Canada. No matter what your opinion about whether or not physician assisted dying is morally right, it will be a human right henceforth under certain circumstances.

We have aired a broad spectrum of views on this forum in the lead up to the Supreme Court of Canada’s , released this morning. Even CMAJ’s editors are divided in their personal opinions. We have discussed our personal views in many an editorial meeting, and CMAJ’s Editor-In-Chief, John Fletcher, put me on the spot to declare my position publicly when we were recording the of the journal.

Many Canadian physicians will feel unhappy about the decision, perhaps even angry ...continue reading

The December 9th issue summary podcast is presented by Dr. John Fletcher, editor-in-chief, and Dr. Diane Kelsall, deputy editor.

Dr. John Fletcher, editor-in-chief, CMAJ

Dr. Diane Kelsall, deputy editor, CMAJ

 

 

 

 

 

 

Dr. Fletcher and Dr. Kelsall discuss the following topics:

  • What matters to patients and their families in end-of-life discussions
  • Ibuprofen versus morphine for post-fracture pain in children
  • How to engage in deprescribing meds
  • Adverse health effects of solitary confinement
  • Importance of head-tilt chin-lift in CPR
  • Pap smears
  • Diagnosis in progressive headache
  • Holiday Reading highlights

And more....

...continue reading