End Of Life
I have spent as little time as possible on the staff of hospitals. The interface between doctors and administrators has always seemed to be dominated by petty politics. People are interested in money, and secondary to that, some vague sort of reputation or power.
A large and prestigious Midwestern hospital used to have a certain kind of meeting every few months. This hospital had only the vaguest of University associations — just enough to make it look academic and research oriented. I knew perfectly well it was neither.
It was a luncheon meeting of the medical staff and a few administrative types — uncommonly well-catered. There were about 25 folks, but only two other women who looked as uncomfortable as I was.
The meeting was to discuss certain hospital statistics, including some case details. As the meeting agenda was passed around, the head of the hospital reminded us of the meeting “rules.” We were gently reminded that no recordings were permitted and neither were extraneous notes. We each received an agenda, which were carefully counted out as they were distributed. We were told that at the end of the meeting they would be collected — and counted — before any of us could leave. Read more on Hospital Accountability Is An Ideal (Not Always Reality)…
Recently, a patient’s widow called to cancel a routine assessment because the patient suddenly died. There had been no freak heart attack and it had not been one of those undiagnosed cancers. He just “died, suddenly, in his sleep, I guess,” she said. That got me thinking.
The first class of drugs I think about, when I think of sudden death, are the stimulants. I remember when someone decided that everyone who was going to get stimulants needed to have a “cardiocentric” examination first. Doctors asked a lot of questions about chest pain, and administered an electrocardiogram. These precautions were especially interesting because they were – of course – used before prescribing Ritalin. Many child psychiatrists had laughed at me when I cautioned usage of this job, claiming it was the safest medication ever invented. Once – at the peak of my massive weight — an endocrinologist offered me a prescription of Meridia, to get rid of my excess weight. He did not think the fact that there had been a “few” reports of sudden death should get in the way of my using it. Read more on Sudden Death in Psych Patients — From Medicine…
“Old Marley was as dead as a doornail.”
– A Christmas Carol (1843)
Thank you, Charles Dickens, for creating such a wonderful, enduring story, and such an apt simile. If you hadn’t heard it before, that’s probably because it is usually omitted from the children’s versions of the oft-told (and filmed and broadcast) tale. With everyone from Michael Caine to (my favorite) Mr. Magoo starring as the wickedest man who ever snorted “Bah Humbug!” and was converted to the most ardent celebrant of Christmas by the end of the story.
A wonderful, happy story — and it deserves to live forever. But death is not terribly suitable material with which to start a children’s story.
Young women (and men) — some no older than children and many who could be termed “recent children” — were ardent fans of singer Amy Winehouse — who is now “dead as a doornail.” Read more on Amy Winehouse Proved Drugs Aren’t Glamorous…
She was a young female staffer in her first professional position. What she may have lacked in experience, she made up for with a lot of heart and she extended her maximum effort for every single patient.
I had been like that in the beginning, too. At first, you have no body of knowledge to draw upon, but you quickly learn every time a new patient comes in. With experience, you see it becomes clear patients are more alike than different, and the work is at least a little less onerous.
But our newbie had a very few months experience with this intense clinical situation. So every single patient was new and scary, and she gave her all. One week before she had dealt with one of the most difficult situations.
I had never seen this slightly disheveled 52 year old woman before and she was crying her heart out. Her father had died 24 hours earlier from what she could only call an “all over the place” kind of cancer. His struggle had been long and hard and she thought she had done a good job of preparing herself psychologically. But still, the depth of her grief was pretty immense, so I managed to get her to talk. She said that all her life, she felt she had never been able to please her father, and now she knew she never would. He wanted all kinds of academic achievements and prestigious jobs for her, none of which she got. It simply made her feel like a failure.
Well, even though I am mainly a “pill pushing mama” to the world, I wanted desperately to say something to ease her pain. It would not help much if I told her the truth of what is going on, that she was crying not for dad, but for her own feelings of inadequacy. Read more on Pleasing Daddy — And Failing…
I actually worked in Palmdale, California, once upon a time. I remember my final day on the job, my husband took a photo of me leaving the front door of the county mental health clinic, looking thoroughly jubilant.
Why is this woman smiling? Let’s just say, “Relief.” In all of Los Angeles County it is the place where one can live cheapest. It is the farthest settlement from the metropolis. In fact it’s actually closer to Bakersfield, which is in the next county. Not quite rural, but one of the several patients who had left the congestion of downtown Los Angeles for Palmdale told me that at least you could breathe the air in Palmdale. It was also a place where exchanging sexual favors for rent in a trailer park was not uncommon. It was also a place where local TV pickings were slim enough that I was actually on television. Not as a physician, mind you, but singing the songs of Edith Piaf. In those days before “American Idol” they broadcast from the local karaoke bar on a weekly basis. The night I was there, the special guest star was the fellow who played harmonica on the hit record “Moon River” forty years earlier and had been a bit-part actor in movies such as “The Wild One” with Marlon Brando. He had fallen on hard times – he dressed like a homeless person and used a length of rope as a belt for his pants.
That’s my impression of Palmdale. Read more on Cults Are Still Around, So Watch Out…
Of all the trials and tribulations we can suffer in life, none is so devastating as the loss of a loved one.
Unfortunately, we will all eventually suffer such a great loss and the grief that it brings.
Believe it or not, a properly trained professional can help minimize the grief and help those sufferers to cope. Much of this horrible experience can be truncated, if not removed, by people who know what they are doing.
But it seems that most people don’t believe this, and some people will never learn. Read more on No Need To Suffer Through Grief — Get Help!…
All of this balderdash from opponents of so-called “Obamacare” health care reform about “Death Panels” that will come and put your grandparents to sleep like an injured Chihuahua makes me think about the patients I’ve had to counsel regarding end-of-life issues.
I have a wonderful patient who is still struggling, after many years, with her father. He is, like many men of his era who spent a fair amount of time in the military, the kind of guy who speaks little. He has outlived his wife, which is statistically unlikely, for she was very ill for a very long time. He is tired, just plain tired, of medical interventions. He had a hunk of colon taken out some years ago, and there was something somewhere between normal and cancer on it. Who knows when he tells his daughter. Her confusion is expressed to me through tears.
Most of the times I am involved in “should-we-pull-the-plug” type decisions, it is at the end of life and not the beginning.
A “DNR” or “DO NOT RESUSCITATE” order simply means that if someone has a heart or lungs that cannot work on their own, the decision is made NOT to use artificial heart or lung type machines to prolong life. I have seen people sign their own documents to this effect.
As a matter of fact, I saw a DNR order signed by my father when he was in a nursing home, basically bed-bound, and it was a correct decision.