End of Life Care

“Why I Hope to Die at 75”

  Zeke Emanuel, well known oncologist, policy wonk, and eldest brother of Rahm (Mayor of Chicago) and Ari (Hollywood powerbroker), always has a way of garnering attention. Published in the latest The Atlantic, Zeke pens a very provocative piece on when he plans on calling it a day.  In his case, age 75.   (more…)

You think you know what predictive analytics means, huh?

  This month's Health Affairs dedicates itself to the subject of big data, a term in the news quite a bit these days.  If you think you know what big data implies, mainly dredging data sets to build the clinical decision support in your EMRs, you would be incorrect. We are talking much, much bigger. One article grabbed my attention, whose lead author practices both law and bioethics.  The piece delves into how information requires handling--legally, medically, entrepreneurially, and ethically.  I got way more out of reading the citation than I thought. To whet your appetite, think about the quote below: (more…)

Do You Want Us to Do Everything, Or…

“One more question:  do you want us to do everything, or do you just want palliative care.”  The first syllable of the word “palliative” emphasized, drawn out, left hanging.  This is one version of the five-second, halfhearted code status discussion for seriously ill patients being admitted to the hospital with either a new disease or an exacerbation of an existing one.  We all have phrases that grate on our nerves, and this is one of mine. There are similar statements that are not much better.  “Well, we’ve done all we can, how about palliative care?”  Or, “You know, I think it’s time to go the palliative route.”  These are sometimes said as providers are backing out the door, mentally and physically disengaging from their patients. We have a problem in our culture with discussions about end-of-life and advanced care planning.  Politicians and pundits use distrust of the healthcare system to…

Good Enough

I read with avid interest the recent  Saturday essay in the Wall Street Journal (9/6/13) where Katy Butler eloquently describes her mother's decision to forgo a valve replacement surgery, electing instead, at 83, to live with the real possibility of her death, though perhaps earlier than her cardiologist would have liked.  She chose a natural death that per her daughter Katy was one that was imperfect yes, but also "good enough."  It really made me think about the cultural sea change going on within our hospitals.  I walk by patients' rooms, I look in and often see a wasted temple, a frail and elderly patient, a skinny leg, alone and awaiting the next transition, often to rehab or a nursing home; rarely to home, to an envelope of love, comfort and care, and to the waiting arms of natural death. My own experiences with natural death have been wholly positive.  My…