Saturday, March 28, 2015

Learning to Say No to Dialysis


Paula Span has written a thoughtful and important Op-Ed piece on dialysis in the elderly for The New Old Age series in the NY Time (March 30, 2015).


Image from NY Times article
People over age 75 are the fastest-growing segment of patients on dialysis, and the treatment’s benefits and drawbacks add up differently for them than for younger patients. A growing number of nephrologists and researchers are pushing for more educated and deliberative decision making when seniors contemplate dialysis.

It is a choice, they say, not an imperative.  “Patients are not adequately informed about the burdens. All they’re told is, ‘You have to go on dialysis or you’ll die,’ ” said Dr. Alvin H. Moss, a nephrologist at West Virginia University School of Medicine and chairman of the Coalition for Supportive Care of Kidney Patients. “Nobody tells them, ‘You could have up to two years without the treatment, without the discomfort, with greater independence.’ ”

To weigh the pros and cons, however, kidney disease patients need better information. Among 99 patients at dialysis centers in North Carolina, for instance, two-thirds told researchers their doctors had not mentioned the treatment’s risks or burdens. The same proportion said they felt they had no choice.


Editor's Note:  This is a choice for patients, not a mandate.  I have an 86 year-old patient who has been on hemodialysis for three years.  He is the main caregiver for his 83 year old wife who has mild dementia.  Dialysis allows them to keep living independently.

Wednesday, March 25, 2015

Bearing Witness

by Jo McElroy Senecal is a moving essay that appeared in the NY Times "The End" series.  Ms. Senecal worked for the Big Apple Circus Clown Care Program.

It’s sacred business, watching on the periphery as someone is dying, knowing that person may soon find answers I can only dream about. Being in that room is about being inches away from someone’s intensely personal, unique, painful, awful, scary, gorgeous scenery. Just being there without judgment or agenda; just being there with a shocking amount of love and compassion...

Whether a newborn, a toddler or teenager, a middle-aged or thoroughly wrinkled soul, when they are too sick to get out of bed and their breath is ragged and their hands are starting to curl into their palms, they are the sacred vulnerable and it is up to the ones standing to take good care.

This is a touching piece, it comes from the heart.  Read "Bearing Witness."
Bride at father's death bed




Monday, March 23, 2015

Stigma Around Doctor-Assisted Suicide Still Lingers


March 22, 2015

In the realms of politics, medical ethics, religion and technological innovation, assisted suicide is the source of challenging legal and moral questions, perhaps none more searing than whether doctors ought to be permitted to usher incurably ill patients into that next room. Should they be able to help sufferers end their lives by supplying medication that would make looming death come faster?

Five states, in various forms, countenance doctor-assisted dying. Others are considering it. In California, legislation to permit such assistance is scheduled to receive a hearing this week. A lawsuit in New York that seeks a similar result was filed in State Supreme Court last month by a group of doctors and dying patients.

The emotional wallop of these issues is self-evident, and it is captured in a 14 minute NY Times video documentary.

Continue reading: Stigma Around Doctor-Assisted Suicide Lingers.  Video link is on this site.


Thursday, March 19, 2015

As I Lay Dying


The Atlantic, April 2015

Two doctors say it’s far too hard for terminal patients to donate their organs.  This is a thoughtful article about organ transplantation. “When organ donation works, families view it as a positive end to a tragedy,” but our regulations do not facilitate the process.  As I Lay Dying, written by two transplant surgeons from the University of Wisconsin, gives many  insights.

The End


The End [is a series of occasional articles in the NY Times that] features essays by people who work in fields dealing with death and dying, like medicine, ethics and religion, as well as personal essays by those who have experienced the death of a loved one.”  Many of these pieces are moving and important.

A Pioneer for Death With Dignity


Barbara Coombs Lee is the president of Compassion and Choices, the leading nonprofit organization committed to helping everyone have the best death possible.  In a March 18th, NT Times 2015 essay, she writes about Frank Roberts, “A Pioneer for Death With Dignity:”

More than two decades before Brittany Maynard’s public advocacy for death with dignity inspired lawmakers in Washington, D.C., and at least 16 states to introduce legislation authorizing the medical practice of aid in dying for the terminally ill, Senator Frank Roberts of Oregon sponsored one of the nation’s first death-with-dignity bills.

Had he lived longer, Frank might have been able to benefit from Oregon’s becoming a state that allowed death with dignity. But he died too soon.
 
photo from the Times article

Monday, March 16, 2015

The Trouble Wiith Advanced Directives

This very useful article is worth reading closely.  Paula Span is one of the most lucid and important writers about aging.  She is a regular contributor to "The New Old Age Blog."

NY Times, March 17, 2015 Trouble With Advanced Directives, by Paula Span


"People who aren’t sick or frail, but have strong feelings about what should happen when they are, can’t rely on a POLST or an advance directive alone.

"What they really need, experts say, is an ongoing series of conversations with the relatives or friends who will direct their care when they no longer can. In a crisis, doctors will turn to those people — more than to any document — to learn what the patient wants.

Sunday, March 8, 2015

About My Mother

Marla Kissing Mommy
Yesterday was the anniversary of my mom's death. On that day back in 2006, in the afternoon, my mom took her last breath, in her own bed, just as she had wanted, just as it should be. She was diagnosed with Acute Myeloid Leukemia one year after my dad died. It was terminal.

I remember when I went to say the mourner's prayer for 11 months at synagogue. I met so many people in the same situation. They were of great comfort to me. This daily prayer and those people there helped me get out of bed every morning. It was there that I met one of my now dearest friends, out of my tragedy...

Here is page with a link to the whole essay.

Saturday, March 7, 2015

Their Dying Wishes

by Ann Neumann:
I met Mr. C. because he was dying and his wife needed someone to sit with him Saturday nights while she attended Mass. I was a relatively new hospice volunteer, not long out of training, and Mr. C. was my first assignment with a patient at home, rather than in a hospital or health care facility...

Their Dying Wishes is a moving piece by a hospice volunteer.  It's part of a series in the NY Times called "The End" that "features essays by people who work in fields dealing with death and dying, like medicine, ethics and religion, as well as personal essays by those who have experienced the death of a loved one."

Sunday, March 1, 2015

Finding Joy in My Father’s Death


Image from Times essay
Ann Patchett’s essay about her father’s last years and his death from a Parkinsons-like disorder is honest, moving and helpful. It reminds me in some ways of Katy Butler's book, Knocking on Heaven's Door.

“My father died last month at 83 when my sister and I were on the plane, coming out to say goodbye for what felt like the 57th time. There was a message on my phone from my husband when we landed. What I felt when I heard the news was joy.”