When it comes to end-of-life care, perhaps we do need a bigger hammer

 by Richard Sontheimer.

While sitting one evening with my terminally ill elderly mother, she again asked me to help her end her suffering.  This time it was, “Could you just go get the hammer and hit me in the head?” Her previous requests had included “Son, you are a doctor, can’t you do something to help me with this?”  And then, “They treat animals better than this.”

On previous occasions, I had to remind my mom that we lived in one of the 48 states in the USA that does not have a death-with-dignity euthanasia law.  Her response was, “Then can you move me to Oregon or Washington?”

Rick Sontheimer is an old friend of mine.  His article is well-written, deep and important.  You can access it at Kevinmd.com.

Escape From the Land of the Pink Bibs

This is the story of Narcy Houle’s father, a highly respected orthopedic surgeon, developed Alzheimer’s.  During the course of the disease, he broke his hip. One day when we visited him at the nursing center, about six months after his accident, we found him sitting in a row of patients all wearing pink bibs, left on after they had finished eating. Like the others, his head was bent toward his lap; though his eyes were open, they were not focused on anything. His shoulders slouched, like a rag doll’s, and his mouth hung slightly ajar.

What he needed was a geriatrician.  Most health care professionals have had little to no training in the care of older adults. Currently, 97 percent of all medical students in the United States do not take a single course in geriatrics.

Recent studies show that good geriatric care can make an enormous difference.  Older adults whose health is monitored by a geriatrician enjoy more years of independent living, greater social and physical functioning and lower presence of disease. In addition, these patients show increased satisfaction, spend less time in the hospital, exhibit markedly decreased rates of depression and spend less time in nursing homes.

See:  An Aging Population, Without the Doctors to Match by Marcy Cottrell Houle (NY Times, September 23, 2015)

A Racial Gap in Attitudes Toward Hospice Care

Dateline Buffalo: Twice already, Narseary and Vernal Harris have watched a son die. The first time — Paul, at 26 — was agonizing and frenzied, his body tethered to a machine meant to keep him alive as his sickle cell anemia  progressed. When the same illness ravaged Solomon, at 33, the Harrises reluctantly turned to hospice in the hope that his last days might somehow be less harrowing than his brother’s.

This is a fine article about hospice use in the black community. about why it is less frequently sought, and why blacks distrust the health care system.

Helping Patients and Doctors Talk About Death

"Medicare announced plans in July 2015 to reimburse doctors for talking with patients about what treatments they want — and don’t want — toward the end of life. This sensible, long-overdue proposal is likely to have a very wide impact. About 80 percent of people who die in the United States each year are covered by Medicare, and Medicare policies are often followed by private insurers, some of which already pay for these advance-planning conversations.

"Virtually all experts agree that medical professionals will need additional training. Many doctors are uncomfortable talking to patients about planning for death."

See NY Times Editorial.

How to Talk About Dying

by Ellen Goodman, NY Times, July 1, 2015

This is an extraordinary essay.  Well worth studying.  It’s common sense that we need to be reminded of.

Excerpts:

The difference between a good death and a hard death often seemed to hinge essentially on whether someone’s wishes were expressed and respected. Whether they’d had a conversation about how they wanted to live toward the end.

So, a small group of us — each with his or her own story — started the Conversation Project, a nonprofit, out of the belief that surely we could make this easier. (also see the Conversation "starter kit." Our partners at the Institute for Healthcare Improvement gathered experts frustrated at the pace of change who believed that the health care system wouldn’t change until the culture changed. So we are trying to change the culture.

There is now, finally, a real momentum for improving end-of-life care. The signs range from the Institute of Medicine’s report, “Dying in America,” to the success of Atul Gawande’s book “Being Mortal.”

There is also a growing public awareness of the need to break through the reluctance that has kept us tongue-tied for so long. A survey we did last year showed that 90 percent of Americans now think it’s important to have the conversation. But the same survey showed something else: Only 30 percent of us have actually had these conversations. So the gap remains huge.

From all the stories shared with us, we know that what people need most is help getting started. They need a travel guide to take the first steps down an unfamiliar and difficult road. So we created a ConversationStarter Kit.

Dying is not just a medical experience, it is also a deeply human experience.

How Therapicts Grieve

A therapist may spend hundreds of hours, perhaps more than a thousand, hearing about a patient’s most exalted aspirations and most murderous, hateful fantasies. During this time, the patient may endure excruciating losses, unbearable shame, bitter sadness and great triumphs. You may accompany patients through torturous adolescence into adulthood. Or you may meet them in middle age and be with them as they age and eventually die. You collaborate in a deep process of discovery.

Few encounters are this deeply honest, and therefore intimate. The attachment engenders profound feelings, a particular kind of love.

Dr. Robin Weiss' sensitive essay in the NY Times (July 5, 2015) is a good source of insights.

Mother Describes Giving Birth To Stillborn Son

After Dr. Eleni Michailidis delivered a stillborn son, she and her husband sought to honor their infant and the experience. She tells her story in this video.

This is a moving video -- from the heart.