Grim Reaper Cartoon

(Nre Yorker, Feb. 1, 2016)

Where are All the Geriatricians?

This is an excellent article in the Tuesday, January 26, 2016 NY Times Health section.

Excerpts:

Geriatrics is one of the few medical specialties in the United States that is contracting even as the need increases, ranking at the bottom of the list of specialties that internal medicine residents choose to pursue.

Geriatrics is among the lowest-paying specialties in medicine. In 2014, the median yearly salary of a geriatrician in private practice was $220,000, less than half a cardiologist’s income. Although geriatrics requires an extra year or two of training beyond that of a general internist, the salary for geriatricians is nearly $20,000 less.

Young physicians in training find it difficult to muster interest in the slow grind of caring for older patients, and days filled with discussions about medication management, insomnia, memory loss and Meals on Wheels deliveries.

Palliative Care in Kerala

The Indian state of Kerala has a remarkable palliative care program.  It is an example of what can be done with little money and unl9imited compassion.  Volunteers are the linchpin in Kerala’s palliative care system — one that was singled out as “a beacon of hope" in The Economist’s “Quality of Death” study in 2010. Kerala’s achievement is especially significant at a time when richer Indian states and wealthy countries like the United States are struggling with the same challenge: How can health systems offer the possibility of a dignified death to everyone?

Full NY Times article: In India, Dispensers of Balm Travelto Death’s Door

by Ankita Rao January 12, 2016

Volunteer and Patient in Kerala

Assisted Suicide Belgique

“In Belgium, euthanasia is embraced as an emblem of enlightenment and progress, a sign that the country has extricated itself from its Catholic, patriarchal roots.

Belgium was the second country in the world, after the Netherlands, to decriminalize euthanasia; it was followed by Luxembourg, in 2009, and, this year, by Canada and Colombia. Switzerland has allowed assisted suicide since 1942. The United States Supreme Court has recognized that citizens have legitimate concerns about prolonged deaths in institutional settings, but in 1997 it ruled that death is not a constitutionally protected right, leaving questions about assisted suicide to be resolved by each state. Within months of the ruling, Oregon passed a law that allows doctors to prescribe lethal drugs for patients who have less than six months to live. In 2008, Washington adopted a similar law; Montana decriminalized assisted suicide the year after; and Vermont legalized it in 2013.”

A New Yorker article, The Death Treatment, explores and discusses the Belgian experience.  Ananya Mayukha alerted us to an Economist video, 24 and Ready to Die, focusing on Assisted Suicide Belgique. At 22 minutes, it is well-worth watching.

24 yo woman subject of Economist film

Thanatology Class 2016

A Very Ungrateful Old Lady

Sheila Solomon Klass was the mother of the pediatrician Perri Klass.  In her essay in the NY Times (11/8/2013) she wrote: 

"I am a legally blind octogenarian. I have wonderful adult children who often help me, but I can never accept their help gracefully.

It is a terrible thing to be a burden. They say I am not, but I know better. Perhaps many of you have parents like me.

See A Very Ungrateful Old Lady.

Sheila Klass died in March 2014. 

Sheila Klass and daughter, Perri

 

My Letter to the World

THIS is my letter to the world,
That never wrote to me,—
The simple news that Nature told,
With tender majesty.
Her message is committed
To hands I cannot see;
For love of her, sweet countrymen,
Judge tenderly of me!

from Emily Dickenson

Pathographies are illness narratives.  As we consider death and dying, we hear from physicians, social workers, psychologists, ethicists, hospice personnel, lawyers, politicians, economists -- but rarely from the dying themselves. That is why, when an eloquent voice appears, we should pay attention.  See: Goodbye2015….Hello 2016!

January 7, 2016 Take-Home Messages

1.  The KOHD blog is a resource on all things covered this month… and more.

2.  First person narratives of dying are rare.  When you find them, read them and engage with them.  See: New Year Letter from a Dying Friend.

3.  Katy Butler has made huge contributions to our understanding about being a caregiver for elderly people, especially one’s relatives. Her book, Knocking on Heavens Door is a manual in narrative form. Her occasional essays on the subject are keepers.

4.  Imagine a Medicare ‘Part Q’ for Quality at the End of Life

By Katy Butler December 9, 2015 New York Times

5. Our fee-for-service fragmented medical system is a bad fit for the frail elderly (and many others as well).

6.  Medicare shapes the way we die by funneling us toward a high-tech hospital death.

7.  We should focus on the Niagara Falls Trajectory: “to feel as well as possible for as long as possible, until one quickly goes over the precipice. Quality of life is more important to most of than quantity of days, if they are miserable days.”

8.  Tattooed on my heart:  The practice of medicine is an art not a trade: a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with powders and potions.  William Osler

New Year's Letter from a Dying Friend

This letter is shared here with the author's permission 

Goodbye 2015….Hello 2016!

I’m not sure how this is going to go, but it’s something I’ve been struggling with for the past 6 months and ‘don’t want to continue. I want the freedom to bring my friends into my realm and have them understand why I haven’t seen or talked to them lately.

Also, it means a lot to me to offer another view of living and dying. Or who knows, this may be the prevalent way and others just haven’t found the need to express it.

I have hesitated to share this news with so many people because I didn’t want them to feel sad, or feel like I’m being overly dramatic. I understand they have all experienced death with a family member or close friend who may have chosen to deal with it privately. I understand as much as anyone could. But as you know, that’s not me.

Here is N.'s full letter. 

(If you want to write a few words to the author, you can do so through David Elpern.)