GlassHospital

Demystifying Medicine One Week at a Time

Category: death & dying (page 1 of 9)

End of Life Rallies

Let’s say your loved one is at the end of life. She’s 84, with advanced cancer that is no longer treatable.

A decision has been made to put her in hospice–which is a level of care more than an actual location. [Most hospice actually occurs at home.]

The patient waxes in and out of consciousness, sometimes lucid, but mostly not.

While no one is ready for her to die, this end-of-life process brings some solace–it’s what your loved one has indicated she wants, and the time at home without aggressive, often fruitless, medical treatment, allows other friends and family members to make visits and share stories.

One afternoon, she perks up and asks for a sandwich. This is surprising, because she’s barely eaten anything in the last ten days. But we get her that sandwich!

She nibbles at it, happy, but doesn’t eat much of it.

That afternoon, she’s talkative and engaged with others in a way that she hasn’t heretofore seemed able to muster.

Is she making a comeback? Healing from her illness?

More likely, this is what is called “rallying,” and while there’s ample anecdote of its occurrence in situations like this, we have very little understanding of it.

How does it happen? As a recent NYTimes article stated:

Physiologically, experts believe that the mind becomes more responsive when a hospice patient is taken off the extensive fluids and medications such as chemotherapy that have toxic effects. Stopping the overload restores the body to more of its natural balance, and the dying briefly become more like their old selves.

It’s deceiving because we think our loved one is getting better. And while she’s more like her old self, unfortunately, it’s not bound to last. Which is why it can be upsetting for some.

Spiritually, some suggest that the dying loved one is simply readying for transition–making sure that earthly concerns will be attended to in her absence and that final goodbyes may be uttered.

I’ve seen it–and especially in elders afflicted with dementia, it can be heartening to see them rally and seem to know what’s going on–accepting their impending death, and engaging with their loved ones before drifting off.

ObiTrio

When I was young, I avoided reading obituaries out of superstition that I or a family member might fall ill or die.

When I was pursuing a medical education, my fear lessened and I became fascinated by obituaries–especially the 2nd paragraph, in which the cause of death is mentioned (or speculated upon).

As I’ve matured, I now read them because they are a distinct form of writing–succinct, and in telling about the decedent’s life, amazing true stories of our time here on earth.

OBIT | Theatrical Trailer Exclusive from Green Fuse Films on Vimeo.


Three recent NYT obits caught my eye, because each one had an interesting connection to health care. In chronological order of when they died, here they are:

John Sarno was a physical medicine and rehab specialist at NYU for almost 50 years. He was adored by his patients, particularly those for whom he helped achieve relief from back pain. He authored several books on the topic, suggesting that most if not all of it was caused by unresolved anxiety and rage. He coined the term “tension myositis syndrome” as a catch-all for the most common form of back pain–muscular pain that in most cases is episodic or short-lived. The obituary discusses how his ideas were never accepted into the medical mainstream, despite the facts that his books sold millions of copies just by word-of-mouth, and his own skeptical physician colleagues turned to him for help.

Spencer Johnson started his career as a medical doctor, but decided against a career in clinical medicine. As the obituary states, “…while working in a hospital, he grew frustrated at seeing the same patients return with the same ailments, as if they were not trying to better their lives…” He went to work for a medical device company, becoming its director of communication. Learning how to write succinctly for lay audiences led him to his ultimate success–co-authoring the massive bestseller “Who Moved My Cheese,” a parable about pushing ourselves out of our comfort zones. It has since sold nearly 30 million copies worldwide and has been translated into 44 languages.

I love the quote he gave to a newspaper writer: “Most writers write the book they want to write. You’re much wiser if you write the book people want to read.”

Keith Conners was a psychologist most known for his work in the world of defining and diagnosing Attention Deficit Hyperactivity Disorder (A.D.H.D.). In the first half of the 20th century, hyperactive children with difficulty focusing were said to suffer from “hyperkinesis,” or the lovely moniker “minimal brain disorder.” Conners brought rigor to the field, and created the Conners Rating Scale, a 39-item questionnaire that became the gold standard for diagnosing A.D.H.D. Conners went on to become a critic of what has become a big industry, stating that A.D.H.D. is now diagnosed about three times as much as its actual prevalence. [If you are interested further in this topic, you can hear a podcast of my interview with author Alan Schwarz of “A.D.H.D. Nation” here.]

These doctor/writers all lived interesting and varied lives–I was simply struck by the proximity of their deaths and the loveliness of their obituaries.

Holiday Miracles

Dr. Kolbaba and his book

Happy holidays, dear GlassHospital readers.

A book recommendation for the season: If you like hearing positive medical stories, ones that are miraculous even, then order a copy of Dr. Scott Kolbaba’s “Physicians’ Untold Stories.”

Dr. Kolbaba is a longtime internist in Wheaton, Illinois. Over the years he’s experienced things that defy logic and rational explanation. The interesting thing is that neither he nor colleagues shared these stories, fearing ridicule or disbelief, until finally the dam broke.

He spent three years producing the book, interviewing 26 different doctors, all of whom have surprising, heartwarming medical stories.

Dr. Kolbaba includes short biographical material on each of the contributors to his book.

Though the word miracle is used throughout, and the presence of God is alluded to, there is no specific religious tradition espoused in the book–so you can decide for yourself about the degree of providence within.

I hope your holidays bring peace and comfort to you and your families.

People of the Book

51LnzMAiHuL._SY344_BO1,204,203,200_Doctors are a group that prize scientific evidence in plying our trade — whether making recommendations to our patients or arguing with each other about how to interpret and act upon our profession’s ever-growing body of research.

I find it pretty easy to lapse into the rationalization that “the latest evidence” is usually right, and therefore should heavily weight both our actions and our “knowledge base.”

But a new book challenges this rationalizing — pointing out that over the decades, many assumptions about best medical practices later come into question and are thrown out — a process known as “Medical Reversal.”

I blogged about this before, as several articles in this genre stood out to me. Now that line of research has been turned into a book: “Ending Medical Reversal,” by Vinay Prasad and Adam Cifu. I was delighted to be asked to review this book for Johns Hopkins Press, and glad to see that they’ve published it (in fact, they used a statement in my review as a blurb (!) on the book jacket).

If you like to know how medical knowledge gets disseminated, communicated, retracted, and paved over, then this will be an enjoyable read. The NYTimes just reviewed the book, with a recommend, only questioning the rather esoteric title, suggesting instead that the book be called “OOPS!” or “Are You Kidding Me?”

I like those.

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This past week I had the opportunity to meet the great Roz Chast, author of the award-winning graphic memoir “Can’t We Talk About Something More Pleasant?”

She visited the Tulsa City-County Library as part of a series of programs put on in conjunction with Clarehouse, a local not-for-profit hospice. The goal of the series is to increase awareness and dialogue about improving care for people at the end of life.dr john schumann 3

No, Not Painless

Both the movie and the TV show M*A*S*H share the same theme song. Even if you can recall the music in your head, many people don’t know the song’s strange title: “Suicide is Painless.”

My latest piece for NPR’s Health site, “Shots,” recalls my mother’s death by suicide from my viewpoint as a son and someone entering the medical profession.

In thinking about my Mom’s death, I’ve always remembered the title of the M*A*S*H theme, but had never really thought about its meaning. Here’s the refrain:

That suicide is painless
It brings on many changes
And I can take or leave it if I please.
I try to find a way to make
All our little joys relate
Without that ever-present hate
But now I know that it’s too late, and…

It’s interpreted to mean that compared to the horrors war, suicide is the less painful alternative.

I’m OK with the thought for soldiers and as a literary device, but I’m here to tell you that suicide is most definitely not painless to those it leaves behind.

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