In a recent blog “Taking Silence for Comprehension,” I talked about how patients may not understand the risks and benefits of treatment options and quality of life considerations and may not know what questions to ask. Similarly, when doctors bring up the subject of end of life care goals, it is not unusual for patients to be silent. I recall a patient saying to me, “I never died before, I don’t know what questions to ask. I really have to think about how I’m going to die.”
A few days ago, I came across a folder on my computer that contained a New York Times article (June 30, 2016) titled “At the End of Life, What Would Doctors Do?” by palliative care physician Dr. Ira Byock. The article explored what doctors think when facing death, referencing Dr. Ken Murray’s online essay “How Doctors Die,” which offered a personal observation that doctors who recommended late-stage treatments may not prescribe the same for themselves.
In digging through files, I discovered a job description of my first position in the world of cancer care. Memories flooded in, including how I initially refused to accept the job. Let me tell you how the door was opened.
Most of us recognize the challenges healthcare institutions face in balancing budgets in a time of escalating costs. So, how do hospital administrators decide what projects or services should be funded and what are expendable? It seems that in most instances the basic principle of “income producing” is what determines what stays or goes.
I was recently re-reading an email exchange with Dr. Skip Durning, who at the time was director of Hospitalist services at North Adams Regional Hospital. He wrote to me following a presentation to hospital staff that included our video “Voices from the Lived World of Illness.” After the viewing, the discussion with attendees highlighted the challenges of healthcare communication, especially when someone is seriously ill.
We have all lost loved ones. Although not forgotten, the departed can recede to the back of our minds unless prompted by a memory such as a photo, song, written note or countless other things personal to the relationship.
“When I was first diagnosed, I felt I didn’t need you,” she said. “After all, I am a nurse. I know how to get what I need in the medical system. I speak their language. Now I find that I need your help.”
I am struck by the similarity between anxieties precipitated by the current COVID-19 crisis and facing cancer. In each, there’s a feeling of not being in control and an uncertainty about the future. These emotions often linger and can be difficult to manage.
I recall a patient telling me that she played “peekaboo” with her cancer diagnosis. She described how hard it was to think about an uncertain future and the prospect of dying. She needed time to look away and catch her breath. How can any of us keep our eyes wide open without a reprieve when […]