Tag: end of life

Extreme Measures: Finding a Better Path to the End of Life.

A critical care/palliative care specialist describes hard cases at the end of life, admitting times when she has been unclear about how to advise families making difficult decisions about taking loved ones off of what she describes as the “end of life conveyor belt” of extreme measures seen in emergency rooms. From NYT book review: “Medical training fosters a heroic model of saving lives at any cost. American can-do optimism assumes all problems can and should be solved. Both doctors and patients tend to subscribe to a ‘more is better’ philosophy. If technology exists, surely it should be used. Physicians’ fears of litigation plays a part, as do patients’ fantasies of perpetual life. For too many, death remains unthinkable and unspeakable.” A 25-minute documentary that features her and shows some of these kinds of conversations is available on Netflix (“Extremis,” 2016)

Extremis

25 minute documentary filmed in a hospital that shows patients, families and health care professionals (Dr. Jessica Zitter, pulmonary/ER specialist and palliative care, is featured. See her book Extreme Measures: Finding a Better Path to the End of Life”) dealing with end of life moments. Talking through concrete decisions of whether to take a loved one off a ventilator in the same room where the patient lies captures the difficulty of those decisions in agonizing detail. Short enough to show in a class, might be too intense for many audiences (maybe to stimulate discussion among pre-med or medical students). Could be used with a reading like “Letting go,” by Atul Gawande, but content warnings are essential. Academy Award nominee.

Un suicidio (asistido) en Colombia que nació del amor de un hijo por su madre

The author lived with parents and aunts. When father and her aunts died, she was left alone to help her mother with grief and deteriorating health. The two women struggled with the idea of assisted suicide, but eventually chose that path over further suffering. About 3 pages; workable for intermediate and advanced learners, compelling storytelling for a community group.

A Strange Relativity: Altered Time for Surgeon-Turned-Patient

This is an 8 minute video made by Stanford neurosurgen and author Paul Kalanithi before his death. He reflects on the experience of time–as a physician, seeing patients and monitoring time and now, as a person with cancer and the parent of a baby.

The video could be used in a course in which Kalanthi’s book is assigned, to give students an opportunity to hear his reflections in his own voice and to see images of him with his family. It is also an example of the larger issue of what physicians notice about medical practice when they become a patient themselves.

Un último acto de amabilidad íntima

Michelle Friedman describes providing home care for her estranged younger brother as he dies from advanced pancreatic cancer. She touches on difficult topics of conversation, her brother’s depression, and grappling with death and religion.

An English language translation of this essay is available under the title, “A last act of intimate kindness.”

Meditating on Death

80 minute podcast that discusses Buddhist notions of death and dying. Emphasis is on being happy about life, noticing its impermanence and questioning the value of always seeking more (money, time, status, things). Provides a detailed contrast point to Western perspectives that could be comforting, reassuring or simply intriguing for a discussion of death and dying.

A last act of intimate kindness

“I had barely seen my brother in decades, but when time was short, he let me in.” In the “Modern Love” section of the NYT, a woman describes the tenderness and connection of caring for a younger brother she was mostly estranged from through his death from cancer. She’s surprised at how positive and touching it is to reconnect with him under such difficult circumstances.

The story could be used to prompt discussion of end-of-life care. The brother declines aggressive treatment and his sister is with him when he dies at home.

This narrative is also available in Spanish under the title, “Un último acto de amabilidad íntima.”

Dancing With Broken Bones: Portraits of Death and Dying Among Inner City Poor

Author David Moller makes the case that the dying poor are doubly invisible, shunned for being poor in an affluent society that denies death. “This book is about providing a face and offering a voice to speak on their behalf.” It includes stories about homeless and poor individuals and their experiences with end-of-life care (or lack of care). It portrays both their social isolation and suffering and their resilience and humanity. The author retells individuals’ stories and these could be excerpted.

Being Mortal: Medicine and What Matters in the End.

A contemplation of the limits of medical care through many specific stories of decision points about when to stop treatment in favor of palliative care. Gawande has been a physician for a long time and an activist/ writer on the side of “know when to say when” – i.e. just because medical technology exists to prolong life doesn’t mean that’s the best thing to do – for almost as long. He makes convincing cases for stopping expensive treatment and “giving life to days” more often than Hail Mary passes that might bring on the 2% chance of a cure.

The book is a readily accessibe read for many audiences and could be assigned in full or excerpted. It was also the subject of a PBS documentory that could be used to supplement class use and bring the text to life.

It’s the ‘life’ in end-of-life that matters

Prompted by Atul Gawande’s New Yorker essay (“Letting Go,” which addresses similar themes as his book, Being Mortal), the author reflects on two experiences he had as a resident in the NICU, one in which all possible medical treatment was pursued inappropriately and another in which extra-ordinary measures were not applied so that a family could spend a final day with a fatally ill newborn. The author blames the broader medical system, and says his frustrations with that system led him to his current occupation as a health services researcher.

In contrast to end-of-life stories that involve elderly patients or terminally ill adults, this blog post provides vivid examples of NICU treatment decision-making.