The care was futile, and the patient's wishes, KevinMD.com

by Jim deMaine, MD

“We have a patient on a ventilator here who is stable enough to transfer to your ICU, if that’s OK with you.”

This call, coming from the transfer coordinator, is emblematic of an insurance generated “medical care” coverage issue. I am salaried under the patient’s insurance carrier so the insurer wants this patient back under its wing as soon as possible.

The community hospital has been keeping Stella Norris (not her real name), an 89 year old woman, as long as possible. She is incapacitated from a massive stroke suffered five years ago. There is a feeding tube inserted through the stomach wall and she has needed total body care. 911 was called when she stopped breathing and she was taken to the closest hospital.

via kevinmd.com

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Don't Put Off Talking About The Inevitable: Care At Life's End : Shots - Health News Blog : NPR

With no end in sight to the controversy about whether doctors should be paid to discuss end-of-life options with patients, we thought now was as good a time as any to review the possibilities for care before you die.

Only about a quarter of adults have advance directives in place. The term refers to two types of documents: a living will that instructs people what medical measures to take, if any, to prolong your life, and a health care power of attorney that designates someone to make medical decisions for you if you can't. States call these documents by different names, but their functions are similar.

 

On the relatively infrequent occasions when people do sign advance directive documents, they're usually thinking about what they would want in a crisis: a heart attack, say, or routine surgery that goes terribly wrong. Most of us don't think about the long, slow decline that may occur with Alzheimer’s disease, for example, that robs people just as surely of their ability to make choices as a medical emergency.

via npr.org

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Death in a hospital is not always comfortable, KevinMD.com

In America, too many people die in the hospital.

I don’t mean that they die due to medical error or incompetence, though that’s always a hot topic of discussion amongst doctors, researchers, administrators, and regulators.

What I mean is that if you ask most people, they say they’d rather die at home, surrounded by their loved ones, drifting off to sleep painlessly after having had last rites administered (feel free to plug in your religious/atheistic ritual of choice here).

Why, then, do so many who want this type of death instead die medically, here in the hospital, undergoing painful treatment and the deprivations and degradations of medical care?

The answer has both simple and complex aspects. But I’ll start by sharing something that most medical professionals believe:

When my time comes, the last place I want to be is in the hospital. Don’t get me wrong–I like GlassHospital–it’s a good place to work, teach, and learn. But when the grim reaper is calling my name, I want to be as far away from here as I can.

No IVs. No needle sticks to test my blood. No waking me up to check vital signs every shift. No hospital food. No fluorescent lights.

No feeding tubes; no bladder catheters (ouch!); for Heaven’s sake, no breathing machines (‘mechanical ventilators’).

via kevinmd.com

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Death, Dying, End of Life, Hospice, Inspirational Poems, Touching Stories

Death, Dying, End of Life, Hospice, Inspirational Poems, Touching Stories:"Occasionally, we are graced with the presence of an earth bound Angel. They are unable to stay with us for long, but while they do, they bring unprecedented joy and happiness to all they touch."
http://www.inspirationalnursing.com/inspiration/categories.death.dying.end.of.life.hospice.htm

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