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Every time I read or see a well thought out piece on end-of-life decisions, it makes me want to go into palliative care medicine. Yes, I am a trauma/critical care junkie--but I also love the holistic approach and paradigm shift that palliative care provides. They are my yin/yang areas of love and interest in medicine. The ability to reach out and pull someone back from the brink---or the skill and wisdom to let go and let be when that is what a patient wants.
I think that Atul Gawande is an excellent writer and though he is a surgeon (i.e. from the specialty that probably gets slammed the most in the media with regard to these issues) he has an amazing grasp of these dichotomies.
I have droned on about end-of-life issues on this blog before, I know, but his article on the matter is a work of art as far as I am concerned. If you haven't already read it, you should. And then you should make your friends read it. And your parents. And your siblings.
I will now step off my well worn tiny soapbox.
6 comments:
More evidence that we are separated at birth! I wrote about the Atul Gawande article you mentioned when its publication dovetailed with a particularly egregious palliative care fail during my first ICU rotation as an intern.
I must admit that Atul Gawande could write an article about my left foot and I would pronounce it a gem to be treasured forever.
I totally understand the importance you place on Palliative care.
I'm generally first to the soap box when the topic of palliation comes up in our PBL sessions. I think it's because of my experiences as a nurse. Working with a number of terminally and/or chronically ill people made appreciate the importance of palliative care and how much it inspires me.
I look forward to reading the article you linked to :)
I don't see palliative medicine as incompatible with critical care at all. If anything they are HIGHLY compatible, and critical care drs have to grapple with these issues more than most others.
PGY--Yes, the incidents from the ED that haunt me are the poorly handled end-of-life situations.
Yeah, he's brill. Do you think the man sleeps?
AB--I think it is really important that people in PBL hear those perspectives.
One of the frustrations with my program is the complete lack of ethical discussions surrounding ANYTHING to do with death. I shudder to think at how some of my classmates will handle these situations (and discussions with family members/patients) in the future.
OMDG--Yes the critical care team grapples with end-of-life all the time. But I think the EM and palliative slant on those issues is vastly different. You almost never hear the words, "quality of life?" during a code.
You do hear "quality of death" though.
@ABB
Have a listen to Scott Weingardt's podcast; he has a whole lecture devoted to how to address end of life issues in the ED.
http://emcrit.org/podcasts/end-of-life-care/
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