Stephanie Hinton is a medical student in the Class of 2019 at Queen's University
It’s August 17th. My grandmother died today. She never made it to palliative care. Instead, she was kept in the corner of a hospital room surrounded by empty walls and a window looking out over a parking lot. She was confined to her bed, barely conscious, and at the mercy of those with little experience in end-of-life care because she had not quite been deemed “palliative.” I sat by her bedside for 12 hours a day, 3 days in a row, leaving only to sleep. I watched her grimace in pain and counted down the hours to the next dose of pain medication. It would finally come — four hours late and barely offering the relief she was looking for. We waited for a doctor to come check on her and answer our questions. We were told they didn’t know where the doctor was or when the doctor was coming, or — my personal favourite — “Doctor’s don’t need to keep you informed of every care decision.”
She had been refused IV hydration and kept NPO, and her vitals were never checked. When they were finally checked, she was saturating dangerously below 90%. On August 17th at 8:00 am, we received a call telling us she would be moved to palliative care. At 8:15 am, we got a call telling us she had died. She was alone. We had been given empty promises the night before that she “might pull through,” and we were unable to stay the night. We were given the “privilege” of seeing her 45 minutes after she had passed, the “privilege” of calling family members to ask them if they would like to come and say their final goodbyes. We had the “privilege” of sitting by her bedside and waiting for family to arrive long after she had transitioned between life and death, doctors and nurses nowhere in sight to offer the support we desperately needed. We sat with a dreadful feeling, wondering how we could have better advocated for her and knowing she was not given the dignified death she deserved. This feeling would linger and creep up months after her death....continue reading →
Serena Arora is a medical student in the Class of 2019 at McMaster University
I love puzzles.
I love looking at the picture on the box, seeing what the completed version will look like and then pouring out all the little pieces — knowing that, somehow, they all come together to create something.
In some ways, practicing medicine is like doing a puzzle. It’s complex, intersecting, and incredibly rewarding when done right. At the same time, medicine is fractured into a thousand different components. As physicians, we look at our patients and we piece them apart into organs and body systems and tissues. We rip the details we think are important from the fabric of their narrative to focus on specific complaints. We take their words and distill them into our jargon, often so much so that their original story would be unrecognizable. Medicine is often an act of reductionism.
Matthew Lee is a medical student in the Class of 2019 at Dalhousie University
I was totally unsure. Meeting a patient who knows they are going to die... wouldn’t it be intrusive, at the end? A student coming into your life: asking questions, getting signatures, asking you to share your precious time. In the same position, I don’t know if I would say yes. That thought makes me feel a bit uncomfortable. Checking in on the floor, with information hurriedly scribbled into the margins of a notebook. A brief run-in with her mother in the crowded room, then twenty minutes spent in the hallway — trying not to be obtrusive while staff hurry by. There are visitors every day, and I doubt I looked out of place.
In some ways, I chose to take on this project in order to become more comfortable with death. It’s something I have faced before, and it took years to move past my friend dying from lymphoma. He quickly stepped away to take a phone call at our convocation. It was a biopsy result. Nearly six months to the day and it was all over. It took nearly everything I had. ...continue reading →
Sarah Hanafi is a medical student in the Class of 2018 at the University of Alberta
In healthcare, we sometimes hear the saying, “I went home thinking about that patient.” I thought I knew what this meant until I met Winnie.
It was a foggy Tuesday and the humidity hung thick in the air. On my first day as an elective student in Palliative Care, I was apprehensive as I exited the elevator onto the hospital unit where I would be spending the next two weeks. Soon after my orientation, I was asked to go meet my first patient. Winnie came to us with pain and shortness of breath due to an advanced lung cancer. We worried that Winnie’s hospital bed would become her death bed. ...continue reading →
David Falk is a palliative care physician working in Calgary, Alberta
Recently the president of one of the Quebec medical federations published a request to the public to give the medical profession some time to accept physician assisted death (or medical assistance in dying - MAiD) “because they do not like change.” I agree and disagree with him about this. Yes, physicians are slow to change without measured assurance that the change would be beneficial to their patients, but, when it comes to the matters of the heart, these changes may not be beneficial nor become mainstream. Suppression of visceral responses does lessen with repeat exposure, just as shoplifting becomes less traumatic the more often you do it, but whether continued suppression of the heart language is good is questionable. ...continue reading →
Interview with Dr. Camilla Zimmermann, head of the palliative care program at UHN in Toronto, associate professor and Rose family Chair in the Department of Medicine at the University of Toronto, as well as senior scientist at Princess Margaret Cancer Centre.
In a research article (open access) she co-authored, Dr. Zimmermann conducted interviews with patients and their caregivers in an effort to understand attitude and perceptions about palliative care. Early palliative care improves quality of life, symptom management and satisfaction with care in patients with advanced cancer. However, stigma associated with the term palliative care may be a barrier to timely referral.
Dr. Rene Leiva is an Assistant Professor with the Department of Family Medicine of the University of Ottawa. Part of his work includes in-patient Palliative Care and Care of the Elderly at Bruyere Continuing Care in Ottawa, ON
I read with interest the CMAJ Editor in Chief’s latest editorial about protecting the right of physicians to conscientiously object to being party to physician hastened death. Principled medicine has dealt with suffering since Hippocratic tenets were first formulated about 2400 years ago. It is only in the last fifty years that causing death has been construed as ‘medical treatment’ for suffering, which I firmly believe to be erroneous. I’m disturbed to see that while Quebec is leading the country on euthanasia only a fraction of its population has access to palliative care. Palliative Care has been around for close to forty years, but Quebec's new law on ‘medical aid in dying’ expects to make that option available to 100 per cent of Quebecers in a matter of months. ...continue reading →
Professor Scott A Murray is the St Columba’s Hospice Chair of Primary Palliative Care Research Group at The University of Edinburgh in Scotland, UK
We live in exciting times for palliative care in general and for palliative care in primary care and family medicine in particular. The World Health Assembly (WHO's resolution-making body) in May 2014 passed its first ever resolution about palliative care. It called for palliative care to be integrated into health care in all settings, especially in the community, and countries will be answerable to this resolution in May20161.
Sébastien Moine est médecin généraliste en Saint Just en Chaussée, France, et doctorant en santé publique (Université Paris 13) | Sébastien Moine is a GP in Saint Just en Chaussée, France and a PhD candidate in public health (Université Paris 13)
[English version follows below]
« Nous sommes très heureux que vous veniez travailler avec nous ! C’est vrai, nous avons peu de médecins généralistes dans notre hôpital. Il est toujours bon de développer de nouvelles relations. » Je ne sais pas pourquoi, mais je sens qu’elle va rajouter quelque chose. J’acquiesce avec un sourire, sans dire un mot. C’est mon dernier entretien d’embauche avec la directrice adjointe des affaires médicales. ...continue reading →
Anthony J. Caprio, MD, CMD serves as the medical director and an Associate Professor for the Division of Aging, in the Department of Family Medicine for the Carolinas Healthcare System, Charlotte, North Carolina
The release of the IOM report was regarded by many U.S. healthcare professionals as a significant step forward in identifying gaps in the delivery of care for seriously ill and terminally ill patients. Specific recommendations were outlined as a “call to action” to improve end-of-life care. Hospice and palliative care physicians, in particular, rallied behind the report. ...continue reading →