Welcome to this week's edition of Dear Dr. Horton. Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!
Dear Dr. Horton,
I've experienced the death of patients before — but this one feels different. I can’t help but think of small things we spoke about, like their dogs and their season tickets to the theatre. How do you navigate the intersection of professionalism and mourning another human you felt connected to?
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 →
Beatrice Preti is an Internal Medicine Resident (R2) at Queen's University
The list is long, but I know your name
Each day before, its spot was the same
Second from the top, the second room on the right
The one with three windows and a broken bathroom light
But today something’s different; the list I have’s bare
I looked for your name, but it wasn’t there
Something has happened, and, in my heart, I know
That though I fought to keep you here, you found a way to go ...continue reading →
"First of all," he said, "if you can learn a simple trick, Scout, you'll get along a lot better with all kinds of folks. You never really understand a person until you consider things from his point of view […] until you climb into his skin and walk around in it." — Harper Lee,To Kill a Mockingbird
This piece reflects a daughter’s internal struggle as she comes to terms with her mother’s suffering through delirium and terminal illness. Touching on the sensitive balance between seeking care and doing no harm, this piece provides an intimate perspective on the challenges many family members encounter in letting go of their loved ones during trying times of declining health, as well as on the difficulties involved in recognizing that ‘more’ is not always better — that, sometimes, less is more....continue reading →
Beatrice Preti is an Internal Medicine Resident (R1)at Queen's University
It was the strangest of days when I met him first
Everything jumping from awful to worse
People were shouting and crying and seizing
Coughing and choking and retching and wheezing
It was nearly twelve hours before I could go home
But the attending doc called direct on my phone
And asked me, please, could I see one patient more?
Well, I couldn’t say no, so I went back to the floor
And met him there, though, then, he was alive, But looking so dead I knew he hadn’t long to survive Yet I took the history, and wrote everything thing down
Signed the orders, made the calls, and finished my rounds
Tucked him in for the night, and was just about to leave
When he said to me, “Doc? How much time do I have, please?” ...continue reading →
Sahil Sharma is a medical student in the Class of 2020 at Western University
Nearing the end of my first year in Medical School, I am amazed by the wealth of knowledge acquired during such a short time. There have even been several moments throughout the year where picturing myself as a fully licensed physician seemed slightly less daunting. I have become comfortable with routine physicals, certain diagnoses, different drugs, and management of a wide range of illnesses. I have no doubt I will encounter each of these facets of healthcare during my career. However, there is one unavoidable aspect of medicine that has been discussed very little: death.
The discussion of death is, understandably, quite sensitive; thus, discussing it with such a diverse demographic of students requires a certain amount of skill and reserve. But after learning about concepts such as palliative care and patient-physician relationships, it seems unjust to gloss over one of the most vital roles of a physician — the ability to comfort patients in their most troubling times. ...continue reading →
When Canada’s Supreme Court struck down the law prohibiting the provision of assistance to someone committing suicide in February last year, I wrote a column welcoming this ruling. That led to an invitation to address the Annual Conference of the BC Palliative Care and Hospice Association in May 2015 on the topic of ‘healthy death’.
More recently, I have collaborated with Dr. Douglas McGregor, Medical Director of the Victoria Hospice, in conversations with hospice staff and volunteers from Victoria and across Vancouver Island. Our topic was physician-assisted death (PAD) and the dilemmas this poses for the people who work in hospice and palliative care.
I am very clear that a ‘healthy death’ is one that enables someone to have control over their way of death. ...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 →
Fred Burge is a Professor in the Department of Family Medicine at Dalhousie University, Nova Scotia.
Finally, a plenary session at NAPCRG on dying. For over twenty years I’ve come to this annual meeting as ‘the’ place to be nurtured as that oddest of breeds in medical research, a family doctor. Early in my academic life I thought I wanted to be a full time palliative care doctor. But over time I realized I loved long relationships with patients, sharing their experience with illness, helping them stay healthy and most compelling to me was being with them at life’s tough moments. What I call the transitions. New heart attacks, the diagnosis of multiple sclerosis, cancer diagnoses, depression, relationship challenges and so much more. Being a palliative care doc seemed only to work at the end of all of this. So, I moved back to being and loving family medicine. ...continue reading →