Notes from the Community - Palliative Care

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Sean G., M.D. -

Couldn't agree more with Mel...this is such an important aspect of our job. Having lost my mother to a very long tedious and painful battle with Breast Ca and mets to like every bone in her body, with reluctant visits to Er's like when her femur snapped in half simply by standing....I experienced ER docs that actually REFUSED to speak to me at times(one I wanted to inform my mom was on 1000mg of ms contin daily at this point and the 2mg Morphine he ordered would probably not cover the broken femur) At these end of life interactions what we do and say as a doc will be remembered forever by the ones who have lost their loved ones. The Natalie Merchant song from the 90's "my Beloved wife" eloquently states how many feel in these situations. Sometimes when we see a cachexic pt who looks nearly a corpse in bed we must remember that the spouse/children at bedside are seeing someone completely different, they are seeing the dad, husband, etc that they loved their entire lives. We must keep that in mind when speaking to them.

Rabbott -

Jean is much more cerebral than I am and can actually carry on a discussion on the fly (without offending people, my specialty). It's helpful to me to have a bit of a pre-planned discussion that will get me started and guide me through these very difficult conversations. My thoughts are a bit too long for the comments here, but I am posting a longer commentary on LifeInTheFastlane for those who might be interested.

Jonathan W., M.D. -


You may also wish to invite a lecture on "Living Wills and DNR" as new patient Safety Problem in the ED.

contact Ferdinando L. Mirarchi DO, Medical Director , Dept Of EM Univ. of Pittsburgh, Harmot Medical Center Erie ,PA

ref : Audio Digest EM 29:10 May 21, 2012

Jon Wasserberger

Kevin M., MD -

Outstanding comments Sean

Mark S. -

Sean, having been in a similar situation I second your comments. See the person behind the presentation.

Rob & Jean: Wonderful segment with some great tips for terms and approaches to the conversation. I learnt a lot and greatly enjoyed the talk. Thank you.

Lauren O. -

Thank you, Jean and Rob, for the excellent discussion. I have to admit, I was guilty of using the "menu" approach when offering care to families. On shift last night, I used your approach (and almost exact words) to help the family of a woman with advanced metastatic breast Ca. They went from the ED to a palliative care room where her 5 small children and husband could spend time with her not surrounded by tubes and monitors. She died a few hours later, peacefully. Since they had not had any previous discussion about end-of-life care with her heme-onc doc, your suggestions were beyond helpful. He even gave me a big hug when they left the ED, thanks to your approach.

ryan harris -

PRINT THESE OFF to have in your ED. we are all about not re-inventing the wheel.

these are perfect for patients or family to review when death is not imminent but the patient is clearly on a bad trajectory over the coming weeks to months.

Jean mentions the authors name.

She started THE CONVERSATION PROJECT. which guides patients and families through the end of life care process. It is a packet with step by step instructions to get people thinking about how they want things to go at the end.

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