Archive | December, 2012

End of life

21 Dec

Yesterday I teared up on rounds as we were discussing end-of-life care.

We were talking about the end of life and how the caring for the person at that point changes when you are balancing quality and quantity of life. More specifically, we were discussing people who are imminently dying and whether or not they feel thirsty or hungry, and whether feeding them and providing fluids for them was doing more harm than good. My attending was telling us that feeling thirst at the end of life isn’t correlated with the amount of fluid the person needs, and that the thirst can often be alleviated by swabbing the person’s lips and mouth with a moist sponge. Over time, people tend to stop feeling thirsty or hungry at all. She described a common scenario where the family of the dying patient are alarmed that their loved one isn’t being fed or given fluids anymore, even if the family understands that the patient is imminently terminal. There’s an instinctive cross-cultural urge to continue feeding the loved one, thinking that it’s needed to be kept comfortable and alive. I was trying to focus on her point which was that when it comes to people who are that far gone, feeding them can lead to more discomfort with increased salivation and GI secretions that can predispose them to choking, infections, increased interventions and potentially a more drawn-out and painful death.

But I was just picturing my grandma in the hospital bed asking over and over for hot water. But she was NPO because they were worried she’d aspirate. I finally wet a gauze and put it in her mouth. She sucked on it and didn’t ask for water any more. A few days later she died, they said it was because of aspiration pneumonia. I cried because I thought I had contributed to that since I had given her a bit of water when she was thirsty. Even though people told me the small bit of moisture in her mouth couldn’t have caused her aspiration, that she already had food remnants in her esophagus before coming to the hospital, and even after hearing from my attending on rounds that providing a swab of water helps relieve the thirsty suffering without risking them aspirating, I still felt sad and teared up.

Funny experience, standing on the ward floor in our white coats and steths around our necks, discussing studies and evidence for this or that medicine or treatment or intervention, while feeling such dramatic emotions inside. We talk about these things without talking about how it makes us feel. It’s ok to bring up previous experiences with patients, but we don’t bring up personal experiences with our own family or friends. Even though I think one of the most important things is to be able to feel what you’re talking about, to be emotional, to empathize, I still struggled hard to dissociate any feelings from what we were talking about, and to look at it as just facts.

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Burnt popcorn, burnt arm, burnt counter.

4 Dec

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Three burns in the process of trying to save a cup from smashing on the floor. I’m up to three cups of coffee a day. It has been gently suggested to me that three cups a day is not good.

From Wikipedia’s Stages of Change:

precontemplation: people are not intending to take action in the forseeable future and are unaware that their behaviour is problematic.

contemplation: People are beginning to recognize that their behaviour is problematic and begin looking at pros and cons of their actions.

But I neeeeeed it…

Link

Spice Island gets some rec

1 Dec

Grenada’s on National Geographic’s list of best trips for 2013!

This was my home for a year!

I’ve been thinking of Grenada a lot lately. Maybe I’ll head back there for a rotation soon, or better yet just a plain old vacation-style visit.

Bless Grenada.

Breakfast with the mamabird

1 Dec

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Coffee and egg with my mom.

Home

1 Dec

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It may be cold but there is snow on the ground and the people feel so normal.

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