November 21, 2014

Reflections on My Past Reluctance to Talk about Death and Dying

Today, I had planned to share my answers to the same questions Dr. Atul Gawande asked his dying father... a process he recounted in his terrific bestselling new book, Being Mortal: Medicine and What Matters in the End. But I need to give those answers more thought.

So instead, I decided to discuss a related issue that has bothered me for years -- how I handled the many conversations I had with my wife in the months she spent at Georgetown University Hospital before her death from cancer in 1978.

I'd usually bike to the hospital from my office. On the 15-minute ride, I'd mentally assemble discussion topics for us -- the same news-weather-and-sports subjects typically bandied about at boring Washington cocktail parties.

My chosen topics were exactly what my wife had NOT been thinking about in her hospital bed. We did talk about our kids, her mother, our history -- subjects I'm sure she brought up. But her thoughts about dying? Never. I was surprised when she asked for my suggestions about her memorial service.

We both would have benefited -- drawn closer -- if I had just shut up and encouraged her to talk.

November 20, 2014

Surgeon and Author Atul Gawande on What REALLY Matters at the End of Life

"People with serious illness have priorities besides simply prolonging their lives.Surveys find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The question therefore is not how we can afford this system’s expense. It is how we can build a healthcare system that will actually help people achieve what’s most important to them at the end of their lives."
--Atul Gawande, from Being Mortal: Medicine and What Matters in the End

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Atul Gawande is a highly respected surgeon and a writer for The New Yorker. His powerful and moving new book -- Being Mortal -- was number four on last Sunday's New York Times bestseller list for nonfiction.

He describes in vivid, heart-wrenching detail the final days of patients who are often in such denial of their imminent deaths that they, or their families, demand futile lifesaving measures. Meanwhile, his own profession treats aging, frailty, and death as if they were simply clinical problems to solve.

Usually at this point in blog posts I would go on -- and on and on -- summarizing the book's message. But I have a new resolve to shorten my posts. More compellingly, Gawande has provided his own excellent descriptions during recent interviews, and he is far more articulate than I am. There are several wonderful interviews at the end of this post.

November 19, 2014

Through a Positive Lens: "Aging" at the Annual Meeting of the Gerontological Society of America.

As I begin my own journey working with a geriatrician, I was intrigued to see a blog post in the British Medical Journal about the annual meeting of the Gerontological Society of America earlier this month here in Washington, DC. With 4,000 delegates this year, the gathering is a leading scientific congress on aging.

Blogger Desmond O’Neill -- a geriatrician and cultural gerontologist from Dublin, Ireland – recapped the gathering in such a way that I wish I’d attended the five-day event… or at least part of it.
I’ve been introduced to the philosophy of aging over the past few years by, an excellent website I visit often. The messages from that site are broad and positive, and help readers understand – among other things -- the foolish counter-productivity of anti-aging efforts. There’s no way to stop – or reason to – that fundamental process built into all life on earth. Instead, we should embrace aging, celebrate it, and find in our elderness the special, unique, and wonderful elements we’d have missed if we hadn’t been blessed with the opportunity to live into our senior years.

Dr Francis Collins, director of the National Institutes of Health (NIH), delivered the keynote address. In it, he described how aging has become integral to the work of all 42 constituent NIH institutes, not just to the National Institute on Aging. No surprise there, as the great wave of Baby Boomers begins to reach critical mass.

As a cultural gerontologist, O’Neill enjoyed a presentation by Dr. Thomas Cole, author of many books, including the Pulitzer-Prize nominee The Journey of Life: The Cultural History of Aging in America. O’Neill describes how Cole -- discussing the meaning of aging through engagement with scholarship in the arts and humanities -- identified three ingredients as intrinsic:
  1. Through compassion we recognize our vulnerability and our emotional, moral and spiritual response to others.
  2. We acknowledge the relationship between knower and the known.
  3. We seek an emphasis on moral and spiritual aspects of growing old, especially meaning. 
O’Neill also enjoyed a presentation by Rita Charon, “the doyenne of narrative medicine,” whose talk celebrated the life of the late Gene Cohen, “whose pioneering insight was that late-life creativity occurred not in spite of old age, but because of it."

November 18, 2014

The Pros Offer Tips for PWPs and their Caregivers

An article in the October 4 edition of reviewed the presentations at a recent symposium for people with Parkinson’s (PWPs) and their caregivers. Doctors and other healthcare providers from the University of Florida’s Movement Disorder and Restoration Department addressed several hundred people at the event, sponsored by the National Parkinson Foundation.

Dealing with a Variety of Symptoms
First up was Ramon Rodriguez, MD, a neurologist specializing in Parkinson’s disease. He acknowledged that his audience’s doctors would certainly be treating their most common symptoms, like tremor, stiffness, gait and balance issues. As a result, he wanted to focus on several other important, bothersome non-motor problems that often accompany the disease.

Low blood pressure and neurogenic orthostatic hypotension (NOH) topped Rodriguez’s list. (These are issues I’ve been struggling with for months now, along with scary blood pressure spikes that typically hit as the levodopa wears off at the end of each pill cycle.)

Rodriguez made these points:
  • PD is an idiosyncratic disease which people experience individually. Therefore, PWPs must learn their own individual blood pressure (BP) thresholds, beyond which dizziness and fainting may occur.
  • Drinking lots of water—up to 64oz a day – helps regulate BP.
  • Eating salt (a remedy I use regularly to help treat hypotension) is very effective in raising BP. Said Rodriguez, “This may be contrary to a lot of doctors’ advice, but anything that comes in a can has high sodium content — so buy it and eat it.”
  • Comfortable compression stockings help regulate BP. They’re less risky than drugs.
  • Rodriguez urged listeners to discuss all BP drugs with their doctors – the drugs that raise AND lower pressure.

November 14, 2014

I'm Finally Seeing a Geriatrician. It's About Time!

Yesterday, I had my first meeting  with my geriatrician Dr. G. My research into seniors' healthcare issues convinced me that seeing a geriatric specialist-- not a standard-issue internist -- made more sense for me. I'm hopeful that my new doctor will help me make my remaining years as comfortable and rewarding as possible.

Dr. G is highly regarded and wasn't accepting new patients. But she recently hired two young doctors as associates. At first I was disappointed that I'd been assigned to one of those young docs -- let's call him Dr. A. --  and wouldn't have  Dr. G. all to myself. But both G and A will work with me as a team. Upon reflection, I think the plan makes good sense.

It wasn't clear from my initial meeting but I  guess the associates will  handle the garden-variety ailments -- gaining experience -- while Dr. G gets more time to concentrate on  complex issues... all the while remaining available to her associates and their patients.

I had a relaxed, fun chat with Dr. A during our first visit. He asked questions and showed real interest in my situation. Often in the past, I've felt like I was on a patient conveyor belt that ran through the doctor's office. The conveyor would stop when I arrived but only for  15 minutes; the doctor would spend much of the time cranking data into a laptop scarcely looking at me. Not so with Dr. A.

What's a Geriatrician?
Geriatricians are physicians who have completed residencies in either internal or family medicine. They also spend a year or two studying the medical, social, and psychological issues common among elderly people.

These specialists diagnose and manage multiple disease symptoms, developing care plans that address the special needs of older adults. Their patients may suffer chronic, complex medical conditions, including physical, social and psychological issues.