Wednesday, February 4, 2009

Palliative Care Grand Rounds Vol 1, Issue 1

Welcome to the inaugural edition of Palliative Care Grand Rounds, a monthly blog carnival bringing you the best and most interesting blog posts about hospice, palliative care, death and dying, grief, quality of life, communication in the medical arena, and anything else that strikes the fancy of the host that month.

If you are interested in becoming one of the upcoming hosts, please comment or email me at ctsinclair @t g-m-a-i-l d0t c0m. Here is the website with the archives and upcoming hosts.
If I ever get some spare time maybe we will get a creative little logo going.

Dethmama Chronicles is going to be the next host on Wednesday March 4th. (PCGR is a monthly blog carnival on the first Wednesday of each month.)

Don't feel you have to read all of these at once. Come back and nibble a little bit at a time. And if you read the posts from the other authors, leave a comment and let them know you want to see more!

FROM THE STAFF

Dr. Bob Wachter reviews the recent Archives of Internal Medicine paper showing patients have difficulty naming their doctors. He discusses many lessons learned from this study in his blog post. As you read it consider if palliative care teams suffer from the same problem. With all the members of your team it could be hard to remember who is who. But I imagine with increased face to face time discussing weighty matters it members of the palliative care team may be easier to recall. But currently that is just an untested hypothesis. Sean or Nate could you get on this?

Dethmama always enlightens and entertains with her recollections of interesting home visits as an on-call hospice nurse. The good ones this month are: "The Photo Op" with a surprise twist ending!, "A Talk with a Doc II", and "Hospice Hitwoman and the CYA."

A palliative care NP named Risa reflects on the bewilderment of family at how clinical inertia can overcome advance directives before anyone pauses to notice in her post "How Did This Happen?" She has another great post titled "Drifter" about how easy it can be to give someone a little respect when they were never given any.

Leo Levy at DNR/DNI completes the "My Code" saga. Great narrative style. Here is an example:

The code gets up to full speed. One of the nurses asks how many times we are going to do this. “Someone needs to bring the family!” I call out. This time my words find purchase. Eyes turn to the fellow. The rest of the team does not know about our conversation. Will she take this as a challenge to her authority? There is a moment of tension in the room. “It’s alright, go get the family,” she says
Hopeful LSW at Confessions of a Young Looking Social Worker posts the many reasons why she loves her job as a hospice social worker. Here are a few of my favorites from her post:
A man who helped build the Sears Tower (I was in awe of his courage)

A woman who was heavily involved in promoting a woman's right to vote and began several activist groups in her town...and continued to do her part after suffering a stroke at age 40...after the birth of her 6th son. Talk about strength!

A man who was a steeplejack, a trade he learned from his uncle that no longer exists
How do you want to die? In your sleep? Nibbled to death by the piranhas of senescence? Ask Duncan Cross.

HospiceNP
lets us know the difference between "the work" and "the job."

Kevin MD brings attention to why it is so difficult to die in American hospitals.

Is being a hospice doctor depressing?
Dr. David Tribble from the Alive Hospice Blog (welcome to the show Alive Hospice) lets you know it is not so depressing.

Dr. Bernstein from the Bioethics Discussion Blog asks which state is next for legalizing physician assisted suicide? What do you think?

Tigermom at Two Women Blogging posts a story about a friend with metastatic cancer who is also a therapist for others with severe illness. Does helping others cope, help you cope?

Aggravated DocSurg spins a story about the death of a trauma patient using the Four Horsemen as a unifying theme. Good literary stuff! Here is an excerpt:
Surgeons and anesthesiologists really don't like it when patients die in the OR, so after the "ex fix" has been placed and the femur appropriately splinted, Billy Bob takes his final ride tour of the hospital, to the ICU. Cold, coagulopathic, and comatose, there is nothing else that can be done, and Billy Bob continues to hemorrhage and eventually develops cardiac dysrhythmias and dies.
Good bedside manner is a key trait for the effective palliative care clinician. When your conversations sometimes go from zero to death in five minutes then you realize how empathy, compassion and good communication skills are wonderful assets to posess. Dr. Centor discusses the responsibility for attending physicians to model and teach good bedside manner. His blog post was spurred by a recent Pauline Chen article about the same issue in the NY Times.

FROM THOSE IN THE KNOW

There are so many interesting posts from Jessica Knapp at The Good Death that I could not just pick one. As a PhD candidate she is focusing on communication as a way to improve the way we approach death and dying. She covers mortuary bands, rights of same-sex partners in illness, and online grief support sites. But my favorite has to be "Cybertime" in which her mother opens a Gmail account and finds 177 unread emails from her recently deceased father. It is a MUST READ STORY!

Niko Karvounis at Health Beat Blog discusses the "Danger of For-Profit Hospices" in our future health care system with the awareness of the rapid expansion in the last decade and the increased scrutiny to the Medicare Hospice Benefit. ANOTHER MUST READ!

Les Morgan from Growthhouse has a great summary on funeral information and questions to ask. Would be great in pamphlet form!

Bill Colby, JD, known for his work in the Cruzan case and now a senior fellow at the Center for Practical Bioethics asks a very important question: Can Living Wills Work?

Tim Cousinais from the Palliative Care Success blog asks an important question and we need some answers: Will health reform accelerate or stall the progress of palliative medicine?

Wesley J. Smith has been a vocal opponent against euthanasia and physician-assisted suicide on his blog Secondhand Smoke. He recently posted a video called "The Euthanasia Blues." The only song I know with 'palliative care doctor' in the lyrics. For a good reflection of the chord this song strieks with people make sure to read some of the comments on his blog and on You Tube. Thaddeus Pope of Medical Futility writes about Smith:
"Smith often broadly attacks end-of-life mechanisms like PAS and unilateral withdrawal, even though such mechanisms can be invoked in justifiable circumstances. Nevertheless, he (and this video) are correct to imply that such mechanisms can be (and are) sometimes illicitly employed."
FROM THE PATIENT & FAMILY

Cancer patients have capitalized on the use of blogs to extend social support networks. The ability to update many with a few minutes at the keyboard seems so simple and yet the lives it impacts is so powerful. Anna Douglas, a popular BMJ blogger chronicling her experience with cancer died on February 1st. Her blog, From the Other Side, was started in April of 2008, and there are only a score of posts, but many offer great insights to her treatment.

HopefulLSW made note of another blogger with cancer, Kindra McLennan, who died on January 2nd of this year. Her post makes note of a Chicago Tribune story about the impact of Kindra's blog and some notable posts.

NPR's contribution to the cancer patient blogosphere has persisted despite the death of the initial blogger Larry Sievers. His wife offers reflections on her bereavement now that Larry is no longer with her. It is now expanding to a community titled, "Our Cancer." A recent post covered the occasional non-fit of a hospice nurse and a patient, but thankfully that experience did not make them turn their backs on hospice support forever. This would be the second time a hospice person would come into our home. The first time was a bad fit. We both couldn't wait for her to leave. So this time around, we were a little nervous.

Gail Rae from Mom & Me Journals relates the thin line caregivers walk when caring for a patient in decline when it comes to nutrition and hydration in her post "I Trust her with my Life." She compares her experience with a 1994 Law & Order episode entitled Golden Years, which focuses on formal and informal caregivers in conflict about feeding a frail home bound elderly woman.


Thanks for reading all the way to the end of the first edition of Palliative Care Grand Rounds. I hope you enjoyed some of the links. Any feedback about this new initiative would be great!!!
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