Standing up for a Harvard Doctor

There was a very important article written in the NY Times today. It highlighted a common medical scenario in my world—the defibrillator (ICD) world. I am going to talk about ICDs here, but the big picture inherent in this story illustrates the important issue of how best to apply invasive therapy to elderly and sicker […]

My ICD presentation to a Hospice and Palliative Care Group

Last night I gave a twenty-minute presentation on ICDs to a group of hospice and palliative care professionals. It was a real honor to speak to such an enlightened and dedicated group of caregivers. These are people who really get it. I wasn’t restricted in what to say about ICDs. They kindly gave me plenty […]

Going gently…

…is how doctors die. Few essays written by doctors are more relevant to today’s crisis in end of life care than Dr Ken Murray’s now famous, Why Doctors Die Differently.  It made it to the WSJ today, thank goodness. It’s available for free in its original (and longer) form at Zocala Public Square. We discussed […]

Let’s stop being ashamed of (discussing) death

I recently wrote a post about what happens when the elderly get sick. It was meant to accelerate the conversation about how modern medicine can’t make us immortal. I meant to say that doctors need to learn to be less ashamed of death. And that patients should at least hear about the risks of life-prolonging […]

When will Palliative Care and Hospice discussions be considered normal?

The patient greeted me with a smile that belied his horrible luck. He was my age, but looked far older. It was a slowly progressive neurological disorder that left his mind intact while his body stopped working. He was now imprisoned in a bed. Various family members fed him, changed his diaper, and freshened the […]

A difficult decision..but the right one.

For me, November 14th will always be a special day. Today is the 16th anniversary of my grandmother’s death. ‘Non’ was in her late 80s when she died. I was in Indiana learning to be a cardiologist, she was at home in Windsor Locks, Ct. I have written about her love previously—as an infant blogger. […]

A simple phone call…

His wife said, “I couldn’t wake him from his nap.”  The coroner told her he died in his sleep without moving a muscle.  His family doctor told me that Parkinson’s had slowed him greatly in the past year. He was 81, and the day before, he had enjoyed the usual lunch with friends. His multi-lead […]

What to do when a chronically ill patient reaches the end of battery life of their cardiac defibrillator…

Years ago at the time of the original cardiac defibrillator implant (ICD), he was a vibrant active man who had suffered from an arrhythmia related to scar from a remote heart attack. Things change.  Life has chapters. It is amazing what can happen to a person during the 5-7 year battery life of an ICD. […]

Do doctors have permission to stop certain therapies…

Here are two vignettes illustrating the failure of doctors to master the obvious and maybe a window onto the future struggles to control medical costs. A 90 year old is referred for care due to “end stage dementia.”  End-stage dementia is medical speak and as such does not really convey the appropriate imagery.  It means […]

Misinformation in medicine is really bad…

The editor in chief of the Journal of the American College of Cardiology, (aka: JACC, the leading cardiology journal) has written an opinion statement concerning end of life care. He discusses a clear cut case of an elderly patient who is dying from advanced heart disease. He appropriately describes the transitioning of life prolonging treatment […]