Grief is Not Self-Pity: Joan Didion ’s The Year of Magical Thinking
by Vivian Lam“Life changes fast.Life changes in the instant.You sit down to dinner and life as you know it ends. The question of self-pity. ”When does grief become “self-pity”? What is the “proper” way to grieve?Joan Didion begins writing what would becomeThe Year of Magical Thinking a few days after her husband, John Dunne, dies from a heart attack. Coupled with the mounting health crises of her daughter, Quintana, Didion ’s world is thrown out of joint. In the ongoing aftermath of these tragedies, Didion, acclaimed novelist and literary journalist, copes by doing what she has done all her life—write....
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 28, 2016 Category: Palliative Care Tags: book Didion grief lam magical media review Source Type: blogs

Number One Palliative-Themed Movie? Wit
by Amy Clarkson(Margaret Edson,author of Wit, will be speaking at the 2016 Palliative Care in Oncology Symposium, so we are sharingthis review from our Arts and Humanities site, originally published in 2009. - Ed.)There are many movies out there with palliative themes, as we can attest to withour top 10 movie post, which garnered much comments. One of my all time favorites, also made number 1 on our top 10 palliative-themed movies list; Wit.I first saw this movie in medical school. In fact,according to the IMDb, this movie is known for being shown at medical schools as an example of how not to practice medicine. Also,...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 8, 2016 Category: Palliative Care Tags: cancer film media play review Source Type: blogs

What Makes Up High-Quality Primary Palliative Care in Oncology?
by Ross AlbertI ' m surprised that I ’m not hearing more about the recent ‘Guidance Statement ’ put out by the collaboration of ASCO and AAHPM on “Defining High-Quality Palliative Care in Oncology Practice.” (OPEN ACCESS PDF) It ’s a report that provides some very interesting insight into what pieces of primary palliative care should be part of general medical oncologists’ practice.When I read it the report, I was pleased to see that it waspublished in ASCO ’s journal, and I noted the impressive list of authors. My eyes briefly glazed over as the discussion moved to Delphi methodology, but a few quick ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 7, 2016 Category: Palliative Care Tags: AAHPM ASCO breast cancer colorectal cancer lung cancer oncology Source Type: blogs

PCHETA has a date with a subcommittee! Thank your rep!
by Christian SinclairHey all you hard-working palliatricians and hospice clinicians, we have some pretty exciting news for you! This Thursday Sep 8th, thePalliative Care Hospice Education and Training Act (PCHETA - H.R. 3119/S. 2748) is going on a first date with the House of Representatives Subcommittee on Health (who even has their ownhashtag #SubHealth).So what does this mean?This legislative hearing includes PCHETA and 4 other bipartisan bills focused on improving public health that are being considered for further advancement to the full committee level and eventual consideration in the house. If it goes well, we are ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 6, 2016 Category: Palliative Care Source Type: blogs

Do hospice patients reveal the secrets to the universe?
This article is the sixth in a series of articles where I take each assumption from the original article and explore the concept in greater depth to include implications and possible interventions. In my last article, I wrote about the assumption thatfamily matters will get resolved.Here is our next assumption: The secrets to the universe will be revealed.I admit I went into hospice work with the expectation that I would have profound experiences at the bedside with dying patients. How could one not have this expectation when we see articles about famous last words, such as theNPR article about Steve Jobs saying, “Oh wow...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 5, 2016 Category: Palliative Care Tags: assumptions door expectations family intervention lizzy miles psychosocial secrets social work universe Source Type: blogs

August 2016 Pallimed Recap
by Christian SinclairAugust 2016 has left the building along with a lot of heat, rain and wildfires.Here is a recap of all of our posts from August 2016. We know there are some you may have already bookmarked, but forgot to read, or maybe you liked it so much you want to share it again.Make sure to follow, engage, like and comment with us onFacebook,Twitter,Google+,Pinterest,Tumblr,Instagram andLinkedIN. We always appreciate it when you recommend us to your peers and social media makes it very easy!CommunicationPalliative Chemotherapy: An Oxymoron by Rebecca Gagne HendersonHumanities/Media ReviewsRedefining " Death in...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 4, 2016 Category: Palliative Care Tags: book burnout cancer chemotherapy comments facebook icu instagram media neuro NICU oncology pediatrics research review self care social media The profession twitter Source Type: blogs

August 2016 Palliative Care Review
by Christian SinclairSome August highlights from non-core HPC journals focusing on palliative care and hospice topics. Anyone who would like to explore any article in depth for a future Pallimed post iswelcome to contact us.Nondisclosure by Dr. Abby Rosenberg, published in JAMA, is a wonderful opportunity to examine if we are doing the right thing for a patient. Having reconnected with the mother of a teenage patient who died 6 years ago, the doctor and the mother were able to talk about the struggle to disclose to Sam, the patient, that he was dying. Dr. Paul Rousseau offers a great analysis of the faulty-thinki...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 31, 2016 Category: Palliative Care Tags: cancer CPR ethics geriatrics JAMA journal article narrative opioids pain research review surgery Source Type: blogs

What happens when it ’s you?
by Michael FratkinNobody was prepared when Barbara ’s husband died quickly last month. It turns out, he was both covering for her difficulties and caring for her 24 hours a day. Barbara was accompanied throughout life by a profound depression and, for 40 years by a man who was many things. Strong with integrity and a dedication to Barbara, he had a 24/7 obsession with Fox News. No one, especially his family, described him as nice. He pretended she was functioning reasonably well, even after an anoxic brain injury took its toll three years ago. Since his death, Barbara’s two daughters suspended their own lives and trave...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 30, 2016 Category: Palliative Care Tags: fratkin hpm hpmchat tweetchat Source Type: blogs

Photovoice Roundup: Self Care
We asked hospice and palliative care professionals to answer us via a picture, " What is your self care activity of choice? "We learned a lot about our colleagues from this exercise. Everyone had unique answers for ways in which they comfort themselves. (Source: Pallimed: A Hospice and Palliative Medicine Blog)
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 26, 2016 Category: Palliative Care Tags: lizzy miles photovoice roundup self-care Source Type: blogs

Building Resilience in Clinicians to Prevent Burnout
by Arif KamalOn the topic of palliative care clinician wellness, we are starting to recognize that there is some good news to counter all the bad. First, the bad news. If you ’re reading this, and you believe that burnout has not touched your professional life, then it is likely that the colleagues sitting to the immediate left and right of you are not so lucky. Recent survey data of over 1300 palliative care clinicians highlight a sobering statistic: almost two-thir ds of our colleagues report burnout (Kamal JPSM 2016). This is among the highest rate of all medical disciplines, and significantly higher than the 45% aver...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 23, 2016 Category: Palliative Care Tags: burnout kamal The profession Source Type: blogs

Redefining “Death in Dignity”: Sherwin Nuland’s How We Die
by Vivian LamWe begin with an image of Sherwin Nuland as a bright-eyed third year medical student, cutting open a dead man ’s chest and cupping his heart with bare hands.After several moments of desperation, the man, James McCarty, roars a death rattle that stops Nuland in his tracks. We look upon a vivid scene of carnage and defeat —Nuland is soaked with sweat and blood, sobbing and “demanding that he live, screaming his name into his left ear as though he could hear me, and weeping all the time with the frustration and sorrow of my failure, his” (7). Dave, the intern on duty, comes into the room and holds Nuland ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 17, 2016 Category: Palliative Care Tags: book lam media review surgery Source Type: blogs

Behind the Scenes: Media Watch by Barry Ashpole
by Barry R. Ashpole(Being avid fans and readers of Barry Ashpole and Media Watch (sample issue) for years, we wanted to share his story and background with you. - Ed.)Keeping abreast of current thinking in almost any field of endeavour is a challenge. Health professionals, as an example, are often hard pressed to keep abreast of what is being published or reported – monitoring emerging trends or tracking what or who informs the decision or policy making processes. Generally speaking, a health professional’s scope of practice dictates to a greater or lesser extent what sources of information he or she accesses, for exam...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 17, 2016 Category: Palliative Care Tags: ashpole media Source Type: blogs

Trisomy 13 and 18: When a lethal condition is no longer lethal
by Jenni LinebargerWhat is a “lethal condition” really? How does the definition change as medical advances are made? Several times a year, I meet parents who’ve had providers tell them that their baby has a “lethal diagnosis” (or worse, that the diagnosis is “incompatible with life”) when testing detects trisomy 13 or trisomy 18. Such dire prognostication sets the stage for all future interactions with the health care community. For some, it becomes a rallying cry to prove providers wrong, for others it becomes a sealed fate. For all, it declares a level of certainty that we just do not have.This summer, ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 15, 2016 Category: Palliative Care Tags: ethics hospital linebarger NICU pediatrics surgery Source Type: blogs

Worse than death?...Dependence
This study out of Philadelphia surveyed 180 hospitalized patients with serious illness on their views of various health states, and how severe or unacceptable they considered them. What was fascinating was that the scale used was based on death as the benchmark on their Likert scale—“wors e than death, neither better nor worse than death, a little better than death, somewhat better than death, or much better than death.”The study revealed that in this group of patients with advanced cancers, heart failure, and COPD, health states with significant dependence on machines and on care from other people were frequently de...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 13, 2016 Category: Palliative Care Tags: albert cancer death/dying heart failure pulmonary/copd research Source Type: blogs

FOUR Score: Coma scales and prognosis in the ICU
by Drew RosielleIn neuro-critical care, prediction of outcomes is often tricky because of the wide variability in the ability of the brain to recover and the usual long periods needed before seeing what is the limit of recovery. Most people are familiar with the Glasgow Coma Scale, but back in 2009 Mayo Clinic Proceedings published a study of the FOUR score), which presents some prognostic data for ICU patients. FOUR = ' Full Outline of UnResponsiveness. ' (It is also written as 4S. - Ed.)This was a single institution study (Mayo Rochester) primarily designed to investigate whether the FOUR score is a reliab...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 10, 2016 Category: Palliative Care Tags: icu neuro open access prognosis rosielle Source Type: blogs