living your best to the end

Dr. Michael Fratkin is an enabler

“Most of my healing has little to do with medicine.” “My approach has more to do with being there, listening and helping people with a different approach.” Fratkin, entrepreneur creator of Resolution Care,  is a Palliative doctor whose conversations enable people to see things differently The 37-year old alcoholic He gives me an example: “A 37 year old guy who’d almost drunk himself to death – and not for the first time. I knew this patient because he came to us for Rehab. After 10 months of sobriety, he fell of the wagon: Shit happens.” A week ago, this 37 year old had a 75% chance of dying. Two weeks ago, his doctor wanted to change hospitals: “That’s what the family wants.” I was told. Fratkin thought it was crazy, and not medically indicated. “But I didn’t know enough about the situation, so I checked in on him. He was doing better, but was still high risk. I spoke to his mom via video. His mom loves him, and understands him as an alcoholic. Almost killed his liver with hepatitis, but she loves him.  So I asked: What do I need to know – as a parent – to better understand what’s going on, what you’re feeling. And I determined what the family really wants is for him have to have another chance, they want to know how they can help him to survive. Nobody explored that until I spoke to her. 45 min later, he and his mother were able to see things differently. There was healing in the space: if he dies today, there is healing in...

Extreme Measures: Dr Jessica Zitter on a Palliative mission

“I’m going to call 911: a doctor is torturing a patient.” So said Nurse Pat Murphy to Dr Jessica Zitter  – just as Zitter was about to plunge a syringe into the neck of a patient with a host of health issues. Tho the 911 call wasn’t made, it was a turning point for Zitter – who trained as a critical care doctor, and for whom going gently into that good night felt like she was abandoning a patient, a failure. That encounter with Nurse Murphy led her to completely change her own medical ‘mandate’ – becoming a Palliative doctor – the specialty that embodies the philosophy of ‘patient-centered’ medicine. I first ‘met’ Dr Zitter in a New York Times essay in which she admits on her first night on call as a Palliative doctor she hadn’t yet completely relinquished her ‘critical care save the life at all costs’ ‘tude. A healthcare team in conflict The patient ­– a Holocaust survivor ­– was sleeping peacefully. She’d been admitted with pneumonia, but it hadn’t responded to treatment. As she got sicker and her breathing harder, she was made comfortable. The doctor attending the patient told the team gathered that she had clearly said she didn’t want a breathing tube, but the respiratory therapist wasn’t comfortable not intubating: “I’m not really sure she ‘got it’ she was pretty out of it.” Zitter was also unsure. The compromise was to strap on an oxygen mask overnight and re-assess in the morning. The morning found the patient ‘delirious and terrified, her mask off center and totally ineffective.” Confirmation of commitment to Palliative Care...

Infections in the elderly how to best treat: Are antibiotics always the answer

‘If you don’t give her antibiotics, she’ll go toxic and die.” Although my 96 year old aunt (pictured at left, between me and my cousin – her daughter) had no symptoms of a bladder infection, a urine test resulting from cloudy pee revealed she indeed had a Urinary Tract Infection (UTI. My aunt hadn’t complained about pain or discomfort, my cousin – her ‘power of attorney’ – authorized treatment with antibiotics. Many would agree. However, when I shared this with Dr. Jocelyn Charles, Chief of the Department of Family & Community. Medicine and Medical Director of the Veterans Centre at Sunnybrook Health Center, she shook her head. “Treating the test results and not the patient.” The (assuredly well-meaning) healthcare professional who made that pronouncement was talking about ‘sepsis’: when the bloodstream – and therefore the whole body – has become one big infection it becomes ‘toxic.’ In a younger person, antibiotics – standard protocol – would be a no-brainer. Rarely it seems, is taken into account the repercussions of ‘standard protocal’ in the elderly. Functionality and age should have an impact on treatment decisions From the blog, Geripal – devoted to optimal treatment of the elderly: Survival from severe sepsis: yes the infection is cured but not all is well – the point is made that, in the elderly – unlike those younger, whose bodies have more resources – treatment does not equal ‘back to how she was before’. Instead, treatment that sounds so necessary and logical can lead to increased confusion, worsening dementia, and a more vulnerable immune system. In my aunt’s case, several courses of antibiotics failed....

Dying in the operating room? Rarely happens.

Dying after the operating room is a different story. “People worry about ‘dying poorly’, so one of the reasons for agreeing to surgery is the mistaken belief they’ll likely die – peacefully – in the Operating Room. This rarely happens.” Dr Gretchen Schwarze To understand what can happen even if the surgery or operation is successful, Palliative doctor, Toby Campbell and Surgeon, Gretchen Schwarze feel stories are necessary to paint a picture for ‘consent’.               To illustrate, Dr Schwarze tells this story: “She’s in her late 70’s, with chronic kidney failure and COPD. She’s making it a home with lots of support – but just barely. Now she has an aneurysm, that’s likely going to lead to a medical crisis. Should she have surgery for the aneurysm to prevent the medical crisis?” Using statistics to describe success or failure, her family’s told: 50% chance of not surviving surgery 60% going to need dialysis for renal failure 80% chance going to need ventilator (breathing machine) What the family hears is: 50% chance of survival 40% chance of NOT needing dialysis 20% chance of NOT needing “So, they went for the surgery, took about 8 hours, overall doing well, as best as could be hoped for. When her family came to see her in the ICU, you can imagine what they saw. She was puffy with a breathing tube, with lines and wires and machines. They said, ‘this is not what she would have wanted’ and asked the team to withdraw all supports.” We’ve been so good with innovating in so many areas, communication is...

Death and doctors who don’t want to talk about it

What happens when patients want to talk about death, but their doctors don’t? My 94 year-old father-in-law was relieved and delighted when I brought forth the subject of medical directions, in the event he couldn’t speak for himself. My brother in law – a paramedic – brought a standard Do Not Resuscitate (DNR) form. Although written in largely incomprehensible language for a mere non health care professional, I took it upon myself to discuss more than just the decision to resuscitate – shocking his heart back to life. He was right on board with ‘no heroic measures’ – and even more adamant when he understood what ‘heroic’ and ‘measures’ meant in the context of his quality of life.This form required signature from a doctor, so he brought it to his next regular visit to his long-time family doctor. His doctor was aghast. “Who put you up to this? I’m not going to sign this. I don’t think this is what you’d want.” What?! Not an isolated incident, as I’ve discovered. I’ve been conducting informal interviews with healthcare professionals of all stripes about their reaction to not initiating or discontinuing life-prolonging interventions. This includes supplemental feeding (Feeding Tubes) breathing (ventilators and tracheostomies) and dialysis. It’s as if you’ve asked them to condone murder. It’s as if you’ve asked them what they’d want for themselves.. Often these are the same healthcare professionals who purport to want to follow patients wishes, but who try to talk their patients out of their wishes. “If I do that, you know what it will lead to.” Well, yes. It’ll lead to the death, but possibly...

Palliative Care: Doing ‘nothing’ is not an option

 Dr Daphna Grossman wants to set the record straight “In healthcare it seems we talk about ‘doing everything’ or ‘doing nothing’. With Palliative care ‘nothing’ is not an option. Certainly there are standards and recommendations and then there’s the Art of Treatment: our goal is to treat the whole person – physical, psychological spiritual and social. We look at a person’s goal of care. Can this goal be achieved? Not all illnesses can be cured however, symptoms can be alleviated.” Dr. Grossman is deputy head of the Palliative Care Unit at Baycrest, an internationally respected academic health sciences centre focused on aging, and onsite resident coordinator for their palliative care unit. Her passion for palliative care radiates off her, and she paints this picture: deputy head of the palliative care unit, and site resident coordinator for palliative care. – See more at: http://www.baycrest.org/educate/insights-into-aging-101/presenters-bios/#sthash.yuLPPMKA.dpuf deputy head of the palliative care unit, and site resident coordinator for palliative care. – See more at: http://www.baycrest.org/educate/insights-into-aging-101/presenters-bios/#sthash.yuLPPMKA.dpuf deputy head of the palliative care unit, and site resident coordinator for palliative care. – See more at: http://www.baycrest.org/educate/insights-into-aging-101/presenters-bios/#sthash.yuLPPMKA.dpuf deputy head of the palliative care unit, and site resident coordinator for palliative care. – See more at: http://www.baycrest.org/educate/insights-into-aging-101/presenters-bios/#sthash.yuLPPMKA.dpufHer passion for palliative care radiates off her, paints this picture: “If we only treat patients in terms of their physical issues such as addressing their test results it’s like looking at a picture in black and white. We need to also address the context, the person, who they are, and what is important to them to paint a picture that is in colour.” The thing is, people,often perceive Palliative...