living your best to the end

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...

Organ and Tissue Donation: a learning experience

Donna Renzetti (left, standing) Vice President, Corporate Services and Chief Financial Officer at West Park Healthcare Centre came in on a Saturday to make sure there were plenty of chairs at the ready for the Trillium Gift of Life Network (TGLN) presentation on organ and tissue donation and transplant. She needn’t have worried: the gathering group were all wheelchair bound – or rather, wheelchair liberated (depending on your point of view) with the range of wheelchairs equivalent to a high-end car collection, complete with customization. I’m a public member on West Park Healthcare Center’s Palliative and Supportive Steering Committee, and am always up for attending education sessions that can increase my knowledge and understanding of end of life concerns and issues for their residents. Donation is not just for the able-bodied These good folks, for whom day to day living is their first priority, were interested in learning about organ and tissue donation. Their home is the complex continuing care section of West Park Health Center and many live with terminal degenerative conditions like Lou Gehrig disease (ALS) , Lung Disease (COPD), stroke, traumatic brain injury. Restricted and diminished though these West Park residents may appear to me – it’s clear they know exactly with whom they want to sit and are affectionate and caring with one another – communicating by various means. This is a substantially different crowd than the week prior, when I’d attended an Ontario Hospital Association conference on Ethics and Legalities in End of Life, where TGLN also made a presentation, encouraging discussion, decisions and making wishes known. That group, from various healthcare organizations, heard:...

Dr Michael Gordon: geriatrician and humanist

Dr Michael Gordon on playing music together, information vs knowledge and sex. Dr Michael Gordon, Geriatrician (amongst other things) What a wonderful wide-ranging conversation with Dr. Michael Gordon, Geriatrician, Writer, and Ethicist. Not necessarily in that order. His terrific and highly readable book,Moments that Matter: Cases in Ethical Eldercare was the basis for us talking – but the good doctor rose to the occasion when I put forward my belief about decision-making: it’s rarely the domain of the individual alone. Using a lovely musical analogy that succinctly articulated my observations: decisions are made, not in isolation, but in collaboration and consultation with our community. “Autonomy in decision-making is a misconception. Rarely do we act as soloists: we’re always playing with others. Even virtuosos are usually backed by an orchestra.” We talked about the overabundance of information. “Along the info highway, we’re given lots of data. That data has to be translated into information – which still doesn’t tell us what to do. Information has to coalesce into knowledge, which has to be seen in the light of what’s right for you.” Recognizing the impact of the internet, another tale of well-meant but poorly executed information: “Getting older, we lose our sense of thirst. We’ve all been told to drink 8 glasses of water a day, so this concerned daughter was making sure her mother got the full quota. Meanwhile her mother was becoming increasingly confused. Some simple tests revealed that with all that water, combined with diminished kidney function, her body was losing sodium and potassium. She didn’t have enough salt being retained because she was also taking a...