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...

Coalition for Compassionate Care Summit with ePatients

  ePatients: Engaged and Empowered and Invited The Coalition for Compassionate Care of California (CCCC) promotes high-quality, compassionate care for everyone who is seriously ill or nearing the end of life. What a human-centered, patient-centered goal. And now, the Coalition includes the patient’s point of view –  their  first Summit with ePatients : we who are not afraid to look beyond, ask beyond and search beyond what we’ve heard in doctor’s offices. It’s a given that the ‘e’ includes electronic (email, forums, searches) connectivity after all, in between doctor’s visits patients live their lives, and turn to the digital world for support comfort and information. Palliative approach: ripe for ‘ePatient engagement’ Since Palliative care focuses on all aspects of comfort (or as palliative doc, Daphna Grossman put it: doing ‘Nothing’ is not an option) patients and families have ample time to learn about what may be ahead, and put put mind to what’s important long before the end may seem nigh.  Comfort itself can mean many things, in addition to the all-important pain management.  The palliative approach: perfect opportunity for ‘engagement’. ePatient: Educate and Encourage and Evangelize about Palliative Care Great keynote by #ePatientdave with @KathyKastner in foreground at #cccc16! pic.twitter.com/XEOcpm39ir — Elizabeth Bailey (@PatientPOV) May 12, 2016 This is one of the many reasons I was so over-the-moon at the decision to invite patients to the Summit, and was even more so when I was selected. This, especially so because my fellow ePatients are living with chronic conditions – whether themselves or those they care for – where I am not. Rather I am immersed in the crises,...

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...

Dr James Downar: death is as precious as life

He seems far too young to be dedicated to minimizing suffering at life’s end, but that is, indeed, Dr Downar’s mission. His three specialties are inter-related: critical care, ethics and palliative care. Palliative care changes the focus from cure to comfort. This sensibility doesn’t fit with the military language often used in healthcare situations: battling, fighting, giving up, winning, losing. Dr Downar’s take puts that tough language into ‘life’s end’ perspective: “In healthcare, you’re always fighting. At life’s end, what your fighting for changes and what one person means by fighter is different than for another. The goal is to determine what you’re fighting for.” When people are asked about Cardiopulmonary Resuscitation (CPR), they often answer without understanding what is involved, and what the consequences may be. CPR can cause pain and suffering, and studies show that the survival rate after CPR in the hospital is very low. “When the heart stops, it’s usually not a random event. For 95 per cent of the population, death is a predictable event caused by a chronic and incurable disease.” Dying has become a foreign concept for many boomers “An unanticipated consequence of modern medicine is that many adults have never seen someone die. It’s not like previous generations where the dying were attended to at home. As a result, we have trouble accepting death, and we may request therapies that will fix a small problem but actually worsen the quality of life for a dying person.  We need to be comfortable with the idea of improving care by NOT trying to ‘cure’ some problems, such as a pneumonia in a person with...

Quality of Life Better with Less Care at the End

The study focused on patients dying of cancer, but results apply across all chronic illnesses: a multicenter study suggests patients have a better quality of life towards the end if aggressive, life-prolonging measures are avoided and if they are able to die at home. Physician engagement improves dying experience “Physicians who are able to remain engaged and ‘present‘ for their dying patients – by inviting and answering questions and by treating patients in a way that makes them feel that they matter as fellow human beings – have the capacity to improve a dying patient’s ,“ according to authors Although some earlier research has focused on general aspects of end-of-life care, such as pain management and physician responsiveness, the specific factors that matter most to patients with terminal cancer and their families have not been fully explored, the researchers said. “The concept of quality of the in cancer patients has been underexamined in cancer medicine in the quest to develop newer, more advanced, and effective modalities of interventional cytotoxic therapies,” wrote Alan B. Zonderman, PhD, and Michele K. Evans, MD, of the National Institute on Aging in Baltimore, in an invited commentary. In analyses, factors that predicted worse quality of life included major depression, panic disorder, and a high degree of worry, while “a sense of inner peacefulness” at baseline was associated with better quality of life at the end. In the analysis considering the variance in quality of life, the researchers determined that, aside from intensive care stay and in-hospital death, factors that explained quality of life variance in a negative fashion were patient worry, feeding tube placement...