Wednesday, April 1, 2009

Palliative Care Grand Rounds, Volume 1, Issue 3

Welcome to volume one, issue 3 of Palliative Care Grand Rounds!

Here you will find an overview of what's been happening in the cyberworld regarding palliative care, death, dying, end-of-life care, and all sorts of related topics for the past month. 

Entries in this series are rotating throughout palliative-care-oriented blogs and are hosted on the first Wednesday of each month. Next month's series will be hosted by Thaddeus Pope at Medical Futility on May 6th. 

There is a lot here, so if you want to read a bit at a time and come back later to read some more, that might be a good way to approach it. I do realize it looks overwhelming :)

That said, let's jump right in ... 

This month, a study was released in JAMA telling us that terminal cancer patients who are self-defined as religious are nearly three times as likely to seek life-sustaining measures near the end, and are also less likely to prepare for death—in terms of advance directives, living wills, healthcare advocates.

Also this month, Washington's Initiative 1000 went into law, legalizing physician assisted suicide. One stipulation of the law is that hospitals and individual practitioners can choose to opt out of the legislation. The has the potential to cause massive confusion. As a Washington-based nurse practitioner, risaden of Risa's Pieces, has an excellent post on his thoughts on this law, what he has encountered related to it, and how it compares to Oregon's law.  

Taking a harder look at the risks of skiing without a helmet, and the signs of serious head trauma in the wake of Natasha Richardson's death—a sad reminder that death by falling is the third most common cause of accidental death

60-Second Psych in Scientific American takes a look at whether the suicide of Nicholas Hughes, the son of Sylvia Plath and Ted Hughes, was due to hereditary causes. Children of mother's who kill themselves are more likely to commit suicide ... but is that correlation or genetics?

If the Rapture occurred, what would happen to your bank account? That's right, the Christian Rapture. Well, Mark Head thinks that in the event of the Rapture, in the midst of God's eternal glory, you will still be worrying about what is happening to your financials down on earth, So, for a $40 fee, he has a service that sets up an email that can be sent to your relatives with your bank account information. (And you can totally trust Mr. Head with your financial information.) "Christians on call" for the site log on to it to keep it going. If no one logs on for three days, it is assumed Rapture has taken place, and the emails are sent out. I guess you'd want to pick your most heathen-y relatives, just to ensure they're left behind to receive the email. How do you start that conversation?

This piece is a real doozy. How you go from normal life and a simple spinout in snowy conditions to freezing to death, or nearly freezing to death. And what it's like to freeze to death. Fascinating. Well-written. From Outside magazine online. 

A story about taking care of Sean, a former Fortune 500 company worker with early onset Alzheimer's, from the blog Confessions of a Young Looking Social Worker

A geropsychiatrist writes about two old goats—one figurative and one literal—both using the same meds to good purpose. Funny!

A touching piece that comes very close to my interests. A medical librarian writes about her mother-in-law's good death from cancer—thanks largely to the help of good hospice care—and the bittersweet satisfaction that brought the family. 

The blog Palliative Care Success discusses a NEJM article that shows high-spending regions of the country are more likely to recommend hospitalization for an 85-year-old patient with an exacerbation of end-stage congestive heart failure. They were also three times as likely to admit this patient to intensive care, and 30% less likely to discuss palliative care with the patient and family. The post suggests Advanced Palliative Care Organizations (APCOs) can help reduce the number of people dying in hospitals and reduce the number of days patients spend at the hospital near the end, but APCOs are limited in how many physicians and other professionals they are drawing. 

The relationship between palliative care and the church, the spiritual role of palliative care ... but also the palliative care needed by a dying church (in this particular community) are all addressed in this beautiful blog entry written by a former pastor and Tampa-based hospice worker. 

Fran Johns, one of my favorite bloggers, has a beautiful piece on the therapeutic and restorative qualities of pulling Oxalis. Fran is part of the slow-blogging movement and does not update often, but when she does, it is always something amazing. Be sure to bookmark her site. 

At The Mom and Me Journals dot Net, Gail Rae writes about donating some of her mother's items to a garage sale. The need to de-clutter leads her to rid the place of her deceased mother's items as if they are just things, but one special piece, a tiara, needs an important home. 

Dethmama finds welcome relief from her work as a hospice nurse in the form of a new puppy named Olive. She has also posted a long-awaited sequel to a great story, Hospice Hitwoman and the C.Y.A., about a family who is anxious to see their loved on pass away, before the right time even. 

At the Pallimed blog, Dr. Drew Rosielle discusses a study that shows most people do not understand the actual details of resuscitation, and many would choose to not have chest compressions, shocks IVs through the groin, even though those are sometimes regular parts of resuscitation. Dr. Rosielle also has an excellent post on JAMA's series on palliative care of latinos

Pride and Prejudice and Zombies: Seth Grahame-Smith has reworked Jane Austen's Pride and Prejudice to include zombie battles. You can find a fantastic (in every sense of the word) excerpt here

If you want some death at the movies, check out Sunshine Cleaning, an irreverent and touching comedy about two sisters who open an industrial cleaning business—specifically cleaning up after dead people. The film stars Emily Blunt, Amy Adams, and Alan Arkin

Is it ethical for a wife to use a deceased spouse's sperm for artificial insemination? The Health Monitor at Radiography Schools takes up this issue and contrasts it with other sperm-donor controversies of late.

Is there such a thing as a style for your illness? Dana Jennings writes about getting a buzz cut to develop a tough, "Prison Break"-esque style for his prostate cancer treatent. For him, the haircut is a "visible bulwark against the tide of emasculating side effects caused by the treatment of prostate cancer."

Thanks to all who sent in suggestions! I'm sure there is even more out there I couldn't get to. And if you're interested, here's where you can find issues 1 and 2


dethmama said...

Yay!! Great job, Jessica! Wonderful articles and loved the videos,too.

risaden said...

Thank you for such an interesting and wide-ranging collection to read and watch. Bloggers I haven't met yet, yea! Excellent work!

Thaddeus Mason Pope said...

Thank you Jessica.

This is a wide range of material from hard science to very colorful art. Good stuff I did not (and probably was not going to) see through my regular feeds and clips.

Christian Sinclair, MD said...

Great job Jessica. The inclusion of the songs was a great idea. Pallimed: Arts & Humanities covered the Sufjan Steves song Casimir Pulaski Day a while back. Great song and a great analysis by Amy Clarkson.

Thanks for posting the link about Pride and Prejudice Zombies. that was pretty funny. By all the links one might argue that we are not a death denying society.

Jared Porter said...

Thank you, Jessica! Great to see that there's so much being discussed about hospice care online!

Middle Tennessee's Alive Hospice is also part of the ongoing conversation. For example, our chief medical officer, Dr. David Tribble, recently weighed in on the study in Archives of Internal Medicine about patients feeling abandoned upon entering hospice care. In his view, it's not so much disinterest on the part of physicians, it's misunderstanding of or discomfort with the hospice concept. One of our social workers, Becky Riney, posted some thoughts about life as a social worker in honor of National Social Work Month. And one of our grief counselors, Ruth Williams, shared some insights on coping with the "tide" of grief.

We encourage all to check out these blog posts!

Jessica Knapp said...

Thank you all for the nice comments. It was a lot of fun to put together, actually.

Risaden, that was my favorite part too, finding all of the bloggers I hadn't been familiar with before.

Jared, thanks for the links. I will definitely check those out. And I'm sure Thaddeus Pope will be anxious to look into the sources for next month's carnival, too.

Gail Rae said...

I've just begun perusing all the listings in this edition and am excited about the wide range of the content! Bravo!
By the way, thank you, three times over, for including me. Somehow I managed to space the deadline for this edition but am thrilled that you included me, anyway. The post you picked is exactly the post I had in mind to send you for inclusion!
Although I'm a day late (and probably a dollar short, although I'm avoiding checking my pocketbook), I'm on my way to post the announcement of this edition right now!
Excellent show!

Jessica Knapp said...

Hey Christian, that's a nice exposition of "Casimir Pulaski Day." Thanks for the link. I'm not surprised she was drawn to analyze it. It's so raw and honest. And it's just gut-wrenching how well he's able to get inside that period in his life—whether it's real or fictional. That song is one in a million.

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