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. 

Losing a laptop becomes an opportunity to explore advance directives as a metaphor for being prepared for the death of technology with backup and storage. 

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.