Sunday, November 5, 2017

Physicians are missing the boat on ACP -Advance Care Planning

ACP/ Advance Care Planning is a part of our responsibility as conscientious physicians.
It is a part of the anticipatory guidance we offer patients just like smoking, drugs, alcohol, diet , weight control, accident prevention, vaccination etc.

It is up to us to bring up the question of ACP regarding end of life goals of living / the three questions as described in previous blogs here. We cannot wait for patients to be the initiators of the conversation.

Opportunities to do this are plenty., starting with regular well visits,(medicare even pays separately for it now) or at start of any illness, hospital admission, or with diagnosis of a life limiting illness, admission to hospital with it or even admission to the ICU.

The reason is obvious. Since life is so unpredictable, we have to talk to patients while they have capacity to make their own decisions.(since that capacity can be lost in a flash with trauma or illness.

Thus the sooner we get it done, the better. And better late than never.

If we do not talk to our patients regarding their end of life wishes while hey have capacity, then we have missed the boat!! This is a great disservice to the ones under our care.

In my experience with admitted patients only 30 % have any sort of advance directives /living wills.
We are missing the boat in at least 70% of our patients if we do not actively do this.

Friday, March 3, 2017

The Caring Warmth of Family and Friends

Losses are everywhere. The older you get the losses increase.
First you start to lose your physical abilities, then maybe mental abilities too, eventually your life.
The hardest loss being the loss of your friends and family.
Until a close family member dies, the full impact is not quite appreciated.

How does one cope with such severe losses? I found the answer in the loving arms and presence of my family and friends when I travelled home to Pakistan for my sister's funeral. It was oh so good to have been in the company of so many of them.
We sat together, prayed, ate, cried and laughed as we reminisced of the good life and the good death.

I was also reminded of how hard it was for me when my parents passed away and I could not go to the funeral because of logistical reasons. I was not at peace until I visited with the family 40 days later at the "chaleswan"( the 40th) and got the chance to be with everyone and reminisce.

Relationships are everything. Every day we need to endeavor and build new ones while we strengthen the old so that we are surrounded by a wide, strong circle of caring people who will be there in our hour of need.

I wish you all a big embracing circle of caring friends and family.!


Another Sad Reminder of the Fragility of Life

Six feet under - still so hard to comprehend
There are six of us , rather there were six of us brothers and sisters, three of each. All in mid sixties to eighty years old. It seemed like we would go on for a long long time until reality struck and you were reminded how fragile our existence really is!

The older sister, who had never ever been in a hospital and was in good health was diagnosed with Ovarian cancer. Within three months she succumbed to the side effects of chemotherapy. She suffered for about a week prior to her death.

Did she have a good death?
Most felt that she did in a way. Although she did have a lot of pain in the last few days, it was short-lived and she did not linger on and on for weeks and months. Unfortunate as it was, family is at peace with the will of God and the eventuality. Solace in the fact that the suffering was short lived.

This has really shaken up the siblings. It reaffirms the adage that there is no time to be wasted. Who knows what tomorrow brings.You have to live for today and in the moment. Grateful for what you have when you have it. Revisit priorities and make time for those since all the time you have is now.

Gotta live while you are living!

Peace ...