The gut reaction to Netflix’s new documentary “Extremis” is the ICU is a hellhole.  No one wants to end up there.  Patients enter this purgatory after becoming sick and requiring a higher level of care.  Patients enter the ICU from the ER, the hospital ward, or after surgery. Donna, one of the two patients featured in the film, has myotonic muscular … [Read more...]

  “Extremis” means the crucial point before death. It’s measured by the level of stress and the length of time patients suffer as they die.  You often hear people express consolation to the family with the kind words “at least he didn’t suffer” or “she died with dignity.” In the short-film “Extremis,” Dan Krauss brilliantly depicts how patients … [Read more...]

Ruth was a spry, but frail 98-year-old woman who was stiff and sore following the 6-hour drive from California to Arizona. She had suffered a recent wrist injury and was not recovering well after spending three weeks in a rehabilitation center. She was in the midst of upheaval and discontent – in the throes of relocated to an assisted-living residence closer … [Read more...]

Javier was a heavyset 78-year-old man, remarkably edematous and exhausted, suffering from congestive heart failure. He had been seen by his primary care physician and sent to the emergency department for his difficulty breathing and hypotension. His vigilant son provided the history of the 3-month battle Javier had been waging between heart failure and fluid … [Read more...]

Finding balance between over-treating and withholding medical intervention at the end of life remains problematic when patients are not afforded palliative care. John was one of my patients - another victim of this predicament.  He had recently retired and been diagnosed with advanced lung cancer. While never really liking doctors, he had his share of them … [Read more...]

I cared for a 48-year-old Bosnian woman whose constant chest pain had worsened that day. Her evaluation in the Emergency Department did not reveal any evidence of heart disease. In broken English, with the help of her son translating, she admitted that stress could be causing her chest pain. Moreover, she quickly mentioned that her stress was justified. Ten … [Read more...]

Cancer has a way of spreading separatism insidiously which shields patients from knowing the truth.  In good faith, many patients with terminal cancer maintain a one-track mind toward survival. Doctors tend to appease this mindset by both providing false hope and practicing bad medicine. They enroll cancer patients in separate prognoses for their conditions, … [Read more...]

It has become an unwritten rule that most patients who visit the Emergency department are to leave with a prescription. That is how emergency physicians practice defensive medicine. For instance, physicians rarely incur a lawsuits from prescribing antibiotics. Omission of any medication appears negligent. Therefore, temptation exists in treating most ear, … [Read more...]

We may never be certain about what the universe has in store for us until we begin listening to the world around us. The blog site, Growing Coaches, states that active listening is one of the greatest skills for a coach to practice. I never think of coaches needing to practice. Their expertise seems to arise from knowing more than doing. As my practice of … [Read more...]

On this Mother’s Day I remembered Mom’s advice, if you don’t have anything nice to say, don’t say anything at all. Nevertheless, patients have the right to be informed about their medical condition and treatment options. A frail sixty-six year old male patient with brittle bones presented to the Emergency Department after breaking his foot and … [Read more...]

Do You Hear That? Was the topic at services this Sunday. Working in the Emergency Department, I hear and address a lot of medical complaints. However, since I recently missed diagnosing a premature rupture of the membranes in a pregnant woman, I fully admit I did not hear that being the major point of her visit. Her chief complaint was noted as vaginal … [Read more...]