End-of-life: a special issue of Hektoen International

Published in Chicago by the Hektoen Institute of Medicine, ISSN 2155-3017
Volume 3, Issue 2 - Spring 2011

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Feature articles

There is a time

Vanitas, still life, Adriaen CoorteJoel L. Chinitz, MD, MPH
Philadelphia, Pennsylvania

When the doors flew open, the noisy hoard—many in dirty white jackets and floppy, bloodstained, green pants—circled the nurses' station... More...

 

The sound of a wild snail eating

Elisabeth Tova Bailey

Maine, United States

Inches from my bed and from each other stood the terrarium and a clock. While life in the terrarium flourished, time ticked away its seconds. More...

 

My father's glasses

Geoff Kronik
Brookline, Massachusetts

Holding the glasses starts a movie in my memory, a biography of my father, but if I imagine wearing them a stranger appears on the screen. More...

What about the blood?

Blood cell by Jemere BohnertW. Roy Smythe, MD
Temple, Texas

My beeper went off again. I got up out of my seat in the empty hospital cafeteria, walked over to the wall phone and dialed zero. More...

 

Blind faith

Susan Woldenberg Butler
Canberra, Australia

"Divina won't be needing that toe massage now," I said gently, glancing over my shoulder at the foot of the conjugal bed one frosty, winter morning. More...

 

Streptococcus and me

Andrea Meyerhoff, MD
Baltimore, Maryland

I respect the streptococcus. It is a bacterium—a whole genus of them—that excels at making people sick. More...


Death in art and literature

'The lament of the Old Woman of Beare'

Basil Brooke, PhD
Johannesburg, South Africa

Ebb-tide has come to me as to the sea; old age makes me yellow; though I may grieve thereat, it approaches its food joyfully. More...

 

Crossing boundaries

The Red QueenMary T. Shannon, MSW, MS  Portland, Oregon

How do we as clinicians, caregivers, and fellow human beings talk about death and dying in our culture, or perhaps more precisely, how do we not talk about it? More...

 

Ending one's life on the stage

Angela Belli, PhD
New York City, New York

In recent years, medical discourse has taken center stage in the intellectual drama. Representations of the afflicted and their caregivers are central to modern theater... More...


Caregiving

And a time to die

Katherine Arnup, PhD
Ottawa, Canada

By the time my father was diagnosed with a life-threatening blood disorder, I was already deeply involved in caring for the dying. More...

 

Our father who art on Earth

Peter Sullivan, LCSW, CGP
Rochester, New York

She didn’t like the way he just stood there, staring. First it was at the sink, looking out the window, holding a just-lathered dish midair with the water running. More...

 

The myth of the white coat

white coat, photography by Elena LevitskayaLauren Smith, MD
Ann Arbor, Michigan

Nana, my grandmother, sat expectantly at the edge of the examining table. More...

 

Recreating nursing home

Ellen Jantzen

Photo essay

Ellen Jantzen
Newport Beach, California

A Christmas party

Loretta Downs, MA
Chicago, Illinois

Photography by Todd Hochberg

 

Father's Day on the 12th floor

Maggie Schwarz
New York City, New York

"Are you guys watching basketball? Would anyone mind if I brought my dad in here to watch tennis at 3:30?"
It is a rainy Father’s Day in the visitor’s lounge on the twelfth floor of Memorial Sloan-Kettering Cancer Center.. More...

 

Anticipatory grieving

Constance E. Putnam, PhD

Concord, Massachusetts

preview

We cannot —and should not—try to tell others how to deal with their sorrows, let alone tell them how to grieve. More...

 

The homemaker

Poem by Jessica A. Harder, MD
Boston, Massachusetts

Sitting here

Poem by Shalamar Sibley, MD, MPH
Minneapolis, Minnesota

Leaving you behind

Poem by Marah
Rutland, United Kingdom


Facing death

Rethinking knowledge of terminal illness

James B. Rickert, MD
Bloomington, Indiana

I found myself sitting again with an oncologist waiting to hear the results of treatment. I felt calmer this time because my friend had requested that I come ... More...

 

Immortal death

Photograph by Karen De LoozeKaren De Looze, MS
Brussels, Belgium

"What do you mean by 'immortal death'?" a friend asked me, "Do you mean that death is a constant in the universe ..." More...

 

A dying patient's perspective on truth-telling

Shimon M. Glick, MD
Beer Sheva, Israel  

“Several days ago, I asked you how much time I have to live, and you told me that I did not have too much time because I have a bad illness. This is not the way you should talk to patients.” More...

The birth and death of the day

Tree of life sculpture by Jeff JollyLisa Lunney
Edmonton, Canada

In early summer 2009 I was diagnosed with cancer. Growing up, I had thought that cancer had a face. It belonged to the old and the gray. More...

 

Beech leaves

Poem by L. N. Allen
Trumbull, Connecticut

Immigrants, all

Poem by Eric Pfeiffer, MD
Tampa, Florida

Seasons & Random

Poem by Donna Pucciani
Wheaton, Illinois

 

What matters

Poem by Anne Clemente, MSW, LCSW
Charlottesville, Virginia

Continuation day

Poem by Shaista Tayabali
Cambridge, United Kingdom

Always, autumn leaves

Poem by John A. Vanek, MD
St. Petersburg, Florida


Hospice care

Living well before we die

Caroline Wellbery, MD, PhD
Washington DC, United States

Imagine having a passion for dying. Imagine 1,500 doctors and nurses at their annual meeting, gathering to support each other in that passion. More...

 

La Maison

Photograph by Eric BreitbartEric Breitbart
New York City, New York

Gardanne, the last stop on the local train from Marseilles to Aix-en-Provence, was once a thriving mining center. More...

 

Dame Cicely Saunders

Dame Cicely Saunders PhotographJulie Silverman, MD
Seattle, Washington

Saunders maintained that “a society which shuns the dying must have an incomplete philosophy.” More...

The US hospice movement

Emily Bethea
Chicago, Illinois

Unlike its modern concept, hospice began as “a house of rest and entertainment” not only “for pilgrims, travelers, or strangers” but also “for the destitute or sick.” Like the images conjured by these words, the first hospices are believed to have originated in the 11th century when the Crusaders permitted the incurably ill into centers dedicated for treatment of the sick. More...

  Hospices de Beaune, Grande salle des pôvres, by Christophe Finot  

Reverse birth

Poem by Helen Montague Foster, MD
Richmond, Virginia

Bold flavor & Full pockets

Poem by Jan A. Jahner, RN, CHPN
Santa Fe, New Mexico

In my ending ...

Poem by Sister Eileen Haugh, OSF
Rochester, Minnesota


Planning end of life — advance directives

Turning points

Photograph by Loretta DownsLoretta Downs, MA

Chicago, Illinois

My mother's end-of-life was 15 years long. It began the day my father died... More...

 

The spiritual dimension of advance directives planning

Kathleen Blanchfield PhD, MPS, RN Romeoville, Illinois

As a registered nurse, chaplaincy intern, and faith community nurse, I have been privileged to assist in advance directives planning in the congregational setting. More...

 

Ice cream or Mozart?

Leon Morgenstern, MD
Los Angeles, California

How would I answer a question if the quality of my life depended on the answer? More...

 

Advance directives

Poem by Daniel Becker, MD, MPH, MFA
Charlottesville, Virginia

And should I ever appear in shorts that need suspenders because my hips and butt have slid under the glacier of old age, you are directed to suspend all life support measures... More...


Medical education teaching death

Desert blooms

Geraldine Gorman, RN, PhD
Chicago, Illinois

Springtime has come to the desert. It is subtle, but spring, nonetheless. I am here with a group of nursing students... More...

My mom's death

Kristen Erickson
Urbana-Champaign, Illinois

Letters to Dad

Erin Brady
Chicago, Illinois

 

Teaching death

Boris D. Veysman, MD
Piscataway, New Jersey

Another day as an ICU intern: endure hours of rounds, complete dozens of daily tasks, and watch another patient die. The patient's systems were failing in sequence as they were probably designed to do. We had done everything the family wished. Today, it was not sufficient. More...


When children die

Latricia

Kristin Adams Forner, MD
Dayton, Ohio

We were running. The stampede of our wooden clogs beat the linoleum that lined the hallway from the operating rooms to the… More...

  Photography by Elena Levitzkaya  

In the OR

Kelly Klein, LMSW
Ann Arbor, Michigan

I work at a large teaching hospital as an Emergency Department social worker. It is easy to get lost in a place that large … More...

 

Balloons

Poem by John A. Vanek, MD
St. Petersburg, Florida

Four-leaf clover

Poem by Dr. Upreet Dhaliwal, MS
Delhi, India


Ethics

Death and the organ donor

Crop of collage by Cathy PetersKaren Dyer, LLM
Buckingham, United Kingdom

Historically the "death debate" has been long and intensive, and the definition of death has evolved over the centuries. More...

 

End-of-life care: contributions from WD Ross's ethics & the Judaic tradition

Ronald W. Pies, MD
Boston, Massachusetts

How “aggressive” should medical care and treatment be near the end of life? How do the traditional principles of medical ethics apply to the patient in the final stages of terminal illness? More...

 

Must life always be prolonged?

Patrick D. Guinan, MD, MPH
Chicago, Illinois

This is an open-ended question and, for that reason, difficult to answer. We agree that life is a natural good and should not be willfully terminated... More...


Reflections: Is there a good death?

The good death

Raeford E Brown, Jr, MD

Lexington, Kentucky

Physicians and nurses experience death all too often.... But because of the pace of the work we do, we may fail to minister to the emotional needs of a patient, their loved ones, or to ourselves as the patient embarks on his last days. More...

 

Is there a good death?

Contemplation study, by Jenny WrightFrank Gonzalez-Crussi, MD
Chicago, Illinois

Is there a good death? I contend that there is no answer to this question. There is indeed a rare species of questions that are unanswerable, and this is one of them. More...

 

Dr. Gianakos, I think he's awake now

Dean Gianakos, MD
Lynchburg, Virginia

It's 2 am, and I'm on the phone with my first-year resident, Sherry.  "Dr. Gianakos, I have one of your patients here in the emergency room, Jack Jones. More...

Time

Paul Rousseau, MD

Charleston, South Carolina

Selfishly, time is either too short or too long, the moment never appreciated. More...

 

A good death

John Henning Schumann, MD
Chicago, Illinois

In America, too many people die in the hospital. Yet if you ask most people, they would rather die at home surrounded by their loved ones, drifting off to sleep painlessly. More...

 

Where is the dignity in death?

Death in the sickroom by Edvard MunchTherese Kwiatkowski
Chicago, Illinois

In my experience, the end of life is neither peaceful nor dignified. I wish I had been told that death is hard work... More...