My Virtual Reading Room

A nurse with fatal breast cancer says end-of-life discussions saved her life

By Amy Berman September 28

To: Centers for Medicare & Medicaid Services:

News reports say you will soon make a final decision about paying doctors and other providers who talk to their patients about end-of-life planning, I have a fatal form of breast cancer, and I’d like to tell you how such conversations have allowed me to survive, and live well, in the five years since my diagnosis.

I am a nurse, a nationally recognized expert in care of the aged and senior program officer at the John A. Hartford Foundation, which is devoted to improving the care of older people in the United States. Yet my perspective is not simply professional. For, you see, I live with Stage 4 (end-stage) inflammatory breast cancer. And while this metastatic cancer will one day kill me, the advanced-care planning conversations I have had with my health-care team have been lifesaving since my diagnosis.
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Healthcare Needs Pit Crews, Not Cowboys, Says Atul Gawande

(I couldn't agree more). Here's the beginning of the article:

Hospitals implementing surgical checklists have achieved dramatic improvements. "The average reduction in complications was 35%, and the average reduction in death was 47%," he reported.

"There isn't a drug or device that can do anything like this, and it's free. It's hard to believe. But hospitals weren't all pulling in the same direction to begin with," Dr Gawande explained.

More to Life Than Living Longer

During his presentation, Dr Gawande advocated for a new checklist: seven end-of-life questions for terminally ill patients. This reflects his professional and personal interest in the problems of aging, which he addresses in his latest book, Being Mortal: Medicine and What Matters in the End.
(read further at the link in the title)

I'm a doctor. Preparing you for death is as much a part of my job as saving lives. by Shoshana Ungerleider

It wasn't until just before graduation that we talked about what to do when a patient is dying. A single three-hour seminar with a group of specialists from the palliative care service; at least it was mandatory.
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Why Nurses Should Lead Efforts to Overcome Palliative Care Consultation Barriers

With many in the community supporting the idea of palliative care being an essential part of critical care, the integration of end-of-life support with curative and life-sustaining intervention is more crucial than ever.

Published in Critical Care Nurse (CCN), a recent report revealed that palliative care patients and their families face a variety of challenges when attempting to discuss care options with consultants who can properly advise.

Being able to provide patients with palliative care enables clinicians to package psychological, spiritual, goal-setting and decision-making support into a single service-based initiative designed to supply comfort.

Patients with life-threatening illnesses and their families can benefit from this kind of specialized care by taking advantage of early initiation of comfort-focused treatment goals, decreased length of stay, reduced costs of care without an increase in mortality and continuity of care.
(read more at the link in the title)

The Disease of 'Busyness'

Introduction:

"The trouble with being in the rat race is that even if we win, we're still a rat."

– Lily Tomlin

Does this conversation sound familiar? "How are you?" "Oh, I'm so busy, just crazy busy, so busy! The more I do, the more behind I seem to get!"

Yes, that is true. The more tasks we think we can do simultaneously, the more we get behind and the more overwhelmed we become. Not only is this present hysteria no longer respectable, but when examined closely, much of it is self-inflicted. Despite the pervasive culture, being over-the-top "crazy busy" is not only an unnecessary, inevitable condition of being in health care, it's actually detrimental to our health and the health of those we serve. "Busyness" is something we've chosen, if only by our acquiescence to it, the outside cultural pressure and feeling of being indispensable, and by how normal it now feels. Funny how we can take even the most distorted experience and somehow call it the "new normal."

Busyness serves to create walls that prevent intimacy and starves any connection between us and others. It pulls us deeper into anxiety and guilt and is insatiably fueled by its evil twin, "Not Good Enough." Sadly, busyness keeps nurse leaders from more worthwhile and important things in their lives, such as authentic, vulnerable relationships. Our collective busyness has become an offensive disease. For purposes of this article, let's call our state of perpetual crazy busyness the Busyness Disease (BD).
(read more at the link in the title)