Round-Up: Physicians Handling End-of-Life, Caregiving Talks, Photo Essays, Scholarships and Awards

I have so much crowding my inbox this will be a big list:

• Most weeks the New York Times Health Section features cases from different doctors. This one from Dr. Jessica L. Israel, chief of geriatrics and palliative medicine at Monmouth Medical Center, urges doctors to slow down to contemplate the moment, whether its to witness a patient's death, or to receive a patient's appreciation.
  

  It’s Monday morning and I meet my new medical student, Nelson, on the hospice unit. I am there to sign a death certificate for a man who died the night before. Nelson is flipping through the patient’s chart, and he asks me, “What are we going to do for this patient today?”
  
  I wonder if he’s kidding, and I say: “Nothing. He’s dead.” Later, recalling this conversation, I still cannot believe I said it so matter-of-factly.
  
  Nelson is still holding the chart and I think I see his hands shake.
  
  “Hey, are you O.K.?” I ask. “You do know what you signed up for, don’t you? It is a palliative-care and hospice elective. People are going to die every day.”
  
  “I know, I know,” he says. “I’ve just never been near anyone who has died before.” Then he says, “Wow, it’s really a big deal.” And he sits down — because he needs to, I think; he needs to respect the moment.
  
  In this moment I learn something from Nelson, a lesson I thought I already knew. I learn to slow down, to feel the gravity of the moment, the power of time and the depth of this important work. Nelson is right. It is a big deal.

• On a similar vein, the Washington Post and Newsweek's On Faith column featured an essay from Ismael Gama, Associate Vice President of Spiritual Care and Mission Integration for Adventist HealthCare. Gama speaks about the need of all members of a health care team to understand the whole patient.
  

  In the 1920s, Anton Boisen, a pioneer in hospital chaplaincy and CPE [clinical pastoral education] , was the first to coin the term living human document in reference to the understanding of a patient’s theological needs. The living human document has since evolved to become a catch-all term in regards to understanding the theological, psychological and social needs of patients.
  
  . . .
  
  Our ability to apply this knowledge in health care, however, is largely dependent on our ability to get to the heart of an individual’s story. While CPE students are already engaged in this discussion as part of their training, we need to engage all members of the health care team in this dialogue because there are lessons in the living human document that can improve the delivery of quality, compassionate care.

• Another New York Times article that got us talking is this one about the rise in medical procedures being performed on the very old, in this case a pacemaker and defibrillator implanted in a 99 year old woman.
  

  Dr. David Goodman, a co-author of the Dartmouth Atlas of Health Care, which has studied the last two years of life, said there is much research suggesting that most aggressive treatment of late-stage chronic diseases does not actually prolong life and can actually decrease its quality. Of Mrs. Homer, Dr. Goodman said, “the odds are that she’s really an amazing exception.”
  
  “The question is not a relatively healthy, smart, sensible 99-year-old getting a life-prolonging procedure, one that prolongs the quality of life,” Dr. Goodman added. “The question becomes the 82-year-old with dementia who has cancer or congestive heart failure.”
  
  . . .
  
  But Dr. Tom Perls, founding director of the New England Centenarian Study at Boston University Medical Center, said that people who reach 100 “have demonstrated a survival prowess.”
  
  “It’s much more the case of the older you get, the healthier you’ve been,” Dr. Perls said. “In my experience, when they’re completely cognitively intact, you cannot in any way or form predict their mortality.”

• Look at Philip Toledano’s photo essay, Days With My Father. At 98, his father suffers from dementia and other health problems. Toledano's photographs chronicle his caregiving journey in a powerful way. (Thanks to The Future of Aging Blog for sharing.)

• Listen to Carol Levine on NPR's Fresh Air radio program. Levine, a home healthcare advocate, cared for her husband for 17 years, who was seriously injured in a car accident in 1990, until he died in 2007. Levine also served on the panel for HFA's 2001 teleconference on Caregiving and Loss.

• Watch this interview of Linda Edmondson, co-chair of the Attorney General's Task Force to Improve End of Life Care in Oklahoma and a member of the Governor's Hospice Advisory Board.

• View the winners of the National Family Caregiving Awards, sponsored by the National Alliance for Caregiving with support from MetLife Foundation.

• There's a caregiving scholarship available through the Rosalynn Carter Institute for Caregiving. The Mattie J. T. Stepanek Caregiving Scholarship provides financial assistance to family, professional, or paraprofessional caregivers of any age who are seeking training or education in specific skills, procedures and strategies that lead to more effective care at the same time that they serve to protect the health and well-being of the caregiver. Four $2,000 scholarships will be awarded. Deadline for application is September 15, 2008.