Cell 2 Soul: The Humane Health Care Blog

My Mother-in-Law’s One High Day

When my mother-in-law was in the final, harrowing throes of pancreatic cancer, she had only one good day, and that was the day she smoked pot.  Read this thoughtful, sad piece from the NY Times Journal of Medicine (12/10/11).

Marginal Notes: El Tío Nayo

We enter the narrow winding cobblestone streets of the port of Cariño and weave our way up the inclines past the fountain in the small plaza. Up above, at the cemetery, the vista opens up. From here you can look down on the red-tiled roofs of the town past the ancient stone wharf across the bay to the Isle of San Vincente and the large expanse of white beach beyond. Off to the left, away to the northeast, the jagged coastline stretches all the way to the punta of Estaca de Bares, the northern most point of Spain. >>more 

Brian T. Maurer has practiced pediatrics as a Physician Assistant for thirty years.  His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life."

Marginal Notes: Web and Flow

While toweling off after my shower, I noticed a grey spider descending from the light above the bathroom sink. Her spinnerets formed a nearly invisible silken thread as she dropped down to hang motionless before the mirror. Shortly, she retreated up to the light and selected another point from which to begin a new descent. This time she dropped down to the shelf below the mirror and crawled behind my toothbrush. Gingerly, I nudged it to the side to reveal the spider resting by a tiny puddle of water.  >>more

 

Brian T. Maurer has practiced pediatrics as a Physician Assistant for thirty years.  His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life."

Marginal Notes: A Life or Death Decision

Technology can be a curse. If we didn’t have ET tubes and ventilators, life would take its natural course. We have created our own demons, and they constantly come back to taunt us: in this case, six additional months of ventilator dependence, dialysis and a feeding tube before death from heart failure. >>more

Brian T. Maurer has practiced pediatrics as a Physician Assistant for thirty years.  His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life."

Engage with Grace

"The One Slide Project was designed to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it.  We're asking people to share this One Slide – wherever and whenever they can… Just One Slide, just five questions to get us talking."

This is an important, well-conceived project.  For more information go to web site:

Assisted Suicide

Two fine pieces appeared on this topic in today's NY Times:

Keeping a Promise When a Life Is Near Its End
By ELLEN D. FELD, M.D
A  mother’s request to her daughter for “help” if something should happen to her is agonized over, accepted and eventually fulfilled.

Landscape Evolves for Assisted Suicide
by Jane Gross
"Washington joined Oregon last week as the second state where physicians are allowed to prescribe lethal doses of medication to terminally ill people who want to hasten their own deaths. But the question of whether doctors should help patients die is far more nuanced than it was 11 years ago, when the Oregon measure took effect."

Pain

Emily Dickinson said it best:

After great pain a formal feeling comes--
The nerves sit ceremonious like tombs;
The stiff Heart questions--was it He that bore?
And yesterday--or centuries before?
The feet, mechanical, go round
A wooden way
Of ground, or air, or ought,
Regardless grown,
A quartz contentment, like a stone.

This is the hour of lead
Remembered if outlived,
As freezing persons recollect the snow--
First chill, then stupor, then the letting go.

The subject of pain and pain control is a huge one -- suitable for textbooks not blog entries.  However, we would like to bring to your attention two recent articles from the NY Times which address this topic.  It is shameful that opioids are not available  to the majority of the world's population considering they are safe and cheap.

1. Drugs Banned, Many of World’s Poor Suffer in Pain  September 10, 2007

2. Japanese Slowly Shedding Their Misgivings About the Use of Painkilling Drugs Sept. 10, 2007

3. In India, a Quest to Ease the Pain of the Dying September 11, 2007

4. Francis W. Peabody wrote a classic piece "Notes on the Effects of Morphine" in 1927.  It was completed shortly before he died of stomach cancer and while he was relying on opioids so he could function.  Here it is for those who are interested: Download peabody_on_morphine.pdf

A Cautionary Tale

An important article appeared in the NY Times Magazine today:

When Is a Pain Doctor a Drug Pusher?

"Ronald McIver is a prisoner in a medium-security federal compound in Butner, N.C. He is 63 years old, of medium height and overweight, with white hair and a calm, direct, intelligent manner. He is serving 30 years for drug trafficking, and so will likely live there the rest of his life. McIver is a doctor who for years treated patients suffering from chronic pain. 

"Opioids have immense power — both to harm and to heal. They can be life-destroying, but high doses allow patients to work, to be with family, to be who they are. In its prosecutions of pain doctors, the government fails to recognize the duality of these drugs.

"The basis of the physician-patient relationship is trust. Trust is especially valued by pain patients, who often have long experience of being treated like criminals or hysterics. But when prescribing opioids, a physician’s trust is easily abused. Pain doctors dispense drugs with a high street value that are attractive to addicts. All pain doctors encounter scammers; some doctors estimate that as many as 20 percent of their patients are selling their medicine or are addicted to opioids or other drugs. Experts are virtually unanimous in agreeing that even addicts who are suffering pain can be successfully treated with opioids. Indeed, opioids can be lifesaving for addicts — witness the methadone maintenance therapy given to heroin addicts. But treating addicts requires extra care.

This is a strange sad article.  If points to how we ignore many patients as we allow government agencies and the courts to control the management of a disabling medical problem.

Indeed, opiates have been used for centuries to control pain.  In 1927, F.W. Peabody, a Boston physician, was dying of stomach cancer.  During his final ordeal, Peabody wrote an article called "The Care of the Patient" which is the most cited article ever written in the medical literature.  He wrote it while receiving morphine for incapacitating cancer pain.  In a separate, as yet unpublished, paper Peabody wrote that with morphine "I am brought back to my  best normal intellectual level and to an improved physical level."  He quotes Sandoz who said that "morphine differs from other drugs in that the subject shows symptoms when he is not receiving it, rather than , like alcohol, when he is under its influence."

It is unfortunate that as a group, most physicians do not know how to prescribe opiate drugs today.  Those who do are forced to use newer more dangerous (and expensive) analogs and face marginalization and prosecution.  The result is that many patients are under-medicated.  Perhaps, we might never have had Peabody's seminal article "The Care of the Patient" if the D.E.A. had been as powerful then as it is today.

To read the full NY Times article click Permalink

Deeya -- Small Light

A Place to Turn When a Newborn Is Fated to Die

by Neela Bannerjee
March 13, 2007

Most couples choose to have an an  abortion when they learn that the fetus has a fatal condition. But experts say about 20 to 40 percent of families given such diagnoses opt to carry the pregnancy to term, and an increasing number of them, like the Kilibardas, have turned to programs called perinatal hospice for help with the practical and spiritual questions that arise.

To read this important article please click Permalink