Decision Making At The End Of Life, Redux

In the hospital

Photo: Phalinn Ooi

When I was a third-year medical student rotating for the first time on a general medicine service inpatient ward, my team admitted a thirty-year-old woman in acute congestive heart failure. That a thirty-year-old was in congestive heart failure was unusual enough. Even more shocking was the cause: an echocardiogram revealed a tumor sitting on top of her mitral valve preventing the normal flow of blood out of her lungs to the left side of her heart. No one on my team, including the attending physician, had ever seen anything like it. A CT scan revealed widely metastatic cancer throughout her entire body—it looked as if every square inch of her had been splattered with buckshot—with no obvious dominant lesion to suggest its point of origin. Continue reading…

The Importance Of Good Influences, Redux

mimic

Photo: Brian Snelson

While I was growing up, my brothers (I’m the eldest of four boys) often chided me for being so much like my father. I suppose it was inevitable that I would be; firstborn children tend to be rule followers (if you believe in the significance of birth order) and I fit the stereotype.  Some boys use their fathers to push against as they struggle to establish their own independent identities. I used mine as a role model.

My decision to do this was largely, though not entirely, unconscious. Continue reading…

How To Help People Grieve

Photo: Beverly

Photo: Beverly

After a prolonged, debilitating illness, two weeks ago my father–at long last–died. As a physician, I’ve observed many people experience loss, but this is the first time I’ve lost someone close to me. This has, not surprisingly, put me on the receiving end of many condolences. Yet unable to rid myself of my analytical mind even in the midst of grief, I’ve found myself noting that the level of comfort people have in supporting others who are grieving seems to vary as much as the number of ways in which people grieve. And while everyone who’s expressed their condolences for my loss has been wonderful, I’d like to offer some guidelines for those who feel awkward when called upon to express support for people who are grieving and don’t feel they know how. Continue reading…

The Art Of Microcompromise, Redux

“What do you want for dinner?” I asked my wife.

man_woman

Photo: ralphbijker

“I don’t know,” she answered.  “What do you want?”

“How about hamburgers?”

“No, I don’t want hamburgers.”

“What do you want then?”

“I don’t know…pasta.” Continue reading…

My Father Is Dying

my dadSomewhere around 2004 or so—I no longer remember the exact year—my father was diagnosed with Parkinson’s disease. We’d been wondering why his legs had been feeling weak, and at first had thought he might have cervical spinal stenosis (a condition in which the spinal cord becomes compressed in the neck). But when the tell-tale cogwheel rigidity appeared, a neurologist confirmed Parkinson’s was the cause. We weren’t too concerned as even I, with my doctor’s knowledge, considered Parkinson’s primarily a disorder of movement, and a treatable one at that. I’d had many patients with Parkinson’s whom I’d cared for over the years and all seemed to me to have maintained a fairly good quality of life right up until they died. Continue reading…

How To Tear Up The Good Guy Contract

Photo: Mike George

Photo: Mike George

In a previous post, The Good Guy Contract, I wrote about the particular challenges faced by people dominated by their need to be liked by others. In that post I recounted my own inability to say “no” and then went on to describe my discovery of the reason for it: I’d signed a Good Guy Contract: Continue reading…

The Right Way To Think About Your Risk Of Ebola

EbolaEbola has riveted our attention: It’s a deadly disease with no known cure, and as is true of most infectious diseases, it’s easy to imagine how it could become a global pandemic and threaten us directly. For what it’s worth, though, here is what the federal Centers for Disease Control and Prevention tells us about Ebola: Continue reading…

How To Give And Receive Feedback, Redux

feedbackMy student’s voice trembled as she answered my question.  “How do you think you’ve done so far?” I’d asked her.  We’d been together on the general medicine inpatient ward for two weeks—the midpoint of the rotation—and as was my usual custom I was giving her feedback on her performance by first asking her to rate her performance herself. Continue reading…

The Middle Age Spread And How To Combat It

Photo: bark

Photo: bark

The reason so many people gain weight as they enter middle age is no mystery: if, as an example, you only eat 50 extra calories per day over a period of twenty years that you don’t burn off by exercising, it will result in a weight gain of 104 pounds. (Here’s the math: 50 extra Cal/day x 365 days/year=18,250 extra Cal/year. 18,250 extra Cal/year x 1 pound/3,500 Cal=5.2 extra pounds/year. 5.2 extra pounds/year x 20 years=104 pounds.) Continue reading…

How To Be Nice To The Ones You Love Most

 

hurt girl

Photo: Clemens v. Vogelsang

Why is it we so often find ourselves treating the ones we most love the most shabbily? I don’t think, contrary to popular wisdom, that the answer is that familiarity breeds contempt. After all, it’s not that all the wonderful things we loved about our loved ones when they first entered our lives gradually become repulsive to us (“I hate that you’re so kind to everyone!”). Rather, I think it’s because our tolerance for all the things we disliked invariably diminishes over time. Continue reading…