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One last visit to my patient

October 10, 2017

 

 

 

Dr. DANIELLE OFRI writes in ‘The New York Times’, with endearing clarity, about his last visit to a 91-year-old patient of 20 years, who was suffering from fibrotic lungs and a weak heart.

 

Even as her body and mind grew frailer, she was unfailingly cheerful, says Dr. Ofri, and liked to sing along with hymns on the stereo. She had bounced back from several stays in the I.C.U. even well into her 80s.

 

Eighteen months earlier, when he had raised the issue of hospice care, the family was hesitant — they were very private people and didn’t want anyone in their home. Then his patient and her family agreed to give hospice a try. The hospice nurse visited weekly and whenever a clinical situation arose. Even though they weren’t pursuing “curative therapy”, they were able to put out the little fires before they became big fires.

 

Their apartment was brimming with ferns, vines and succulents, as if they’d recreated the jungle of their home country in the concrete of New York City. In the midst of this verdant lair, his patient reclined comfortably on the couch, her face radiating warmth and welcome amid the greenery and medical equipment surrounding her.

 

Sitting there, it dawned on him that his patient’s final days were being spent on her own couch, among her plants and family, her favorite TV shows and music.

 

That evening her daughter called to inform that her mother had died peacefully on the couch, just hours after the doctor had left. Even as they spoke, the hospice team was taking care of the logistics so that the family could focus on the emotions of the moment.

 

He ends the write up with, “I hope we all have that chance.”

 

In some ways, hospice care struck can be described as the original “concierge medicine,” says the doctor, where a whole team of players dedicated itself to the patient’s every need. Dr. Ofri says that though hospice, for most people, meant “game over”, it should actually be thought of as “game on”, a time to really start taking care of the patient.

 

The paradox is that a patient can qualify for hospice care only if he or she has a life expectancy of six months or less, if the disease runs its normal course. Most patients, sadly, get referred to hospice only in the very last days or weeks of their illness. Even for patients with end-stage cancer, the earlier they are referred to palliative care (care focused on patient comfort), the longer they usually live.

 

Read full article here: https://www.nytimes.com/2017/09/21/well/live/one-last-visit-to-see-my-patient.html

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