- N Engl J Med 2022; 386:e54
Although the Covid pandemic drew renewed attention to problems in U.S. nursing homes, the underlying issues with long-term care are long-standing. Susan Mitchell moderates a Perspective Roundtable about shortcomings and possible solutions.
- N Engl J Med 2022; 386:1869-1871
More than 30 years after the Nursing Home Reform Act, the United States still fails to protect nursing home residents and provide them with high-quality care. The Covid-19 pandemic’s devastating effect on nursing homes reminds us that further reforms are sorely needed.
- N Engl J Med 2022; 386:1010-1011
The patient’s eyes close as his diagnosis sinks in. The resident sits with him in a silence filled with racing fears of the unknown. It’s that moment when everything has changed for this man: he’s gone from before to after. The resident knows this moment all too well.
- N Engl J Med 2022; 386:1008-1010
The perception that a good death is one that occurs at home is ingrained in our cultural and social history. But palliative care clinicians have begun to question this idea. What is needed is high-quality end-of-life care that aligns with individual goals and needs.
- N Engl J Med 2022; 386:302-303
After her grandmother attempts suicide, a physician finds that the medical team’s avoidance of honest conversation about her grandmother’s reality and desires creates a chasm between the clinicians and the family that is counterproductive and painful.
- N Engl J Med 2021; 385:2119-2121
The traditional model of autonomy sees patients as atomistic, and the clinician’s duty as providing information and protecting the patient from undue influence. But people are interconnected and interdependent, shaped by communities and relationships with loved ones.
- N Engl J Med 2021; 385:1448-1449
The promise of the “good death” was one of the outcomes that had inspired the physician to pursue a career in palliative care. But not all patients’ stories play out according to this script, and we need to admit that for some patients, death can be difficult to tame.
- N Engl J Med 2021; 385:1254-1255
The patient’s eyes say I know that you know that I know. I know that I am dying, and you know that I am dying, and you won’t say it; you can hide behind your prim white coat, but I see you and I demand that you behold me.
- N Engl J Med 2021; 385:391-393
The 11-year-old girl knew that her mother had cancer, but it fell to me to tell her that the cancer had spread to her mother’s brain. Breaking such devastating news to a patient’s young child is not normally my job, though I am no stranger to devastation.
- N Engl J Med 2021; 384:2332-2340
An 81-year-old man presented with fever, cough, and shortness of breath. Within a few hours after presentation, chest pain and respiratory distress developed. A chest radiograph showed bilateral patchy airspace opacities, with predominance in the peripheral lower lung zone and with relative sparing of the perihilar region. A diagnostic test...
- N Engl J Med 2021; 384:1488-1489
I had always pitied people who end up in nursing homes and judged the families who put them there. But I had to face the fact that my parents could no longer give Nanima the care she required, and I was in no position to do so either. She needed...
- N Engl J Med 2021; 384:494-495
Over years of rigorous medical training, from cold cadaver labs to physically demanding, gruesome codes, it gets easier to stop giving love so freely, to cover a dying person’s face, to put on your mask. Yet there are moments in medicine that crack our thick exteriors.
- N Engl J Med 2021; 384:400-401
Experience with his 103-year-old grandfather teaches a physician-bioethicist that for people without terminal or mental illness who desire to end their life, the alternative to physician-assisted dying — to stop eating and drinking — is just too challenging.
- N Engl J Med 2021; 384:345-352
After planned withdrawal of life support and determination of death by cardiac criteria, 14% of 480 patients had one or more cycles of a return of blood pressure of more than 5 mm Hg detected by arterial catheter monitoring after a period of pulselessness, all occurring within 5 minutes.
- N Engl J Med 2020; 383:2600-2601
Two New England blizzards, two patients dying alone, and one resident desperate to bring their loved ones safely to their side for a final goodbye. Could one patient’s “good” death undo the harm of the other patient’s “bad” death?
- N Engl J Med 2020; 383:e141
Our approach to early Covid cases was as thoughtful as it could have been, but we didn’t know enough, and many patients died. Over time, perhaps we’ll uncover the toll Covid-19 has taken on clinicians, in terms of anxiety, depression, and post-traumatic stress disorder.
- N Engl J Med 2020; 383:1204-1205
“If I can’t sit on the floor and play with my grandsons, I don’t want to live.” My mother made it clear she valued her mobility, her golf game, and her language. If there were no treatments that could ensure all those abilities, she wanted to be allowed to die.
- N Engl J Med 2020; 383:e80
“We’re Black,” said my teenage patient’s aunt, “and we know how the system works.” Having lived her life in a system that didn’t work for people of color, how could she see my unilateral decision to make her dying nephew DNR in any other way?
- N Engl J Med 2020; 383:e71
Effective family meetings build rapport and offer support, provide updates about a patient’s medical status and prognosis, and ensure treatment that is consistent with the patient’s goals. Such meetings can result in better use of health care resources. This video demonstrates how to have an effective family meeting.
- N Engl J Med 2020; 383:e53
We had planned. Our plans had evolved, but we had still planned: for targeted pills, for early goals-of-care discussions, for radiation, for hospice, for dying at home, comfortably, with family. Yet our plans were being thrown out the window by a virus.