- N Engl J Med 2022; 386:2413-2423
A 29-year-old woman was evaluated for a soft-tissue mass in the pancreatic head, discovered after diarrhea and jaundice occurred. Diagnostic procedures were performed, and management decisions were made.
- 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; 385:391-393
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 2020; 383:2404-2405
The young triathlete with brain metastases has rapidly become debilitated. But his wife, a cancer survivor, has a sagelike calm, born in part of experience volunteering with dying children. Her husband — and his oncologist — are fortunate to have such a caregiver.
- 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; 383:306-307
As a palliative care leader plans for a Covid surge, she sees that planning for the worst isn’t as simple as she imagined when she asked patients to do it. In many ways, the pandemic is forcing clinicians to gain insight into the experience of seriously ill patients.
- N Engl J Med 2020; 382:890-891
At 35, Mr. J. was dying of an invasive pelvic sarcoma and had a tolerance to opioids. Despite his pain, he wanted to be present with his family and friends. When his physician broached the possibility of palliative sedation, he said, “We aren’t there yet.”
- N Engl J Med 2019; 381:998-999
The boundary between physicians’ personal and professional lives is breached when we’re called on to care for people we know personally. Burnout may be exacerbated by such requests, which are likely to increase sharply in the coming decades, as the population ages.
- N Engl J Med 2019; 381:701-703
Though the dying process may offer an opportunity for truth telling and atonement, reconciliation and expressions of love, it may also allow a space for life to go on just as it was. If we’re lucky, we’ll continue to live as we always did until the very end.
- N Engl J Med 2018; 378:2060-2062
Because 18% of the U.S. population lives in jurisdictions where physician aid in dying is legal, physicians need to anticipate that patients may inquire about it. But physicians may feel unprepared, uncertain, and uncomfortable when confronted with these conversations.
- N Engl J Med 2018; 378:e19
The indications for pleural drainage are diagnostic and therapeutic. This video demonstrates ultrasound-guided placement of a small-bore pigtail catheter for drainage of a pleural effusion.
- N Engl J Med 2018; 378:1313-1322
This randomized, controlled trial showed that, among patients with malignant pleural effusion, the insertion of talc into the pleural space through an indwelling catheter resulted in a higher frequency of successful pleurodesis than placebo.
- N Engl J Med 2018; 378:887-889
Performing an ultrasound on a 41-year-old man who has just lost his 2-year-old son, a young physician discovers something intimate and heartbreaking. Though he has seen many other sad cases, he finds there is no space within him for this one.
- N Engl J Med 2017; 377:805-807
Having arranged for a patient to be transferred from another hospital to a hospice across town, the oncologist still feels sucked into a vortex of issues beyond her control. When, out of guilt, she visits, a nurse tells her, “Many patients just feel dumped at hospice.”
- N Engl J Med 2017; 377:709-711
Reluctantly leaving an end-of-life house call with a patient who has decided to avail himself of his state’s death-with-dignity law, a physician hears a musical composition that reframes the experience in terms of the dialectic of Man versus Nature.
- N Engl J Med 2017; 377:492-494
Data from physicians in the Netherlands show that the percentage of patients in whom an end-of-life decision preceded death increased from 39% in 1990 to 58% in 2015. Continuous deep sedation was provided in 18.3% of all deaths in 2015.
- N Engl J Med 2017; 376:2101-2102
Jerry is not innocent, nor does he claim to be. His vilification, however, is the result of an all-or-nothing approach to pain management under which the pendulum has swung from one unsustainable end of the spectrum to the other in the past two decades.
- N Engl J Med 2017; 376:2082-2088
After Canada legalized medical assistance in dying (MAiD), the University Health Network in Toronto implemented a hospital-based MAiD program. UHN offers a framework for assessing patients for and providing MAiD while respecting the rights of patients and staff.
- N Engl J Med 2017; 376:1478-1482
U.S. states vary in their procedures for appointing and challenging default surrogates, the attributes they require of them, priority ranking of possible decision makers, and dispute resolution — with important implications for clinicians, patients, and public health.
- N Engl J Med 2017; 376:1078-1082
Patients in Oregon are less likely to receive intensive care and more likely to receive hospice care at end of life than patients in other states. The authors argue this reflects the Physician Orders for Life-Sustaining Treatment Program and efforts to honor patients’ preferences.