Archive for June, 2012

Round Mountain Wild Fire, Colorado

Round Mountain Wild Fire, Colorado (Photo credit: Striking Photography by Bo ( Swamped))

This morning as I was listening to the news as I got ready for work, I was drawn out to the living room by a desperate and shaken voice. It was a woman from Colorado who had been required to leave her home with only a few minutes’ notice because of the wild fires. She told the reporter that she’d grabbed a few pieces of clothing, photos and her cats before fleeing. Her parting words were, “I don’t want to leave my home.”

Weather and natural disasters often cause losses that are difficult to deal with. We hear about the fatalities and secondarily about the displaced people who lose their homes. To me, home truly is where the heart is. My home is my center, my place of balance, safety, privacy, freedom of choice – all things I value highly. To imagine losing this place, with no notice, no opportunity to ingrain it in my memory, no chance to pack or sort or identify the important things versus the unimportant – it would be terrible.

Compounded by fear, uncertainty and emotion, the loss of a home is significant. It deserves attention and time to grieve. At Horizon recently, we’ve been discussing the idea of “home” a lot. What makes a home, what people (our patients, volunteers and staff) value in a home, how to find out what home means to others. I feel personally that the essence of home, no matter who you are, is security.

I send my thoughts to those who are suffering through the fires, and wish for them some sense of security, despite being forced from their physical homes.


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In a meeting last week a colleague handed me an article written by a women who was shocked to discover the cost of care for her husband in his final weeks of life.  Her husband died of a cancer that was not curable.  From the article it appears that he had the best of care with nothing held back.  In hindsight the wife muses that wouldn’t it have been nice to spend that money to feed thousands of starving children.

The colleague gave me the article because I am in hospice and she felt that I would agree.  It was a compelling story and I pondered the author’s opinions for days.  I gathered my thoughts and observations and am sharing them with you today.

As Americans, we can be fiercely independent.  We want and demand the best in care.  We want it now, we expect it to be safe, and we believe in our chances for success.  Physicians are also Americans and they want the same things for themselves and their patients.  We are strong we are invincible and we succeed.

We also feel free to sue if things do not go as we expect.  Our television air waves are filled with lawyers suggesting that you sue for experimental treatments gone wrong, any kind of wound, or any imagined wrong.  It seems to be the American way.

We are a death denying society.  We willing admit that live is short, live it to the fullest, but we do not really think that death applies to us, at least not until we are over 90.

I do believe that end of life care is often provided in ICUs or expensive hospital beds when the location and level of care is futile, though I know first hand how difficult it is to tell families that it is time to seek hospice.  Not to do another scan.  Not to try another treatment.  People fly loved ones all over the country and world for experimental treatments on hope alone most times, even when they have experts in their own home town.

Is it possible to tell a patient and family no to another possible treatment when there is a 2% chance that it might work?  What if the chance is 5% or 10%?  We all hear about those miracle cases.  When is enough, enough?  We spend allot on care at the end-of-life because we have the tools.  Man will use the tools Man has.  Is it right?

I believe that we need to be honest with patients and families about the disease process and our current tools to deal with their disease.  We must, as providers, admit to what we can do and what we can not do.  We are not yet able to prevent death.  At some point all body systems will fail and we will not be able to forestall the inevitable.  I also believe that we need to use our expertise, experience, and wisdom to help our patients have the best death possible.  We help mothers and fathers bring babies into this world and we need to help patients and families leave this world with the same dignity and celebration of life.

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