GeriPal - Geriatrics and Palliative Care Blog

Click here for a link to Dying to be heard, Part 1



I meant it when I told Mr. Garcia that I would support him in his decision to forego dialysis. But I fully expected him to change his mind, just like every other patient under 85 years old with advanced kidney failure I had ever encountered.

“I’d rather die than have dialysis,” they all said.

But without fail, they all changed their minds when the symptoms they could no longer deny came. When death was in their personal space, staring them in their eyes. They were all willing to give  dialysis a try.

Death was tiptoeing up to Mr. Garcia when I met him. He already had severe anemia that wouldn’t respond to our medicines, but he said made him feel better. He already had fluid building up in his lungs, but he blamed that on his blood pressure medications. He actually seemed relieved when I referred him to hospice.

Until hospice actually came.

Then, he resented hospice. Their visits and their questions. He felt they were unnece…

In the notes of the three nephrologists who had seen Carlos Garcia in the weeks before me, I read about how they had spent considerable time telling him about dialysis and how they recommended that he start dialysis as soon as possible or he would soon die. I read how they had spent even more time trying to get him to agree to do it after he had adamantly refused time and time again. I didn’t want to repeat what they did. But I needed to make sure he was sure.

He was only 63.

“Sometimes people refuse dialysis because they think it does things that it really doesn’t. Can you tell me what you think dialysis would be like so I can be sure your decision is based on the reality?”

He exhaled and hung his head with the disappointment of here we go again. He flung up his arms and shook his head as he spoke, showing me his sunken temples from different angles.

“You have to be connected to a machine for almost the whole day almost every day.”

“Well, not exactly. Hemodialysis is only ab…

by:  Jeffrey M. Levine MD, AGSF

I had a chance to interview Roz Chast, the New Yorker cartoonist and best selling author of Can’t We Talk About Something More Pleasant?  This bestselling graphic memoir is quite unique as it deals honestly with personal and emotional issues of caregiving for aging parents, and on the way covers many issues that geriatricians and palliative care specialists deal with on a regular basis.   It is also now available in paperback.

Jeffrey:   You are an artist known for your cartoons for New Yorker magazine, as well as your books that bring out the humor in everyday life.  I am a fan of yours and it’s a pleasure to have this assignment from the Geriatrics and Palliative Care blog to ask you questions about your book.

Let’s talk about the title of your book.  The title underscores a basic issue that geriatricians deal with on a regular basis – that is how to get an elderly person to face the difficult conversations of end-of-life choices.  When you wrote thi…

by: Alex Smith, @AlexSmithMD


Do you know what the operator or person at the front desk is saying about palliative care?  When people call, saying the want palliative care, how are they responding?


A study being presented in abstract form at the palliative care and oncology research symposium addresses this simple but critical question. 


Researchers at Duke (Kathryn Hutchins, 3rd year medical student first author, Arif Kamal, oncopal researcher, senior author) cold called 40 major comprehensive cancer centers.  They used a "mystery shopper" approach.  They pretended to be a family member of a recently diagnosed inoperable liver cancer patient asking about palliative care services.  All 40 major comprehensive cancer centers report having palliative care services.  Here's what they found:
When asked straight up if they offer palliative care services, 10% gave an answer other than yes, including palliative services are for the end-of-life only or being unsure of what the te…

by Paul Tatum (@doctatum)

This Labor Day weekend it is time to feel grateful for the politicians in Washington DC who are working together to improve health care.   The entire palliative care community should send a giant note of thank you to the members of the House Energy and Commerce Subcommittee on Health.  The Subcommittee on Health has scheduled the Palliative Care and Hospice Education and Training Act (PCHETA), House bill H.R. 3119, for a legislative hearing on Thursday, September 8, 2016 as part of a hearing entitled “Examining Legislation to Improve Public Health.”

PCHETA is a bipartisan bill which has broad support from both patient and provider organizations.  Forty-four separate organizations signed a letter from the Patient Quality of Life Coalition requesting a hearing for PCHETA. While PCHETA by now is well-known to regular readers of Geripal, the bill has had some improvements added from prior years.  If you don’t read the complete bill in the link above (the Senate …

By: Laura Petrillo, @lpetrillz

The End of Life Option Act has been in effect in California for almost three months.  How is it going so far?
In the news, there have been a few publicized cases. First, the death of a young woman with ALS in Ojai, California fit perfectly with the romanticized image of an intimate goodbye among friends and family, followed by the sip of a potion and a long, gentle sleep.  The most common sentiment I heard from people was “You have to admit that was lovely,” yet the media coverage led me to wonder whether the rules of reporting on suicide (avoiding sensationalism to deter copycats) apply here— apparently not.  
Other stories were less rosy. Another woman with ALS in southern California struggled to find anyone to write a prescription, and when she finally obtained the medication, her death was a frenzy that involved an urgent ferry from the pharmacy via Uber and a rushed crushing of pills in a race against her symptoms. The woman’s niece wrote, “It didn…