Death with Dignity
January 25, 2013 | 
Author
It’s not often that I see a young patient* who doesn’t want any treatment in the immediate aftermath of a cancer diagnosis. In fact, I am so used to making a case for palliative and supportive care that the story of this patient nearly stumped me. The patient's friends had convinced the patient to come see me as a second opinion because they were concerned that the patient was delaying decision making about treatment. In fact, the patient was even talking about applying for Oregon’s Death with Dignity program for physician assisted suicide and had been discussing this with her primary care physician. Read the rest of this entry »
Posted in 
Avastin for Palliative Management of Brain Tumors: A Victory for Patients and Providers
In 2009, the FDA gave accelerated approval to avastin for use in recurrent, high grade brain tumors (glioblastoma and anaplastic astrocytomas). Avastin is an anti-body that removes a circulating protein thought to help tumor make blood vessels: not traditional cytotoxic chemotherapy, which directly kills cells. As clinicians began to use the drug in brain tumor patients, some interesting observations were made. Read the rest of this entry »
Seeing Your Doctor Tear Up
End-of-life care specialists learn to deal with the emotions that come along with our job in different ways. Many of our habits are a reflection of what was modeled to us in medical school, and our own underlying belief system. Read the rest of this entry »
Tell me what miracle means. by JPM Columnist Seema Nagpal, MD
Tell me what miracle means.
From the first appointment I have with them, many patients tell me they are looking for a miracle. That they believe they will be in the tiny percent of patients who are long-term survivors of glioblastoma, one of the most deadly brain cancers. Or that their brain metastases from metastatic lung cancer will disappear. Read the rest of this entry »
Which arguments are worth having…and which arent
I'd rather not have to think about this, but as my brain tumor patients reach the end of their lives, I frequently have to ask myself this question. "Which arguments are worth having with this family?" Read the rest of this entry »
Reflections on a 9th Grade writing assignment
My first assignment in "advanced 9th grade English" class was to write a 1 page description of a scene. No plot, just a description trying to include all of the senses using words. I had NEVER been in an ICU, never had anyone close to me pass away, and had as much medical knowledge as you'd expect a 9th grader to have. Yet, .... Read the rest of this entry »
Thoughts from a clinical trials course (and hello!)
Today, I am thinking about clinical trials because I am at a clinical trials class. It is a fabulous way to make you realize you don't know much. The course was extremely focused on pharmacology, but we also spent some time talking about "end points." As usual, folks interested in "quality of life" were having a difficult time defending outcome measures. Read the rest of this entry »
Subscribe Free: JPM Updates
Follow this JPM Blog
