Potpourri from Clinical Work IV

I was palliative care attending for a month, from mid-December to mid-January.  Here a few observations from my time on service:

• Holding on for the holidays.  In mid-December the hospital was pretty quiet and the hospital half full.  By the time I left in mid-January, the hospital, ICU, nursing home, and hospice unit were all full.  I’ve heard of people “holding on for the holidays,” but this was pretty impressive first hand experience.  Does anyone know if this phenomena has been studied?  Pretty impressive evidence of a mind-body connection.
• Passing of the greatest generation.  A 95 year old veteran I cared for described serving in General Patton’s battalion in Europe.  Patton planned to storm a village at night, and told the troops, “We will take that village tonight!  I don’t care how many dog tags we go through, we are going to take that village!”  That was Patton.  These are the last years we will care for these great veterans.  Sad.
• Vietnam veterans are dying.  This is completely anecdotal, but I feel like as the Vietnam veterans are starting to die in higher numbers, we’re seeing more diseases associated with alcohol and substance abuse, specifically, cirrhosis and head and neck cancer.  Does anyone else feel this way?
• Don’t forget the bowel regimen.  A resident I worked with said that the saying in her residency is “The hand that forgets to write the bowel regimen is the hand that disimpacts the patient.”  That will make you remember!
• Palliative Care Consult.  How do you respond  when you get one of these palliative care consults?

by: Alex Smith