Introduction to the Medical Beat

James Whalen, MD

Welcome to the Medical Beat.  I have created this blog out of a desire to share my experiences as a hospice physician.  In addition, I will identify and explicate issues that lay people concerned about healthcare in the United States will find of interest. I have published such articles in the past in periodicals that, frankly, have a modest readership, and I am hoping the magic of the internet will provide me with a larger audience.  These articles were not short on opinion, and I will continue in the same vein.

A word about hospice.  The mission of hospice care is to provide comfort care for the terminally ill.  It is funded primarily by Medicare, with services being delivered mainly in patients’ residences.  Patient care teams consist of a nurse case manager, a physician, nurses who deliver the care, home health care aides, a social worker, and a chaplain.  I was the team physician for a team that cared for patients in homes and institutions like assisted living facilities and nursing homes.  We typically had about 60 patients under our care, with four or five new admissions per week balanced by the same number of deaths.

Dying Well: A Hospice Physician’s Memories and Reflections

One of my most memorable experiences in hospice involved the care of an old man.  Richard was 100 years old, and even though he had no life-threatening illnesses, he had decided that he had had enough of living.  HIs spouse was dead, his friends were dead, his children were dead.  His only close companion was his dog, a mutt, that had been with him for at least a decade.  The dog, with debilitating arthritis, was in worse shape than its master.

The gentleman’s plan was simple: quit eating.  As he became weaker, but still rational and steadfast on his course of action, his dog walker urged him to engage hospice care.  He reluctantly agreed.  

When I first met him, Richard was off-putting, suspicious that I would take measures to extend his life.  Once I convinced him I had no interest other than ensuring his comfort, he became quite friendly, regaling me with memories from an era inaccessible to most people.

When the inevitable outcome of his decision drew near, hospice personnel monitored him for any sign of discomfort.  His dog lay on his lap for the duration, and the patient slipped into unconsciousness.  A hospice Certified Home Health Aide (CHHA) reported that he had a perfect hospice death—he was completely calm, and had no  pain or any other kind of discomfort.  A few minutes after he died, the dog struggled to its feet, rolled off the side of the bed, and staggered to a corner in the bedroom.  Whereupon he lay down and died.