end-of-life care

so you think you want to stop dialysis?

After recording my latest YouTube video for the fifty-leventh time before getting a usable version, I realized I didn’t answer the question posed by the inspiration email. In the video, I talk about how to bring up the notion of stopping dialysis to the nephrologist, but the writer was asking how to bring it up to their sister on dialysis. Anyone familiar with the vernacular “fifty-leventh” knows that means I did not have it in me to do even one more take. But I can address their question here.

the meaninglessness of an eye flitter

A couple of weeks ago, I was the attending nephrologist for our hospital consultation service when I met Mr. Jones. He had suffered a severe heart attack. His heart was stunned into stillness and couldn’t effectively pump oxygen-filled blood to his kidneys or any of his other parts for the however many minutes it took for the ambulance to get to him and start resuscitation. Once he was transferred to the hospital, the cardiologists successfully reopened the major coronary artery responsible for the attack, but his kidneys weren’t working as well as they had been before. But his kidneys were the least of his troubles. My interaction with his family reminded me of an experience in my own life from about twenty years prior.

truth be told

I had just finished presenting my body of research for the prior six years in hopes of convincing the committee I was worthy of promotion from Assistant to Associate Professor of Medicine when the chairperson said, “It is clear palliative care is your passion, so you should stop wasting your time with the dental research." I. Should. Stop. Wasting. My. Time.