Letting go

I recently attended the funeral of a patient. He was lucky to have lived both long and well. It was an honor to have known him and to be a participant in his life at an important point. With much input from specialists, thought and prayer on my part, and numerous conversations with family members, it was decided to let him go - to stop the life-sustaining treatments in favor of a better quality of life. What a gift his family gave him - to be at peace at the end, to take death on his own terms, as he would have wanted.

Save the Beans

This isn't exactly along the lines of this blog's themes, but it is my issue of the day. You know how one think kind of sticks in your mind all day. Well today, my issue is kidneys and the heaps of abuse they take before they finally throw in the towel for good. In the U.S. diabetes and high blood pressure are the 2 leading causes of kidney failure (and need for dialysis). I had at least 3 patients today who have chosen not to do their part to control these diseases (like take their medications). They range in age from their 20's to their 60's and they are all along the path from normal kidney function to complete dependence on a dialysis machine. What is it about our society that we have these great medications (I know the irony of posting this after my last rant about pills) but still fail to take them? How hard do I push medication compliance with patients? Should I be gentle or firm, threatening or low-key? Ultimately, it is the patient's choice what they do with the recommendations I make, but I think they would make different choices if they saw the end result as clearly as I can.