Discover and read the best of Twitter Threads about #endoflife

Most recents (15)

1/🧵 A personal story of misjudgment as a physician.
 
Years ago, when I was a young doctor, I had a patient in the ICU on a ventilator who was doing so poorly, day after day, that I was certain he was going to die.

I confidently told the family he was going to die.
2/ The family members all gathered and were extremely distraught. They listened and trusted me.
 
But I was wrong.

#PalliativeCare #EndofLife
3/ For many years to come, I received Christmas cards from this man.

It was extremely humbling.
 
Until I learned, this happened many other times in my life as an ICU doctor.

Sometimes I was off by just 2 weeks, sometimes 2 months, and other times by 2 years.
Read 8 tweets
This 👇👇👇 (h/t @joemd)

Also, at midcareer female success is threatening to men our age AND to younger men who rely on patriarchal patronage systems. Women, overpoliced by the system, then, yes, are tougher bosses AND we *do* tend to adhere more closely to ethics.

I do do all:
On #MedTwitter there is a pattern of “callouts”, yes vs all genders & ages, but also pattern of misogyny and misogynoir. It happens towards nurses & doctors alike. One of the reasons I connected with @ShrimpBrokkoli is because I saw a yt male resident ridiculing her online.
I saw that behavior being taught by NON-clinical faculty & that REALLY crossed a line.
If you are a woman + nurse + frontline + Black/WOC, you already live with so much violence towards you. Added online made up drama from a trainee vs nurse?
No, no, & no.
webmd.com/a-to-z-guides/…
Read 16 tweets
This is what targeted racial harassment looks like: nitpicking things like “smiled” or “wore clothes like a celebrity, as a celebrity” or “bought cookware.” It is part of the “gold digger” narrative.
This is common in #healthcare#professionalism” where there is hazing & bullying by racist &/or classist made up non-rules lacking standards…yet people are called “breaking the rules.”

It’s exactly how bullies operate: double standards, mislabel/smear, exclude, marginalize.
In the U.K., “BAME” includes the formerly colonized, thus making race constructs or power different from U.S. as latter had race-based chattel slavery.

Thing is, those formerly colonized have many who have internalized self hate & racism.

psycnet.apa.org/record/2021-69…
Read 76 tweets
Those of us with immigrant backgrounds have NO idea what debt we owe these women for risking their lives so some of us can shop at Whole Foods with other suburban moms, then drive a Lexus home to ride on a Peloton, & think only our own hard work created this access to success.
Those of us who are Muslim have a partial experience of what it is like to be made the face of threat and danger and vilified.

…But “the West “still wants to “save” Muslim women… make us a token or mascot of saviorism & evidence of being a shining city on the hill.
In comparison, the black woman doesn’t have that opportunity to be paraded around as the most recent woman “saved” & celebrated - the tropes are universally harmful & exploitative/pejorative vs Black women in society/media + centuries of economic barriers/being exploited.
Read 47 tweets
Daily Bookmarks to GAVNet 11/30/2021 greeneracresvaluenetwork.wordpress.com/2021/11/30/dai…
Manatee death rate spikes to highest number in nearly 50 years

fox13news.com/news/florida-r…

#manatees #DeathRate
Brilliant GIF shows how Humans, Birds and Insects Breathe

zmescience.com/science/biolog…

#GraphicVisualization #breathing #animals
Read 13 tweets
When you want to know why
-women & minorities leave medicine
-why research lacks data to serve needs of anyone not white & male
and/or
-why different mortality rates in patients by gender, race, SES

this is why

This is #MedBikini#professionalism” again

#MedTwitter
#MedEd
Is insidious
but highly effective
maintains
-segregation
-different access
-barriers

As women, LGBTQ, minorities, disabled enter or advance in medicine, this professor’s public stance will be cited to mislabel having #ethics as “lacking #professionalism

bioethics.net/2020/07/medbik…
#medbikini is not one article
=attitude of many physicians
=drives this

We saw this happen with @ayshakhoury and @uche_blackstock and so many others. It especially happens at midcareer to WOC, especially black. Also if Muslim, LGBTQ, disabled, #mentalhealth

#MedEd
#MedTwitter
Read 52 tweets
@adamcifu - the idea that doctors should not be political is why the entire field of #pediatrics walked out on the rest of #medicine. Children don't have the luxury of "every man for himself" mindset. Also, Muslim patients' or atheist patients' autonomy at #endoflife : political
All of us are trained, in residency, on "political" dollars from #Medicare and much of our #EBM is funded by tax dollars from #NIH and elsewhere. Tax dollars are public money, managed by elected officials, who are put in place and held accountable by the political process.
Then there are seemingly extreme examples, but are they so extreme given how often horrific things happen in history & even uptick of violence in the U.S.? Should doctors opt out of protecting vs this? These camps, if formed, may utilize doctors/nurses

time.com/4574680/muslim…
Read 5 tweets
Throughout December I'm doing a #PalliativeCareAdvent; every day I am going to challenge #misconceptions about #PalliativeCare, #EndOfLife and living with a #LifeLimitingIllness. Some personal, some factual. Do join me!
#Hospice #EOLC #PallMedEd #HPM

lucy-watts.co.uk/palliative-car… Image
Day 1
"#PalliativeCare is only for those who are imminently dying".

Palliative care can help people throughout their illness, from point of diagnosis. It can help people live well, live longer and focus treatment/care around their wishes.
#PalliativeCareAdvent #Misconceptions Image
Day 2
"#PalliativeCare can only occur in the absence of life-prolonging interventions"

It can be given during life-prolonging treatment or in the absence of it. It's about quality of life, symptom control, the person's wishes and preparing for the future. #PalliativeCareAdvent Image
Read 27 tweets
1/ Women in Critical Care:

👍 Just recorded #ISICEM roundtable w @frubulotta @ElisabethWaele @FlaviaSepsis & Dr. Juffermans. 🎥 🍿 on Sept 16th.

Let’s eliminate prejudice based on gender, sexual pref & color. Here is a Baker’s Dozen of Women ICU Leaders!

#heforshe #medtwitter Image
2/ The first woman leader in Critical Care I discussed was Dr. Christina Jones from UK. She is a Biochemist, Nurse, Masters Social Work, PhD in Psychotherapy.

👊Mother of ICU Support Groups & ICU Diaries. As an expert, she shaped our field!

#sccm #esicm #pulmcc #ICUrehap Image
3/ 2nd world leader in Crit Care presented was Dr. Deborah Cook, from McMaster Univ in Canada. Seminal trials in Ulcer Proph, Bioethics, CCCTG trials, and now edifying us about how to provide healing in the dying process through her 3-Wishes Project.
#endoflife #palliativecare Image
Read 8 tweets
Deathbeds. Some thoughts. A thread.

Most of us haven't seen somebody die in real life. We get our inner pictures from TV dramas, cinema screens, media stories. We've had more of those media stories than usual during Covid19. But we haven't been there for real.

1/n
Worse: for some of us, our beloved person died and we weren't allowed to be there. We have pictures in our minds of how it might have been, but no way of knowing for sure.

2/
Some of us work in health or social care. We're more likely to have been alongside dying people. But unless we recognise the process, then we may not understand what we are witnessing.

Some experienced workers aren't aware that there are similarities between most deaths.

3/
Read 25 tweets
When I started working on #scabies outbreaks in #carehomes some of my colleagues thought it was a weird, marginal interest. Now with #COVID19 it's changing. Everyone's realising that infection is a big deal in these #EndOfLife settings. Image
#Carehomes for older people are hard to study. Residents often have #dementia, staff are run off their feet, #consent to research is difficult - brilliant colleagues including @MedVetAcarology sorted this academic.oup.com/phe/article-ab…
Life expectancy on entry to a #carehome for older people is typically 8 months - these settings are largely #LastHomes. Everyone needs a plan for what will and won't happen for the common things likely to make them ill or deteriorate. #CPR probably not part of it
Read 13 tweets
THREAD

1/ This is one of the most important #covid19 articles you will read

This is about advance care planning

About talking to your doctor- who you know/trust- before you're critically ill about what you want done if you are faced w/ the end of life

jamanetwork.com/journals/jama/…
2/ There has been so much discussion about ventilators, ICU bed capacity, ECMO, dialysis etc

We know that outcomes in the elderly w/ #covid19 in the ICU have been abysmal.

Many of these people will end up dying alone on ventilators, if they even get on one.
3/ But is this really what all of these people would even want?

And is the time to discuss this when someone is critically ill in the hospital surrounded by people they've never met?

Primary care doctors NEED to be reaching out to their high risk patients, NOW
Read 9 tweets
She was sleeping when I walked in her room, pushing the curtain aside with my elbow while cleaning my hands with Purell. She looked peaceful. Outside her window, night was falling. 1/8
"Mrs. M***," I lightly shook her left arm, which was folding across her chest. I almost never wake patients up in the hospital because their sleep is often more important than my visit. But this was my last chance. 2/8
She opened her eyes and blinked a few times. With my blue scrubs, white coat, and face mask, I was not easily recognizable. I told her my name. "I'm your oncologist," my smile was hidden by the mask. 3/8
Read 9 tweets

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