Thread by @k_liebowitz

On a serious note:
Tuesday is my father's 2nd yahrzeit
Sunday 4/21 was the 2y anniversary of his death.

In reflecting back, I have some thoughts for #medtwitter, #Jews and the general public...
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#death #dying #grief #PalliativeCare #medicine

1. Condolence notes just need to say, "I am thinking of you" or "I was sorry to hear your news" or "I am sorry for your loss."

Don't overthink it, and don't offer false platitudes. Send your note or make your call, and the person who is #mourning knows you care.
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2. Show up.
For #shiva, for #kaddish. The first week, there's a lot of people around in a #Jewish house of mourning. Then everyone goes home, and we are left alone.
Offer to go to lunch. Bring dinner. Take a walk.
Join us in shul. Kaddish that first time in services was hard.
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3. The very last mitzvah you can do for a person is to bury them.

I'll just let that sit there for a minute.

The first shovel of dirt that hits the coffin is truly dreadful

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Back to #medicine...
4. #Physicians, some of your patients will have weird, rare sh*t, and they will know more about their illnesses than you do.

Don't blow them off

(Frankly, this goes for a lot who aren't dying, too. Ahem, #celiac)

There's no shame in asking questions

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5. Also for #MedTwitter: coagulopathic patients can bleed out into spaces like thighs and the retroperitoneum

Typical transfusion for my dad after a fall: 10-20 units PRBCs.

They can die from this.

Get a hematologist involved

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6. Anticoagulants can be almost impossible to manage in some patients.
No matter which anticoagulant was used in my dad, he bled uncontrollably when injured.
These people will fall & they will bleed & you can easily be screwed
IMO, NOACS are not a good choice
#MedTwitter
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7. Get doctors involved who know your complicated patients. They will do better and everyone will be happier.

8. Be honest about #mortality risk. TELL THE TRUTH. Complete a #MOLST form

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9. Hospitalization for an acute, painful condition (see above re massive hematoma) is not the time to taper a #chronic #pain patient's narcotics. I am fully aware of the #opiate epidemic, but intubated patients shouldn't be writhing and crying.

Don't be mean
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10. Your patient who always gets pneumonia will have pneumonia

11. You probably can't shape the behavior of difficult patients too much. Remember their outpatient physicians are working with them, and have learned to pick their battles
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12. If a patient's child is an out-of-state physician who has permission to speak to you, CALL HER BACK

Hell, it doesn't matter if she's a physician. If the patient has given permission, CALL HER BACK. And don't turf it to the nurse or intern.
#MedTwitter #SoMeDocs
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13. Be respectful of your patient's choices. You might think the patient is circling the drain (and s/he may be), but that doesn't negate the need to be respectful.

Not everyone wants to be a DNR. Or #hospice

That's ok.

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14. Last, but not least: remember the #families.
In many cases, families live with the cost of #chronicillness for years, and it takes a toll on everyone.

#BeKind. It costs nothing
#MedTwitter
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If you read this far, thanks for indulging me, and hopefully you will find one item here you can apply to your own medical, Jewish or personal experience.

For the inimitable Dr. Greene

@greenehousenyc @TinyPandaBear & the others (u know who u are)

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