Wednesday, April 24, 2019

Getting to Know Our Patients - The New York Times

His email started out in a straightforward way, as most of the communications I receive from trainees do. He identified himself as being in his final year of medical school and asked about spending time rounding with me on our inpatient leukemia service. But then he went into territory I didn't anticipate.

"I am going into surgery and feel underprepared in managing patients with terminal diagnoses,'" he wrote. "I was hoping to spend this elective learning about this as it would be useful to my career in the future."

Medical students usually don't enter surgical fields for a love of terminal illnesses. Most are attracted by an approach to medical conditions typified by the braggadocio-laced line, "A chance to cut is a chance to cure." Surgery remains the most effective treatment for the majority of cancers. But leukemia, similar to other hematologic malignancies, is not a cancer for which surgery is a useful therapy, since its source, the bone marrow, can't be removed with a scalpel.

I respected him for recognizing that his education was deficient, and also suspected that whatever event had occurred leading to his request must have been traumatizing. He was asking to spend some of his precious remaining time as a medical student taking care of patients who would never be a part of his future practice. I invited him to join me.

More ...

Tuesday, April 23, 2019

Life — after life: Does consciousness continue after our brain dies? | National Post

He could see a nurse and doctor, a bald, "chunky fella" dressed in blue hospital scrubs. He watched as they frantically worked on his body, which was remarkable, considering he was, essentially, dead.

The man had suffered a cardiac arrest. Normally there is no measurable, meaningful brain activity after the heart stops beating. Within two to 20 seconds the brain "flatlines."

But the man would later tell researchers that he could see an unfamiliar woman beckoning from a corner up in the ceiling. "I can't get up there," he remembered thinking to himself, and then the next second, "I was up there, looking down at me."

He said he saw his blood pressure being taken, and a doctor putting something down his throat. He saw a nurse pumping on his chest. He accurately and vividly described the people, sounds and events of his "resurrection."

The case was part of a widely reported study Parnia published in 2014 called AWARE — the awareness during resuscitation trial, the world's largest study of what happens to the human mind and consciousness in the early period of death.

More ...