MS-4

Yes, I’m still alive

…but many of my patients are not.

That’s right, folks, this month I’m on a palliative care rotation, which mostly means checking in from home while drinking my morning coffee — not because I am trending someone’s creatinine or following up on that MRI brain with and without contrast (oh, sub-i, is it weird that I miss you?), but because I need to know how many of my patients still have a heartbeat.

It’s actually a really fantastic month. My attending and fellow are both great teachers, and I wholeheartedly embrace the palliative care paradigm, as I think I have mentioned before. I have had innumerable patients over the last few years who really *should have* been seen by palliative care.

I think what I love most is the idea that “palliative” does not mean “give up.” There is so much that we do for these patients, in a tangible, practical way. That includes sitting down – literally! — with them and their families to talk about goals and values. It also includes some hardcore symptom management. Mostly pain, but also nausea/vomiting, constipation, delirium….

Morphine. Dilaudid. Methadone. These drugs have a certain mystique about them, rarely prescribed and always with great caution.  But they are all over the place for these patients. They are normalized, just as ordinary as Keppra for seizures or metformin for DM. I feel a lot more comfortable around them now, because I know what to look out for, how to assess their symptoms.

Ok, time for a little bedtime reading: management of dying, and the apocalypse.

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