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| .p004 4th year UCSF med school, then three years of internal medicine .p005 much time for tests and records, little time with patients .p007 patient Donna: would a shorter life be better without dialysis .p008 Dr. !McCormick; "two medicines help prevent gasping, toxins make you sleep, death after loss of consciousness, a merciful way to die." .p009 patient dies after praying with chaplain .p010 weeks before end of med school, Puri experienced caring for a dying patient .p011 living well in the time remaining .p015 Mother from Mumbai, grandparents West Punjab Hindu refugees, sectarian violence killed 1M - 2M people .p016 grandfather taxidriver, 5 children in 2 room flat, 7yo daughter/mother decided to be doctor .p017 begging and scholarships Mumbai medical school .p020 author: I followed my mother into medicine because that's where she was .p022 Mr. Tan, patient writes: ''You are here in morning, afternoon, night. When do you go home?'' .p029 family meeting with wife and daughter (UC Davis) .p034 Puri attempts to communicate seriousness, Mr. Tan climbs (impossibly!) out of bed, says he WILL see is daughter graduate in 2 years |
.p04 4th year UCSF med school, then three years of internal medicine .p05 much time for tests and records, little time with patients .p07 patient Donna: would a shorter life be better without dialysis .p08 Dr. !McCormick; "two medicines help prevent gasping, toxins make you sleep, death after loss of consciousness, a merciful way to die." .p09 patient dies after praying with chaplain .p10 weeks before end of med school, Puri experienced caring for a dying patient .p11 living well in the time remaining .p15 Mother from Mumbai, grandparents West Punjab Hindu refugees, sectarian violence killed 1M - 2M people .p16 grandfather taxidriver, 5 children in 2 room flat, 7yo daughter/mother decided to be doctor .p17 begging and scholarships Mumbai medical school .p20 author: I followed my mother into medicine because that's where she was .p22 Mr. Tan, patient writes: ''You are here in morning, afternoon, night. When do you go home?'' .p29 family meeting with wife and daughter (UC Davis) .p34 Puri attempts to communicate seriousness, Mr. Tan climbs (impossibly!) out of bed, says he WILL see is daughter graduate in 2 years |
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.p90 stumble with daughter of first patient .p92 some patients reject palliative care ("to save money"), others comforted .p93 quality of life and treatment goals .p96 Ideally, palliative care ... helps patients think through complex personal questions .p111 Intubated patient Alice, combative husband Chris. Alice writes "no more tube" .p112 sometimes supporting colleagues as much as supporting patients .p114 extubations unpracticed, can be difficult |
That Good Night
Life and Medicine in the Eleventh Hour
Sunita Puri 2019 / Beaverton Library 610.92 PUR
- med student studies palliative medicine
- p04 4th year UCSF med school, then three years of internal medicine
- p05 much time for tests and records, little time with patients
- p07 patient Donna: would a shorter life be better without dialysis
p08 Dr. McCormick; "two medicines help prevent gasping, toxins make you sleep, death after loss of consciousness, a merciful way to die."
- p09 patient dies after praying with chaplain
- p10 weeks before end of med school, Puri experienced caring for a dying patient
- p11 living well in the time remaining
- p15 Mother from Mumbai, grandparents West Punjab Hindu refugees, sectarian violence killed 1M - 2M people
- p16 grandfather taxidriver, 5 children in 2 room flat, 7yo daughter/mother decided to be doctor
- p17 begging and scholarships Mumbai medical school
- p20 author: I followed my mother into medicine because that's where she was
p22 Mr. Tan, patient writes: You are here in morning, afternoon, night. When do you go home?
- p29 family meeting with wife and daughter (UC Davis)
- p34 Puri attempts to communicate seriousness, Mr. Tan climbs (impossibly!) out of bed, says he WILL see is daughter graduate in 2 years
p40 I will suffer if you give up on me. As long as I am with them I will be OK
- p42 Two years later with Mr. Tan, watching daughter graduate
p43 I told you I would get out of here!
- p45 Second year, choose specialty training?
- p47 palliative medicine changed focus to quality of life rather than last months of life
- p49 parents (Anesthesiologist mom) dismissive of palliative care
- p50 pulmonary artery catheter, mother says "Now you know how long each one of those procedures takes. That's why I left home so early for so many years"
- p51 celebrated successful ICU treatments, troubled by patients in ICU for weeks or months
- p53 Puri redo: would have asked wife about husband's definition of suffering in ICU
- p59 Human suffering wasn't a topic we discussed in medical school.
p59 The Nature of Suffering and the Goals of Medicine book 1982 Eric Cassell
- p61 1970s, Karen Ann Quinlan, parents ask for natural death, doctors refused, New Jersey Supreme Court permits
- p61 Puri tells wife and son that patient only getting sicker, "we may be causing more harm and suffering"
- p63 life support removed, patient peaceful, dies 15 minutes later, wife thankfuk
- p65 Puri father says "if you pay attention and help ease the suffering of others, that is God's work"
- p67 spring 2012 Puri accepted into Stanford palliative care fellowship program starting July 2013
- p75 Puri chooses comfort care for dying patient, attending agrees "that's the difference between an intern and a resident"
- p90 stumble with daughter of first patient
- p92 some patients reject palliative care ("to save money"), others comforted
- p93 quality of life and treatment goals
- p96 Ideally, palliative care ... helps patients think through complex personal questions
- p111 Intubated patient Alice, combative husband Chris. Alice writes "no more tube"
- p112 sometimes supporting colleagues as much as supporting patients
- p114 extubations unpracticed, can be difficult