descent into dementia …
William Utermohlen’s series of self-portraits after his diagnosis of dementia. NYT essay slide show JMP article
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to be courageous …
Imperative 8 To be courageous. Courage is contagious. The defining moments of history have been immortalized because common men and women inspired others with their courage and together they all accomplished the seemingly impossible. No one and no thing must ever cause us to shirk our duty to a patient who relies on us to
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in settings of ambivalence and resistance …
… don’t push (“righting reflex”) but reflect … Pollack et. al. discuss how to talk with patients and families when they are resistant to discussing the future or are ambivalent and unable to make a decision. Criteria to know if we have been successful … Letting patients talk as much as clinicians; Keeping question-asking to
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forgiving ourself … offering ourself …
“You have to forgive yourself for the things you don’t know, and forgive others for the things they don’t know, and we do know. Working with others, who are different, is difficult for everyone, but above all for scientists who, contrary to what is thought, are very conservative, so much so that “entrusting themselves” is
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a world without fear … ?
“Liberalism and illuminism want to insinuate us in a world without fear; they promise to do away with every type of fear. They wish to eliminate every dependency on another and its intimate tension. This search for security is founded on a total auto-affirmation of the self which denies the risk of going out of
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the precarious nature of the team when challenges are faced …
Swetenham et al and Hegarty etal study the impact of refractory suffering on the interdisciplinary team. “Refractory suffering – that is, suffering that persists unrelieved despite all attempts by an interdisciplinary team to ameliorate it, is one of the most difficult and challenging aspects of palliative care practice. Its effects on clinicians have been documented.
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the thread of life …
… The mother herself becomes a key element of the drama: she weaves the thread of life, in contrast with the image of the Fates, who weave the thread, but they are always ready to cut it. The artist wants to underline the importance of the presence of another person, although silent, which is able to
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to be strong … to be weak …
Imperative 9 To be strong. Strength has a resolute spirit that stands in spite of overwhelming obstacles. We can become a source of strength to our patients and their families. They can draw strength from us. If we are willing to hold their disappointments, their fears, their guilt, not succumbing to desperation, even when that
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the illusions of psychiatry …
Marcia Angell summarizes the ‘medicalization’ of psychiatry and its support by the pharmaceutical industry. There are many lessons here for palliative care as both a discipline and in its practice. “In short, a powerful quartet of voices came together during the 1980’s eager to inform the public that mental disorders were brain diseases. Pharmaceutical companies
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the act of service redeems the experience of suffering …
… The stories of our patients frequently do not end well, no matter what our patients do, and no matter what we do. In the end, if not now, then later, all pass from this world. All too often the service we provide, this most personal service, will fall short as we come up against the
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