I wholeheartedly agree with Dr Davis that palliative care should become our focus as patients near the end of their lives. Perhaps I could have been more exhaustive in my discussions with Mrs Lopez and her family. They did know that she had a terminal condition; we had discussed her wishes regarding resuscitation. Had I recognized at the moment of her last stroke that her situation would quickly deteriorate it would have been easy to spare her the nasogastric tube and central line. Given that she had just bounced back from a similar episode 2 weeks before, I found that call more difficult to make.
Our work as physicians offers us limitless opportunities to establish high standards for ourselves as we minister to our patients. Having set the bar, we may find that reaching it in every situation can be extraordinarily difficult. Just as we look for ways to comfort our patients, I hope that physicians can find ways to share, listen, and comfort one another when we try our best and still fall short.
Paul R. Gross, MD
St. Joseph’s Medical Center
Yonkers, New York