Dad’s Last Week

Jennifer E. DeVoe

doi:10.1370/afm.1908

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Heroic Measures
Saria C Saccocio

Published on: 31 May 2016
This is what personal doctoring looks like
Rebecca S. Etz

Published on: 23 May 2016
Executive Director
Thomas Vansaghi

Published on: 20 May 2016
Powerful
Reid B Blackwelder

Published on: 20 May 2016

Published on: (31 May 2016)
Page navigation anchor for Heroic Measures
Heroic Measures
Saria C Saccocio, Chief Medical Officer
Merle's last days were spent with dignity, respect, and love surrounded by friends, family, and his greatest protector, Jen Devoe. We often refer to heroic measures as resistance to death through uncomfortable procedures and futile interventions. In this case, the heroic measure was saying "no". Jen's resistance to giving in to the pressures and daily work of a busy pulmonologist on auto-pilot, and standing at the beds...
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Merle's last days were spent with dignity, respect, and love surrounded by friends, family, and his greatest protector, Jen Devoe. We often refer to heroic measures as resistance to death through uncomfortable procedures and futile interventions. In this case, the heroic measure was saying "no". Jen's resistance to giving in to the pressures and daily work of a busy pulmonologist on auto-pilot, and standing at the bedside with a courageous voice saved her father from a less than ceremonious farewell and years of regret and wonder whether she herself could have done things differently.
Jen saved Dad from missing the opportunity to say goodbye, hug his grandchildren one last time, and die on his terms. How many of us would have the strength, the wits, and state of mind when informed consent was but an expected nod on the way to being wheeled into the bronchoscopy lab? Her split second decision, added days of comfort and peace. How many patients and families experience a similar scenario every day?
Though I don't blame the pulmonologist for doing what comes naturally in his shoes and his specialty, I am saddened by knowing we often get through days on auto-pilot without the mindfulness to ask if we are doing right by the patient in front of us. We all have the capability and heart to be personal with our patients, to look them in the eyes, and ask them what is most important to them. Luckily, Jen was there to perhaps save a pulmonologist from regret and wonder, too.
Jen, thank you for your wisdom, courage, and sharing your Dad's story with us all. As I take a deep breath today, I am grateful for personal physicians like you.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (23 May 2016)
Page navigation anchor for This is what personal doctoring looks like
This is what personal doctoring looks like
Rebecca S. Etz, Associate Professor
Jen DeVoe - thank you for the gift.
It would be easy to read "Dad's Last week" as a personal story. Easy to think of Dr. DeVoe as brave, to commend her willingness to share her vulnerability, to be touched by the story, and to move on. To do so would be to miss the point.
This is a story about personal doctoring. The story shows that the human experience of illness and death is one that is filled with...
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Jen DeVoe - thank you for the gift.
It would be easy to read "Dad's Last week" as a personal story. Easy to think of Dr. DeVoe as brave, to commend her willingness to share her vulnerability, to be touched by the story, and to move on. To do so would be to miss the point.
This is a story about personal doctoring. The story shows that the human experience of illness and death is one that is filled with many decisions - some minute and some of lasting significance. Nutrition by mouth or IV, intubation or ability to talk, to keep or dismiss beeping alarms, how intrusively to monitor and for what purpose. In the flood of experience flowing by, it would be easy for big decisions to hide among little ones, looking the same and so not getting our full attention. It is fortunate that Dr. DeVoe was able to see them and note the difference.
This is a story that so clearly demonstrates the healing power of personal doctoring for both patients and their families - equal in their need for care. By comparison, it highlights the potential unnecessary pain and isolation experienced by so many who do not have with them, in the room, the expertise to know when options are available, when decisions are not inevitable, when the authority of the treating physician should be questioned in light of the interests of the patient and their family.
This story exposes the ways in which personal doctoring can interrupt social inequity. It shows the well-intentioned and yet never-the-less direct and indirect insults to the human experience that hospital stays so often include. It demonstrates that evidence-based decisions can be wrong as personal decisions; that a myopic focus on medicine can fail to notice the humanity of individual circumstances resulting in conversations that appear more like bullying than like care. Dr. DeVoe was able to allow humanism and compassion a space in the conversation.
"Dad's Last Week" shows policy cannot make up for lost relationships. Written last wishes are helpful but silent if not placed in a web of meaning, interpreted through knowledge of the personal and integrated into all end stage, if not end of life, decisions. It is fortunate that Dr. DeVoe was able to provide that knowledge.
Personal doctoring is as personal as it is medical. It integrates what is otherwise fragmented. It does not prevent death, but can provide healing to the dying and to their families. I am glad that Dr. DeVoe was able to provide this service to her father and family. When her father was gone, it was Jen that was left in the room. In a better world, a personal doctor would have been sitting next to her, caring for her as she or he had cared for her father. Fortunately, Dr. DeVoe had spent a week creating a team and that team was able to see her through.
Competing interests: None declared
Show Less

Competing Interests: None declared.
Published on: (20 May 2016)
Page navigation anchor for Executive Director
Executive Director
Thomas Vansaghi, Executive Director
I commend Jen's courage, conviction and compassion in the final days of her father's life. The North American Primary Care Research Group, which Jen is currently the president, is 100% committed to patient centered approaches to medicine especially at the end of life. Jen's account of her own experiences and how she and her father were treated (as a revered professional in medicine) is a testament to the millions of pati...
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I commend Jen's courage, conviction and compassion in the final days of her father's life. The North American Primary Care Research Group, which Jen is currently the president, is 100% committed to patient centered approaches to medicine especially at the end of life. Jen's account of her own experiences and how she and her father were treated (as a revered professional in medicine) is a testament to the millions of patients who don't have a voice in their medical care. Congratulations Jen on your bold and insightful article. This story needed to be told.
Competing interests: Jen DeVoe is the the current president of NAPCRG.
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Competing Interests: None declared.
Published on: (20 May 2016)
Page navigation anchor for Powerful
Powerful
Reid B Blackwelder, Professor Family Medicine
First and most important - Thank you Jen for sharing this deeply personal and intimate story. But telling such stories is one of your strengths. And now I know from whom you got this skill. Your father was obviously a beloved person in his life, and made a profound impact in the lives of many others.
By sharing this story you two have the chance to make even bigger impacts as you clearly identify aspects of "He...
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First and most important - Thank you Jen for sharing this deeply personal and intimate story. But telling such stories is one of your strengths. And now I know from whom you got this skill. Your father was obviously a beloved person in his life, and made a profound impact in the lives of many others.
By sharing this story you two have the chance to make even bigger impacts as you clearly identify aspects of "Health Care" sadly missing from our culture's processes. You show so powerfully the importance of relationships, and not just between families. We in the healthcare system must respect that power, and ask to be a part of the narrative it creates in all we do caring for people and families (because we never take care of only a person, and certainly should never treat a disease!). You and your father had good and not so good examples along the way in his last days. I hope all who read this, and physicians especially, choose to be like the one who was open, honest, direct and supportive. Too often we are seen as patriarchal, directive and shaming. And worse, too often we are.
Your strength in standing up for your father, and his incredible strength to verify your speaking his truth brought tears to my eyes. It is so sad it took such an effort to finally have care become patient- centered. But you two made it happen! What a gift to have such time with loved ones, and friends. The need for such closure in each of our life's story is too often ignored and the chances missed to reach out, reconnect, and say goodbye because we seem not to embrace this level of truth and compassion with our patients, or ourselves. No one would choose death in a hospital over finishing this journey of life surrounded by loved ones in our home. What a blessed gift you gave him, yourself and your family.
Blessings and heartfelt thanks for this story. I will carry it now and share it
Reid
Competing interests: None declared
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Competing Interests: None declared.