0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Perspective |

“Saving” Bonnie

Kathleen Bartholomew, RN, MN1
[+] Author Affiliations
1International presenter, currently without institutional affilations
JAMA Intern Med. 2014;174(1):13-14. doi:10.1001/jamainternmed.2013.12104.
Text Size: A A A
Published online

Extract

My mother in law, Bonnie, stopped eating just after her 88th birthday. A Christian Scientist, she had only seen a physician a few times in her entire life. Bonnie never talked about death because her religion did not acknowledge it. But as 50 pounds dropped rapidly away, she finally acknowledged to my daughter that she was dying.

Still, when I arrived at the emergency department, I was surprised at her motionless, emaciated body. Only yesterday evening, the Christian Science house where she had been living had discharged her to a skilled nursing facility (SNF) because she was too weak to stand. In the morning, her sons had visited and panicked: her legs were grossly swollen and suddenly leaking copious amounts of fluid. Without a physician present at the time, they were advised to take her to the emergency department.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment
Misguided anger
Posted on November 21, 2013
Kim Dutton-Johnson RN
UT Southwestern Medical Center
Conflict of Interest: None Declared
I find so many mishandled steps in this woman's journey, none of which in my judgment is owned by the emergency room staff. I wonder if this article was written due to a bit of self imposed guilt for being part of the creation of this situation. She was clearly very ill at the time she was transferred to a skilled nursing facility. At that very moment, the family, social worker AND patient should have had a conversation directed at hospice or palliative care. Instead, she was transferred a step higher to an emergency room. Treatment is anticipated by most people who present to an ER. As the D-I-L, you did not have the first line decision making for her although your input was clearly well intended, simply after the fact. The ER physician was absolutley appropriate in asking to speak to his/her patient in private. If this patient's family who has known her for many years has not felt comfortable preparing medical directives, why would you think an ER physician who has known her 2 hours would feel comfortable. While I appreciate the difficulty and pain the family experienced. The medical staff acted appropriately.
Hospice & Palliative Care in the ED
Posted on January 27, 2014
Gail Austin Cooney MD
Hospice of Palm Beach County, West Palm Beach, FL
Conflict of Interest: None Declared
This story demonstrates another important reasons for hospice and palliative care to be available to patients through the emergency room. Too often, appropriate discussions have NOT been had earlier in the course of disease - the reasons are myriad. But this should not prevent health care providers from offering palliative care when it is needed and wanted. No one should die in pain, being shuffled from one health care setting to another.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();