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A Piece of My Mind
November 3, 2015

When Minutes Matter

Author Affiliations
  • 1Division of Hematology/Oncology, Department of Medicine, University of Wisconsin, Madison; and School of Nursing, University of Wisconsin, Madison
JAMA. 2015;314(17):1799-1800. doi:10.1001/jama.2015.9204

The day I realized I had bucket lists all wrong was a sunny, warm, Wisconsin summer day. It started with a bike commute through the University of Wisconsin campus along the shores of Lake Mendota en route to a home visit. I first met Keith and his family in the hospital for a palliative care consultation. Keith, who had lower motor neuron disease, had been admitted with hypercarbic respiratory failure following a clavicle fracture sustained in a fall from his wheelchair. We decided during the consultation that Keith would not be ventilated and that he was at peace with dying. He was discharged home with bilevel positive airway pressure (BiPAP) and hospice support for end-of-life care and was not expected to live long: “A few days,” the hospitalist had estimated. However, 3 months later I received a phone call: Keith was “struggling.”