Real Intentions for Life

September 2016

How to Draw the Red Line in the ER


Self-determination often escapes patients while not feeling well and being hoisted onto a stretcher:

Ms. Lacy was 86-years-old and barely weighed 80 pounds. She had an anxious look in her eyes while having difficulty breathing. Her lung cancer was resistant to chemotherapy and had gradually destroyed her sense of well-being for 2 years. Her oncologist had recommended three more treatments before stopping. Ms. Lacy seemed agreeable to this plan of action and ongoing misery.

While fate had determined her lot in life, had she considered drawing a red line to receiving unnecessary medical intervention? Was this red line preset, left to her doctor’s discretion or arbitrarily established in the ER? Patients dealing with life-threatening conditions are often angry or anxious, triggering a chaotic response. They rarely maintain control of these situations.

Three simple guidelines can help patients draw a red upon admission to the ER:

  1. Establish where you are and where you are going.

Ms. Lacy’s medical condition had progressed beyond any hope of survival, making further medical intervention futile.  She knew the end was near, but seemed to be distracted by the promise of more treatment. In the meantime, she was experiencing a nervous breakdown. She was used to playing by the rules and having her doctors determine her plan of action. Ms. Lacy had never considered the prospect of a carefree existence. Breaking the rules was difficult for her to imagine.

Ms. Lacy’s arrival in the ER was a commencement exercise. A clear demarcation between the past and the future. It was time for her to take an inventory of her life and reset her priorities. Instead of minding follow-up appointments with her oncologist, she could tend to some personal files that she had been neglecting to organize. She was encouraged to create another type of nesting phase in anticipation of much-needed relaxation and enjoyment during her final days.

  1. Choose between evidence-based and common-sense medicine.

Did Ms. Lacy prefer the doctor listen to her medical history or focus more results from lab studies and x-rays? Self-determination requires forethought, while being exploited appears to be an afterthought. The tourniquet had been placed on Ms. Lacy’s arm to draw blood as per protocol, yet the need to pursue abnormal lab findings at the end of life rarely makes sense.

After being given the option to defer another needle stick, Ms. Lacy was beginning to appreciate the benefits of drawing her red line. The concern about mission creep at the end of life –whereby patients receive unintended care/consequences – might be traced back to the very moment that the invasive needle slithers under the skin. This procedure crosses the red line between using common sense and relying on evidence-based medicine.

  1. Change your mind and begin to feel fulfilled

There is always room for improvement, but not perfection. Ms. Lacy was lead to believe that if her lung cancer did not improve, she was a failure or a goner. Life happens and cancer occurs as a natural part of living. No one is perfect, yet Ms. Lacy was led to believe that she would be good if her cancer was cured. However, there was nothing truly wrong with her. She was actually being given the opportunity to feel fulfilled in life.  She also deserved to be given reassurance, like receiving a badge of honor.

With drawing a red line to further treatment, the mission was directed toward calming her anxiety and alleviating suffering. She was offered medication to help her relax, which she accepted. Almost immediately, life no longer seemed miserable. With her husband and daughter at bedside, Ms. Lacy expressed overall gratitude for her good fortune. She was able to regain control of the situation by taking a different perspective of thanksgiving. By not crossing the red line in the ER, Ms. Lacy was able to retreat and say to herself, “Mission Accomplished!”

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                             Twice monthly email tips that promote compassionate end-of-life care.


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3 Reasons Yoga is Contagious and Helps Manage Your Grief


Spread the word: September is National Yoga Month.

I’ve practiced emergency medicine and yoga for 15 years and often sing its praises to coworkers and patients. Yet it has been difficult to describe this invigorating experience in words until I read “Contagious: Why Things Catch On by Jonah Berger.

Why is yoga so popular?

Because, Berger proposes, anything that goes viral –like flu, iPhones or videos — have similar infectious aspects that create a shared experience.

One contagious aspect in life is the loss of a loved one. My father died four months ago, and I’ve found yoga to be a powerful coping skill to handle grief. Grief, like stress, can stream through the body unconsciously and result in muscle tension and chronic illness.

Here are three reasons yoga is contagious, especially in coping with grief.

  1. Yoga is emotional.

It stirs deep-seated tension and feelings. Yoga positions trigger an internal tug of war. While my limbs are being pulled in opposite directions, my mind is screaming, “Good Grief!” This mental breakdown opens the door to a spiritual breakthrough.

Quieting the mind awakens the heart. The blood, sweat and tears you suffer while stretching allow muscles to release and rebound. In one simple breath, my mood swings from feeling tormented to feeling liberated. As breathing becomes deeper and more deliberate, my heart pumps stronger and redistributes the pain.

  1. Yoga is practical.

You can apply its principles to daily life. Most yoga students attend their first class for a reason, usually to feel better or fill an empty hole. They restore the missing pieces to the puzzle through a through a holistic connection of mind, body and spirit.

The discipline to stay present and create awareness by breathing in and out consciously for one hour teaches me how to ease pain and suffering. From child’s pose to corpse pose, I have learned to use yoga to acknowledge grief, stir it up and let it go.

childs-pose-balasana-300x200 corpse-pose-savasana-300x200

Whether it’s a mom trying to release the cares and worries of the day or the son losing his father, yoga is exactly what the doctor ordered.

  1. Yoga is social.

It connects us to others. Students enter the studio as individuals but leave feeling a bond with others in the room and can’t help but feel on the top of the world: relaxed and free. People who grieve tend to isolate until they get over “the bug.”    Grief counselors often advise those mourning to “go through it” and “find your own way.”

Strength in numbers can hasten recovery because it helps you draw energy from other people. Similar to group therapy, yogis grieve together and share the four elements necessary to grieve: earth, wind, fire and water. While perspiring, breathing, stretching and feeling grounded in the child’s pose of virtual powerlessness, the four elements unite harmoniously. An opportunity to bask in serenity. While in corpse pose, I pictured myself being connected to my father –resting in peace.

Who knew grieving could feel so good?

During National Yoga Month, share this post with someone you know who’s grieving or needs recharging.

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dr-h-redKeep in touch with me through signing up for Dr. H’s Clipboard:

                             Twice monthly email tips that promote compassionate end-of-life care.

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