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Profil korisnika/ce DavidJuurlink
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David JuurlinkOvjeren akaunt

@DavidJuurlink

Internal medicine, clinical pharmacology/toxicology and drug safety research @UofTmedicine. Inexplicably fortunate husband. Mostly water.

Toronto
sunnybrook.ca/research/team/…
Vrijeme pridruživanja: siječanj 2012.

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    David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
    • Prijavi Tweet

    I'd like to share some reflections on the death of a patient. I’ve thought about her a lot. She gave me explicit consent to tweet the details of her case, about four hours before she died. Her hope was that someone might benefit from her experience. /1

    11:12 - 18. svi 2019.
    • 30.756 proslijeđenih tweetova
    • 71.343 oznake „sviđa mi se”
    • Grey aka ⭕️z Fobazi Ettarh Deepti Menon Lel This Justin catherine daniel.seger Sanjam Gill happy
    1.157 replies 30.756 proslijeđenih tweetova 71.343 korisnika označavaju da im se sviđa
      1. Novi razgovor
      2. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        She came to hospital as octogenarians often do: with generalized weakness, falls, poor oral intake, fever, hypotension. Her WBC was 17,000. Blood cultures grew E. coli. Sepsis. Fixable enough. /2

        14 replies 184 proslijeđena tweeta 3.302 korisnika označavaju da im se sviđa
        Prikaži ovu nit
      3. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        But she also complained of pain in her groin and thigh. It was new, progressive and debilitating. Even moving around in her hospital bed was agonizing. /3

        135 proslijeđenih tweetova 2.898 korisnika označava da im se sviđa
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      4. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        A month earlier, she’d been found to have a large pseudoaneurysm arising from her external iliac artery. (And yes, that’s a screw from a previous hip replacement traversing it.) She underwent stenting and returned home. /4pic.twitter.com/pKhoSgfjEb

        14 replies 146 proslijeđenih tweetova 2.803 korisnika označavaju da im se sviđa
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      5. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        Because she was septic and in pain, we scanned her again. The new CT showed extensive gas within the pseudoaneurysm. It was now infected, and that was a big problem. /5pic.twitter.com/gbFXe17UVc

        123 proslijeđena tweeta 2.593 korisnika označavaju da im se sviđa
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      6. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        We continued antibiotics. She improved. We got her pain under reasonable control with hydromorphone and various other meds. But then came the big question: “Now what?” /6

        5 replies 129 proslijeđenih tweetova 2.744 korisnika označavaju da im se sviđa
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      7. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        She wanted no more surgery. Her mind was now sharp, and she was clear about that. But antibiotics alone weren’t going to cure the infection; they would only suppress it. The best option, we suggested, would be antibiotics for the rest of her life. /7

        139 proslijeđenih tweetova 2.866 korisnika označava da im se sviđa
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      8. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        We discussed this option at length. She didn’t want it either. She explained why.   Pain was one reason. Meds helped a little, as long as she didn’t move around much. But our drug options were limited, and pain was going to be a persistent problem. /8

        6 replies 143 proslijeđena tweeta 2.879 korisnika označava da im se sviđa
        Prikaži ovu nit
      9. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        Her even greater concern, looking forward, was quality of life. Over the preceding months, she’d lost her mobility and independence. She wasn’t going to get them back and she knew it. /9

        163 proslijeđena tweeta 3.177 korisnika označava da im se sviđa
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      10. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        She foresaw being confined to her apartment, in pain, struggling with her walker. No more walks outside. No trips to the grocery store. No playing bridge with her friends, as she had done for years. She wasn’t interested in living like that. /10

        6 replies 192 proslijeđena tweeta 3.465 korisnika označava da im se sviđa
        Prikaži ovu nit
      11. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        We discussed palliative care: stopping antibiotics, increasing her pain meds, and keeping her comfortable while the infection took its course. Her family would keep vigil at her bedside for as long as it took. She wasn’t interested in dying like that. /11

        167 proslijeđenih tweetova 3.127 korisnika označava da im se sviđa
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      12. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        She knew she was nearing the end of her life. What she wanted, she told us, was for it to end peacefully, with her mind still sharp, and her family and friends present. She wanted medical assistance in dying (MAiD). /12

        5 replies 282 proslijeđena tweeta 4.313 korisnika označava da im se sviđa
        Prikaži ovu nit
      13. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        We held a family meeting. Relatives came from near and far. They were unconditionally supportive. As it turned out, she’d discussed the prospect of MAiD, were it ever to become an option, several times in recent years. So that became the plan. /13

        154 proslijeđena tweeta 3.650 korisnika označava da im se sviđa
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      14. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        I saw her every day after that. Managed her pain. Listened to her stories. Learned about family members who’d died, and whose deaths had influenced her decision now. Never once did she reconsider. I grew very fond of her, especially her wit and clear-eyed stoicism. /14

        179 proslijeđenih tweetova 4.421 korisnik označava da mu se sviđa
        Prikaži ovu nit
      15. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        After the requisite waiting period and medical assessments, the day had come. I visited her at 7:30 that morning. She was alone but upbeat, eating Cheerios and toast from her tray. (I still regret that this was her last meal. Wish I’d brought her a fresh bagel with lox.) /15

        13 replies 152 proslijeđena tweeta 4.488 korisnika označava da im se sviđa
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      16. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        A few hours later, her room was packed with family and friends. It was literally a party. There was talking and laughing and cognac in Dixie cups. The mood was anything but funereal. They gathered around her bed. I took a group photo. Everyone was smiling. /16

        229 proslijeđenih tweetova 4.808 korisnika označava da im se sviđa
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      17. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        I then watched as a colleague reviewed everything one last time, confirmed her wishes, explained what would happen, and answered everyone’s questions. “Okay, I’m ready,” she said. Her composure was remarkable. “Goodbye everyone. Thank you for everything. I love you all.” /17

        20 replies 384 proslijeđena tweeta 7.131 korisnik označava da mu se sviđa
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      18. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        She received midazolam and dozed off peacefully, her children holding her hands and stroking her head. Next came propofol, an anaesthetic. Then rocuronium, a muscle relaxant. Finally, potassium chloride, to stop her heart. Five minutes after saying goodbye, she was dead. /18

        344 proslijeđena tweeta 5.494 korisnika označavaju da im se sviđa
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      19. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        There were tears, of course. All around. But mostly the atmosphere in the room was one of serenity and gratitude, and a genuine sense of having done the right thing. /19

        224 proslijeđena tweeta 6.314 korisnika označava da im se sviđa
        Prikaži ovu nit
      20. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        I’m no MAiD expert, and I get that some people are opposed to it for various reasons. But I’ve been a doctor for 25 years, and I’ve seen enough deaths to know a good one from a bad one. This was, without exaggeration, the best death I have ever witnessed. /20

        1.081 proslijeđeni tweet 16.357 korisnika označava da im se sviđa
        Prikaži ovu nit
      21. David Juurlink‏Ovjeren akaunt @DavidJuurlink 18. svi 2019.
        • Prijavi Tweet

        We all die eventually. This patient helped me realize that when my time comes, I'll be fortunate if MAiD is an option. And I will always be thankful to her, her family, and a very skilled colleague for helping me appreciate just how good a “good death” can be. / end

        837 replies 2.356 proslijeđenih tweetova 33.156 korisnika označava da im se sviđa
        Prikaži ovu nit
      22. David Juurlink‏Ovjeren akaunt @DavidJuurlink 1. kol 2019.
        • Prijavi Tweet

        Coda:https://torontolife.com/city/life/threw-grandmother-assisted-suicide-party/ …

        6 replies 26 proslijeđenih tweetova 217 korisnika označava da im se sviđa
        Prikaži ovu nit
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