Archive of entries by Dr. David Tribble

In honor of those who serve
11 Nov 2011

Dr. David Tribble

Some time ago at a National Hospice and Palliative Care Organization session on care for veterans, the speaker asked all the veterans in the room to stand up. Then she asked if anyone still seated had been in the service and worn the uniform, and about as many more stood up (including me). She told us, “You are veterans, too.”

I salute all of you who have served, who serve now, and who will serve in the maintenance of the freedoms we enjoy. I am glad we have matured as a nation to the point where we properly honor our veterans, particularly those who have seen combat, but also those who have served and supported them and their families. I am humbled to be considered part of that group. READ MORE

In this 3-minute video, Alive Hospice Chief Medical Officer Dr. David Tribble offers good advice for talking with one’s physician about hospice care. As Dr. Tribble says, hospice is a wonderful option for “good life at the end of life.” Watching this video can make a world of difference for someone you love.

Do you know someone who could benefit from hearing what Dr. Tribble has to say? Please forward this video! Click here.

Dr. David Tribble

Families who have had a loved one in the care of Alive Hospice often comment that they wish they had started hospice services sooner.

Hospice can be a difficult subject to approach for patients, families and medical people. As a result, physicians are reluctant to bring it up because of concern over a patient’s reaction. Families are often reluctant to ask for fear of offending the physician. If patients are to get this marvelous benefit for a longer period of time, it would be useful to know when to start thinking of hospice. READ MORE

Dr. David Tribble

Not long ago, New York passed a law called the Palliative Care Information Act, which requires physicians to present palliative care options (those which aim to enhance quality of life) to patients whose illnesses are considered to be terminal (those with a limited life expectancy).

In a recent commentary on the law published by the New York Times, Jane Brody presents both a summary of the act and physicians’ objections to it as well as some comments that are interesting. I am happy to see this level of support for inclusion of palliative care options and candid disclosure to patients as part of the discussion. READ MORE

Dr. David Tribble

I was privileged to be invited to speak at a retreat held by the ALS Clinic staff at Vanderbilt not long ago. I went prepared to expound the gospel of interdisciplinary care, of exploring the patient’s goals, of seeing the patient as a whole person as opposed to an instance of a disease, and of seeing to the health wholeness of themselves as caregivers.

I was fortunate in two things: I was last on the agenda, and I had the discipline to listen to what the other speakers had to say before I spoke. I learned their style, their successes, their goals and aspirations, and I learned that I had a lot less to teach them than I had thought. READ MORE

Dr. David Tribble

The New England Journal of Medicine published a study recently in which 151 lung cancer patients received either usual treatment or usual treatment plus palliative care. The palliative care recipients had better quality of life scores; were more likley to have decided against resuscitation; received less chemotherapy; and survived, on average, almost 3 months longer.

Electing palliative care is not an act of surrender. It is, for many, the best opportunity for survival that is not only the most comfortable, but also the longest. Active medical intervention for cure or disease modification does not necessarily equate to longer survival or to better qualitative survival. READ MORE 

Dr. David Tribble

One of our own lost her father recently, unexpectedly. With that event, those of us who work with her brought our offerings of care and support and were acutely aware of her pain and her loss. Though we work with death, and the pain it leaves behind, every day, it was different having it this close, this personal.

I am reminded, then, that death is this close, this raw, this personal for the people we have the privilege to serve. Each death is someone’s father, mother, sister, brother and those who remain have these same feelings. For them it is personal, up close, and raw. READ MORE

Dr. David Tribble

For as long as I have been in medicine (some 35 years now), there have been those who advocate authority-driven dictates based on societal outcomes debating hotly with those who uphold individual autonomy above all else. What we have learned in hospice work is that it is rarely a matter of deciding for one side and against the other. Instead, we attempt to negotiate as much autonomy as we can for the patient in terms of what is actually feasible, allowing obviously detrimental autonomy only when the boundaries of the law offer us no choice. READ MORE

Dr. David Tribble

There has been much discussion regarding the recent New York Times article regarding Dr. Desiree Pardi, a palliative care physician who chose to pursue disease-modifying treatment until she died, as if this were somehow contradictory, an abandonment of the principles she espoused in practice.

I have been privileged to read the response from her husband as posted by the Pallimed blog’s Christian Sinclair as well as a thoughtful response by Brad Stuart on Geri-Pal. READ MORE

Dr. David Tribble

There is more attention paid now to the issue of thinking about, discussing, and then making known what each of us wants for ourselves.

Those who fail to learn from history are condemned to repeat it. It is with that thought that we remember the last months of the life and dying of Terri Schiavo, in which two sides of her family waged a bitter and nationally televised legal battle, each side certain that it knew what she would have wanted, and neither side with possession of any firm information that they did, in fact, know.

Tragically, there was also no way for either side to actually find out. READ MORE

Dr. David Tribble

There has been some excitement about studies regarding patients in Persistent Vegetative State (PVS) that have raised questions as to whether comatose patients are “aware.” One of the studies appeared in the Archives of Neurology in 2007, and another earlier this month. In the 2007 study, a comatose patient’s functional MRI (fMRI) showed patterns similar to those of a normal volunteer. It is worth putting all this in perspective.

This all bears a lot more study before we decide it actually means anything. READ MORE

Dr. David Tribble

Last weekend, my wife and I put up the Christmas tree. We didn’t do it last year, feeling stretched between old and new lives and having a one-year-old Great Dane pup in the house. Besides, it is just the two of us now. But, now that it is up, I am glad we did it.

The tree is decked with ornaments that are mementos of numerous events over the years, that are family heirlooms, that are symbols of the season, and I get joy from just sitting in the room with it and looking at it.

We can find peace and joy in the symbols and rituals of the season. READ MORE

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