July

On behalf of the Editorial Board, I would like to thank Dr Sehmer for his letter. He obviously cares deeply about the BCMJ, as we do, and we take his concerns seriously. In fact, we agree with everything he says, except for a few facts that need correction:

•    The Editorial Board has not changed its policies or practices on letters to the editor.

We thank the editors of the BCMJ for the opportunity to respond to Dr Passmore’s thoughtful letter. He provides several important points as well as a context for these difficult and challenging situations. 

I beat the vulture. By “beat” I mean that I slapped its wing at the top of Doomsday Hill while running the annual Bloomsday run in Spokane, Washington. 

In days gone by, there were few people in the world who had the wherewithal or education to actually make any educational choices in their lives. To learn medicine, for instance, would require years of sacrifice and largely self-motivated and experiential training for an acolyte. Few, therefore, could even consider our vocation.

Case 1: A 77-year-old man
A 77-year-old man with diabetes, cardiac disease, and an implantable cardioverter defibrillator (ICD) develops a bleeding colorectal cancer. He is high risk for surgery and decides to forgo it. He requires several hospitalizations and spends the last month of his life bedbound at home with his family struggling to care for him without any community support. He is awoken from sleep by his ICD discharging and has eight shocks on the way to the hospital. He declines further treatment at the hospital and dies the next day.