Background Several studies have described the population of adult trauma patients who undergo withdrawal of life-sustaining treatments (WLST); however, no study has looked specifically at trauma patients who undergo WLST following surgery. Methods This was a retrospective chart review of all trauma patients who underwent surgery at our trauma center between January 1 and December 31, 2017. Demographics were collected along with injury patterns and advance directives. Charts of all patients who died or who were discharged to hospice were analyzed to determine whether WLST occurred. Statistics included Fisher’s exact test and Mann-Whitney U test. Results Three thousand and twenty-five adult trauma patients received care and 1495 (49.4%) had operations. Thirty (2.0%) patients underwent WLST, 15 (50.0%) of whom died in the hospital and 15 (50.0%) of whom were discharged to hospice. Twenty-six (86.7%) patients had a palliative care consult and 12 (40.0%) had prior advance directives. The most common injuries were femur fractures and subdural hematomas. Adjusting for age, white race, and age-adjusted CCI, femur fracture patients had, on average, 8.8 more hours between presentation and surgery (95% CI 2.1-15.4, P = .01) and 39 fewer hours between surgery and WLST (95% CI −107–29, P = .26) than traumatic brain injury patients. Discussion The short time between surgery and WLST in this cohort of patients may demonstrate that surgery was not aligned with patients’ goals of care. A patient-centered approach that includes surgeon-driven palliative care discussions may help avoid nonbeneficial surgery in the last few days of life.

My father was killed by an Islamic fundamentalist in Cairo, Egypt, when he was just 47 years old. It was October 1993, exactly 8 months following the first World Trade Center bombing. I first heard the news from my uncle; I screamed-a feral howl escaping from deep inside of me-and dropped the phone.Terrorism was still a new word and a new concept for many Americans, so my father's death was featured prominently in the national papers and on the evening news. What does one say to a teenager whose father was just shot by a madman screaming "Allahu akbar?" Nobody knew. I didn't know. The silence was incredibly isolating.Two weeks later, my roommate handed me a postcard. "Hello from Cairo and the Pyramids. I miss you! Love, Dad." After 16 days and 6 thousand miles, my father had found me again. Even so early in my grief, the moment was not lost on me; I was awestruck by the magic of it all, that somehow, even in death, my father was right beside me, whispering in my ear. At the same time, the question remained: What does one say to a teenager who just received a postcard from her dead dad? Nobody knew. I didn't know. Despite this connection with my father that seemed to extend beyond both space and time, I felt incredibly alone.Four years later, in September 1997, my mother left a cryptic message on my answering machine, warning me to be careful when I read the paper that morning. Sabir Abu al-Ila, my father's murderer, had escaped from the mental hospital where he was imprisoned and had blown up a bus of German tourists. The Egyptian

The family conference chapter explores, in detail, one of the primary interventions performed by palliative care providers. A successful meeting can actually be viewed as time saving as it offers an opportunity for many issues to be reviewed and for multiple important decisions to be made in a relatively short period of time. By describing the conference in terms of a surgical procedure, during which we prepare, do, and close, this chapter offers specific guidance in a way most likely to resonate with a surgeon. It reviews the steps necessary to prepare for a family conference and describes how such steps may aid the family and the treatment team in managing uncertainty. It introduces the ask-tell-ask model of communication and discusses how this model can help to facilitate shared decision-making.

No abstract

Ever since I was 12 years old, I've associated the shrill ring of the telephone with the delivery of bad news. In January 1987, the phone rang with the news that my paternal grandfather had been killed in a car crash. Six months later, his wife, my grandmother, died as well. Eighteen months after that, the phone rang again with the news that my maternal grandfather had died suddenly of a newly diagnosed cancer. And in May 1992, the phone rang with the news that my maternal grandmother had been found dead in her apartment. Finally, in October 1993, the phone rang with the news that my father had been shot dead by a terrorist. 1 Having lived through 5 sudden deaths in 6 years, I had, foolishly, prided myself on knowing all I needed to know about grief and trauma. Yes, I knew a pain so sharp that it hurt to breathe, a sadness so vast that it hurt to laugh, and an emptiness so wide that it hurt to simply exist. But this fall, I quickly realized that while I knew some about sudden death and complicated grief, I knew almost nothing about the fear, frustration, angst, and anxiety caused by watching a loved one suffer.The phone rang twice on September 28, 2020, before I surfaced from my postcall coma. The previous night at work had been brutal: 10 consults and performing 4 surgeries, each more challenging than