Current Issue
Spring 2014
BMM Current Issue
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Everything We Can
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Thom Meredith has noticed a common thread that binds him and other physicians concerned about end-of-life care: they’ve watched someone they love die from an incurable disease.

For Meredith, an assistant clinical professor of emergency medicine and attending physician at the Rhode Island Hospital emergency department, it was his mother. A runner and third-degree black belt, she developed a strange cough that turned out to be lung cancer. Meredith was in his intern year when she began cancer treatments.

“I moved her down with me so I could continue my residency, otherwise I would have had to leave residency behind. She was my ‘person,’” Meredith says, his biggest supporter. When the treatment modalities failed, she moved to home hospice, where she passed away.

“The moment I became a real doctor was when I was dealing in my real life with someone suffering and dying. It’s clear how it just formulated every experience I have with patients and families.”

And it’s why he’s the go-to person in the ED when a patient seems to be heading downhill on the “death trajectory”— the temporal pattern of the disease process leading to a patient’s death. It’s why he struggles to give patients the death that they choose: in comfort, with dignity, and on their own terms.

Meredith and his colleague, Clinical Associate Professor of Emergency Medicine Elizabeth Nestor, meet people at the end of their lives every day. They see patients with illnesses such as cancer or chronic obstructive pulmonary disease (COPD) who suddenly have a “game-changing event”—an infection, intestinal blockage, or acute exacerbation of symptoms. Too often, these patients have not prepared for such a turn, or worse, were not adequately informed by their primary doctor about the severity of their condition.

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