Palliative care eases patient suffering

Palliative care eases patient suffering

by Dr. Diane Meier

On my first day as an intern in 1977, I received a page to the bedside of an 89-year-old man who was in cardiac arrest. The chest compressions, a breathing tube and electric shocks to the chest to restore a heart rhythm weren't working.

We tried to save his life for over an hour, when the team of physicians and nurses all surrounding his bedside decided to end the code.

The man's chart said he'd been hospitalized for three months with endstage heart failure and unable to walk without oxygen for over a year. But no one had told him or his wife of 70 years that he had an incurable disease or had spoken to the couple about what was most important to them at this stage of life.

And, no one had told me why we were attempting to restart the failed heart of an 89-year-old. I got the message though — our job as doctors was to prolong life at any cost.

Since that time, I've dedicated my career to palliative medicine. It allows me to help create the best possible quality of life for my patients with serious illnesses and their families.

Palliative care teams, which include a doctor, nurse, chaplain and social worker, focus on symptom relief (such as pain), doctor-patient communication, and safe transitions out of hospitals and back into their home. It helps patients gain the strength needed to carry on through daily life.

And unlike hospice care, which is limited to those with less than six months to live, anyone with a chronic disease or serious illness can get this type of care starting with the diagnosis.

Sitting down with the patient and their family for as long as it takes to discuss the good, the bad and the scary shouldn't seem like a radical concept. Outside of palliative care, however, these conversations don't always take place.

During my nine years in medical school and residency training, I never had a course on pain and suffering. And while most doctors have the best interest of their patients at heart, they don't often have the time it takes to communicate adequately in these complex situations.

The mentality to focus only on the cure — even when cure is impossible — is so ingrained, everything else, like a patient's quality of life, can fall to the wayside.

Since my days as an intern, I've had the privilege of getting to know my patients. I comfort them; spend time reviewing their symptoms, diet and medications; and we have lengthy conversations about how they're feeling. Most importantly, I take time to listen carefully before I speak.

When patients are encouraged to express their concerns and wishes and know their treatment options, they can make informed decisions about their care. And I get the satisfaction of knowing I'm helping to reduce their suffering and returning control to where it belongs, with my patients and their families so they can have the highest quality of life possible.

As director of the Center to Advance Palliative Care, Dr. Diane Meier devotes her time to increasing the quality of palliative care programs. Under her leadership, the number of palliative care programs in U.S. hospitals has more than tripled in the last five years. She's also director of the Lilian and Benjamin Hertzberg Palliative Care Institute and professor of Geriatrics and Palliative Medicine at Mount Sinai School of Medicine in New York City. For more information on palliative care, visit getpalliativecare.org.


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Celeste Lescelius, RN

Subject:

I note in Dr. Meier's article that she says "hospice is only for people with 6 months left to live". This much is correct. However she also said that no other type of care provides what her Palliative Care does. I am a Hospice nurse and I feel that hospice when done as it should be, is all she offers and more. At the end of life, there is a special connection formed with a family and the hospice disciplines (Chaplain, Social Worker, Doctor, Nurse and Home Health Aide). Being able to help patients and families in their times of greatest need, to me is the payoff. We help with pain, spiritual issues, durable medical equipment, community resources, Teach the medications, disease processes and progression. Bathe the patient when it is too much for the family or patient to do. Call the funeral home and the ME at the end, sit quietly and just be there until there is closure with the body leaving the home. We help people to die at home with the best quality of life, since quantity is not available. I take issue to the idea that our services are not as rich or that they are not palliative just because there is possibly only six months left of life.

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