Life, death… and taxes. Why I love palliative medicine.

As I have said, Palliative Medicine is AWESOME! It is probably my favorite aspect of medicine. Including within Oncology. I like the people who get cured and I think that is extremely encouraging and exciting and a wonderful thing to be involved in. I like seeing people get better. I also like seeing them feel better and live their life to the fullest. Its just that in Palliative medicine, living is the main goal all the time… Not cure, but living well. No trying to live with terrible symptoms to get through treatment. Treatment only to minimize terrible symptoms. It is a side to Oncology that many dislike. I look at it as a very important and amazing side to be on.

My calling is definitely to care for the sick, but even more so the dying. I worked for a Hospice through my undergrad. It was the best experience of my life. I am ridiculously glad I did it. It taught me plenty about communication, about the importance of good symptom management and most of all about LIVING. Yes, living.

Have the courage to live… Anyone can die. –Robert Cody

I like working with people who happen to be dying. Those in the last stages of life. Those coping with life threatening illness. In reality we are all dying. Some are just doing it more quickly. Those who are nearing the end of life often need increased care and support. But, not only the individual, but their family and friends. I love it all. Being there. Doing small tangible things that make a difference in their management. I love these people who are in this tough time. I feel I have been given a heart for them. Again, not because they are dying, but because we all are, but because they are humans and are in a time of great need and difficult struggles.

Somebody should tell us, right at the start of our lives, that we are dying. Then we might live life to the limit, every minute of every day. Do it! I say. Whatever you want to do, do it now! There are only so many tomorrows. –Pope Paul VI

Palliative medicine is a branch of medicine people are scared of. Even more so than oncology (apparently, I like to scare people). Palliative comes from the root word “pallium,” which means to cloak. The goals of palliative medicine are to ease suffering, to be a cloak of comfort in people’s illness and lives. Palliative medicine is not just for those actively dying, but for anyone with symptoms and disease that can potentially cause their death in a sooner than later time period. I have seen people who lived a year or more on the service (rare, but nonetheless possible). Today, people can be provided with symptom management that can improve their quality and sometimes even quantity of life. Not only physical symptoms are treated, but also emotional, social and spiritual issues. People who are treated appropriately live life with a better quality. It is amazing how very ill and scared individuals can come to a unit or be seen in consult. With appropriate management, these people open up, become more like themselves and live and die in a way that fits them. They often realize, along with their families that palliative care is not to be feared, but loved. Contrary to popular belief, we are not grim reapers.

A Hospice provides this type of care in a home-like setting, as well as grief support and some home support as well. A Palliative care unit provides this type of care in a hospital setting. Both are excellent options. I have a slight preference towards home and hospice care, but I will admit that I am a little biased based on my past experiences.

Palliative medicine is also fantastic as someone on staff because it is generally a smaller caseload than other practices or units. For instance, I have 8 patients at the Hospice house and 7 on the Palliative care unit. Therefore, you have more time to actually get to know people. You can know them well enough to fully grasp all of the things that incorporate to make them who they are and that you can understand their symptoms as well as another can. You can spend time with them doing things that matter, whether that is just sitting, chatting, holding their hand, going for the 20th smoke of the day, reading a book, gift wrapping, cooking or having a jam session. Also, it is one of the few areas of medicine where interdisciplinary care actually happens. It is generally taught and is supposed to be practiced in theory, but there is much resistance and many barriers to appropriate interdisciplinary team based care. I feel like palliative medicine is one of the few specialties (well, and cancer care and infectious diseases) where the interdisciplinary model works and works well. It is nice to have colleagues that you know, respect and trust and who actually communicate with you and the other people as a team. It is also one of the few services that (thankfully) is not afraid of death.

Let us touch the dying, the poor, the lonely and the unwanted according to the graces we have received and let us not be ashamed or slow to do the humble work. -Mother Teresa

The dying are a very marginalized group of people in our society. They cannot often speak for themselves. They are often avoided by people they love most. They are unable to do all of the things they once enjoyed, or at least not to the full extent they once did. Appropriate and timely management of symptoms, unfortunately, is a luxury that all people, even in our socialized health system cannot receive. This is often due to a combination of a lack of resources and a lack of education of both caring physicians, and the general public. The thing is, we all die. Only two things in life are certain… Death and taxes. Most of us will die of a life-threatening illness. Only about 10% will die in their sleep of “natural causes” or drop dead from a heart attack or die in an accident. The rest of us will be sick for a time before death. Most of us with end stage cancer, neurologic disease, kidney disease, heart disease or lung disease. Most of us will have symptoms that need to be managed, whether it be pain, nausea, shortness of breath, confusion or emotional distress. That is where palliative medicine comes in. To help us live. To make us feel a bit better and to not be as scared or overwhelmed. To take care of our families. To make dying seem more like living because really it is. And it should be. They aren’t dead yet. We should have dignity and life to the very end… or beginning. We need to love them.

Love is stronger than death even though it can’t stop death from happening, but no matter how hard death tries it can’t separate people from love. It can’t take away our memories either. In the end, life is stronger than death. -Unknown

On a less serious note… Yet relevant one… A song by one of Patrick’s favourite bands Relient K about “Life After Death And Taxes.”

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7 thoughts on “Life, death… and taxes. Why I love palliative medicine.

  1. Pingback: Top Ten Posts That Give You The Best Glimpse of Me « At least we made it this far…

  2. I am really glad I visited your site today and read your post. I am a longterm caregiver who seems to encounter the dying a lot. I’m not a professional. I’m just someone who encounters friends and relatives who are groping with those last stages.

    Currently I’m caregiver for my 97 year old mom. The goal is simple. Keep her in a bubble. She’s pretty bedridden. Has major heart problems and refused all those surgeries years ago. I keep the stress down, the meals–which she loves–coming, the cats fed and living on her bed with her, and the TV going. The bubble works. She takes maybe 4 pills and they’re rather benign.

    I was caring for both my parents until my dad died 4 years ago. It began slowly with me spending more and more time until his health declined and I had to pretty much move it. In 1994 a very close friend was diagnosed with multiple cancers and I became his primary caregiver because he had no family here. It was fast and far too short, lasting only from August to the day after Christmas.

    People always seem surprised that I am doing this for my parents and I find that odd. Is it easy, no. I’m housebound and seldom get an opportunity to leave other than to buy groceries, etc., but I now that were I not doing this I would feel so much worse.

    Really enjoyed your post and so glad someone like you is caring for those in the final and very vulnerable stages of their lives.

    • I am glad that you visited! Thank you for sharing your story! I love to hear about people who step out and care for those who love!

      It sounds like you are doing a great job with your mom. It is so difficult to be a caregiver, but it is a worthwhile experience, valuable time, and is very much appreciated by those you care for!

  3. Pingback: Why Oncology « At least we made it this far…

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