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Palliative Care and Serious Illness

by Laura Martin, MD

When I was still in medical school, my grandmother had a massive heart attack.  I vividly remember the rush to the hospital and how the doctors said she’d lost much of her heart function.  When I visited her in the ICU she looked weary, but calm. We talked about her life and my life as a student and my plans for the future.   We both enjoyed the visit.

Little did I know at the time, but that was the last chance I had to speak with my grandmother.  The next day I got the call.   Her heart had stopped.  The doctors performed full resuscitation — chest compressions, electric shocks, and placement on a breathing machine.  Her heartbeat returned with these measures.

My next visit with her was dramatically different.  When I walked into her room, I noted that my grandmother was propped up in bed with a tube in her throat and the machine breathing for her.  She had a wild, pained look in her eyes.  She squirmed in the bed and looked very uncomfortable.  She seemed like she wanted to say something, but was unable to speak.

A day later my grandmother passed away.

Fast forward to today.  I feel very fortunate to have had the opportunity to have a heart to heart talk with my grandmother before she died. My memories of this conversation are wonderful.  But, I can’t help but think her last days could have been more comfortable and peaceful.

Palliative care, a specialized form of medical care that focuses on treating pain and other symptoms in patients with serious illness, was not available years ago during my grandmother’s hospital stay. That’s changing.   Many hospitals today have palliative care teams. And a growing number of doctors– I’m one of them– specialize in palliative care.

A palliative care consultation likely would have helped make my grandmother’s death less painful and frightening.

Another focus of palliative care is advance care planning.  My grandmother had not filled out a living will prior to her having the heart attack.  Ideally a discussion concerning a living will – where a person expresses his or her wishes concerning medical care in the event they become incapacitated –  is done when a person’s health status is stable.

On my grandmother’s first day in the hospital, it would have been a huge help if a doctor or nurse had spoken with her about whether she would want or not want resuscitation if her heart stopped.  Not knowing her wishes either way, the doctors were compelled to perform resuscitation when her heart stopped the next day.

In my mind, several questions linger. Did resuscitation and treatment with a breathing machine truly help my grandmother or did it merely cause pain and prolong her dying process?

And did my grandmother really want to be resuscitated and placed on a breathing machine or would she have preferred to have passed more peacefully?

Situations similar to my grandmother’s happen in ICUs across the nation every day.   No matter how aggressively people want to be treated, a palliative care consultation can make a huge difference in the impact of serious illness on patients and their families.

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