Why Care about Palliative Care?
“Our ultimate goal, after all, is not a good death but a good life to the very end.” – Dr. Atul Gawande, Being Mortal
I wish I had words as eloquent as Dr. Gawande when my aunt was receiving chemotherapy. The emotional and physical toll chemotherapy wrecked was heart wrenching to watch, let alone experience. I wish I had a perspective so wise when my aunt passed away and my heart fell through my stomach. Many people consoled, “at least the suffering is over.” But was it a good life to the very end, if she suffered so much at the end? Had I ever thought to ask her how she wanted to die?
This was a difficult question to ask amongst my family, and exists as a difficult question for many people to ask today. However, this is an essential question to ask as a healthcare provider. Treatment throughout a patient’s life does not end simply because life is ending, as it inevitably will. Treatment does not always translate to maximum extension of life. Treatment means meeting the patient’s goals. If Mr. A wants to live to see his granddaughter’s wedding, a provider should prioritize this. If Karen would feel more comfortable at home than surrounded by machines and strangers in scrubs, providers should help her achieve this.
Palliative care is not as glamorous as life-saving surgery, does not provide the adrenaline rush of emergency room care and is nowhere as endearing as rounds in the newborn nursery. Providers do not get directly compensated for taking ample time to have conversations of end of life care with their patients. The end of one’s life can arguably be defined as some of the most important days of life; this is the sunset of life, the final reflections on life and the last moments of interaction with the physical world. How then, can our healthcare system simply give a cursory nod to people in this moment? Palliative and hospice care are gaining momentum as families realize their potential to respect the wishes of their loved ones. Nonetheless, this is a frontier that has yet to be developed into a standard of care within both healthcare and families.
The relevance of palliative care is articulately described by Dr. Gawande in his latest book, Being Mortal. My classmates and I had the opportunity to listen to Dr. Gawande speak on his own experiences and touching personal anecdotes on end-of-life care at a Minnesota Network of Hospice and Palliative Care conference. His thoughtful and frank words remind me of the care and artistry involved in the practice of medicine, aspects I hope to never forget.