Intro to Palliative Medicine

This month I am doing something very different, and very rewarding.  Palliative medicine.  Most people get a glassy “What?” look to this term.  Palliative literally means “Relieving or soothing the symptoms of a disease or disorder without effecting a cure”  It is simply end of life care.

Friday was my first day on this service and it was a very full day. I was involved in two cases in the ICU of patients who were being taken off life support.   One 80 year old woman was very alert and awake, but wanted to be off the breathing tube, knowing it meant her ultimate death.  With her 4 grown children and grandchildren around we completed the process of taking the respirator away.  She had a few hours to say goodbye to loved ones before she passed.

During the second pt’s extubation there was a stat page overhead to the oncology unit for our team. This was very unusual and unexpected.  The palliative care nurse and I went rushing up to the oncology floor to the room with all the action.  A crowd was gathered outside.  We opened the door, not sure what to expect.  The room was very dark, just a small light from the sink area.  A young woman in her 40’s was lying in bed, unconscious. Her children surrounded the bed.  A young blond 6 year old on his 13 year old sister’s lap, and both sat clasping mom’s right hand.  Another young 9 year old boy sat on the bed grasping the left hand.  Around the bed were about a dozen friends and family.  The room was quit except for small sobs from the kids and the occasional gasping breath from the dying mother.  In an instant I understood she was close to death.

The nurse shuttled us outside to whisper why we were stat paged to this room.  “she’s likely to die any minute, and her kids suddenly thought they’d like to have a plaster mold of their mom’s hand to keep”. The palliative nurse nodded her head and said she had it taken care of, to just giver her a minute.  She rushed off, and I went back in the room.  The space between breaths was lengthening.  The silence would often be pierced with the daughter shouting- “breath mom, c’mon, take another breath”.   At one agonizing moment even the dying woman’s sister pitched in “You breath now sister, please, breath”.    In no time the molds were there, and one by one we had each child take their mother’s hand and press it into the mold.  While they did this, we told them how much their mother loved them and had them tell her goodbye.  We stepped out to let them have the last moments alone, and solidified the hand print, something they can have with them always.

Although I was near and involved in 3 people’s deaths that first day, it was a very fulfilling day. Traditionally we as doctors have done well with making the process of coming into the world better.  Of course the process of living is always being improved upon…it’s high time we look to the end, and attempt to make it as meaningful and comfortable as possible too! 

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