Sunday, February 12, 2017

Full of Possibility

In case you don’t happen to be reading eight articles about palliative care, here’s a brief overview. Palliative care is often confused with hospice or with comfort care, but while a given patient might be receiving all of them, they refer to three different things. Comfort care is in turn sometimes wrongly characterized as withdrawal of care, but we were instructed never to put such a phrase in any patient’s chart. (Let alone say anything about “pulling the plug” on a patient, which one of my young colleagues actually did write in a chart. Come to think of it, it was not long after that that we had the didactic on charting, so the two were probably not unrelated.)

Anyway, we never withdraw care. Patients might “transition from cure (or curative care) to comfort care” or they might “transition from intensive interventions to comfort care.” “Compassionate extubation” might occur, or “withdrawal of interventions.” We might, per the patient or his or her decision-maker, “allow for natural death.” Comfort care is focused exclusively on making sure the patient is clean and warm and free from pain and discomfort.

Many patients on comfort care might indeed be hospice patients—people with terminal illnesses who are expected to die within six months. Curative care is no longer provided, a do-not-resuscitate order is almost always in place, and the focus is on helping the patient to live as full a life as possible.

And certainly a hospice patient on comfort care might also be receiving palliative care, which focuses on relieving suffering and providing the best possible quality of life for the patient, who might have a terminal illness and be expected to die within six months but who also might have a condition that can’t be medically cured regardless of life expectancy. Sometimes people begin receiving palliative care immediately after diagnosis, long before becoming a hospice patient.

Quoting from “Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference,” from The Journal of Palliative Medicine, Volume 12, Number 10, “Healing is distinguished from cure in this context. It refers to the ability of a person to find solace, comfort, connection, meaning, and purpose in the midst of suffering, disarray, and pain. The care is rooted in … the recognition that, although a person’s life may be limited … it remains full of possibility.”

That means that even though I might never see F. again, my life remains full of possibility! I felt happy when I read that, and I generally feel happy today because the sun is out, and I got my laundry done, and also my weekly trip to Rainbow, and my periodic giant delivery from Pet Food Express, and later I’m going to the Thomas House potluck.

My shopping list now says “IOS” all over it—buy this thing if on sale. I’m also planning ahead in order to take advantage of various discounts Rainbow offers if you spend a certain amount in a couple of different departments, one being bath and body. Today I got to buy, among other things, six bottles of fluoride rinse, so I certainly felt happy about that.

I also bought chocolate! I have not eaten sweets in more than five years—an even more remarkable feat these days, as the student table at work is always groaning under the load of doughnuts, cookies, candy, cake and pastries. (Actually, I am not at all tempted.) I read in the AARP magazine this week about the health benefits of chocolate, and at Rainbow, I got a bar of Pacari Raw Organic Chocolate, 100% Cacao, socially responsible, no sweetener at all. The only ingredient is cacao. I thought it would taste just like baking chocolate—bitter—but it somehow is not bitter, and it does that nice chocolate melting thing, so life is good.


If you want to read just one extremely excellent article about palliative care, read
“Letting Go: What should medicine do when it can’t save your life?” by Atul Gawande in the August 2, 2010, issue of The New Yorker. I had read this before and it is also one of the eight assigned articles. It is superb.
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