Palliative Care and Hospice

Pt. 2  

For many families hospice is a godsend.  It was for me.  Once I called hospice, I had a "team" which includes a physician, specialty-trained nurses, a hospice medical director, social workers,  inter-faith chaplains, grief counselors, home health aides and volunteers. These folks knew what to do when I didn't.  When caring for a family member or parent, it's stressful to try to get it all "right" in a system that most with most of us are unfamiliar.  There are a scad of choices and decisions to be made.  These are not decisions like Android vs Apple or Paleo vs South Beach.  You may be responsible for someone's pain and suffering and ultimately how they die.  It can be overwhelming,    

As compared to Hospice, palliative care aims to ease the suffering of patients and their families.  It is not necessarily at the end of life.  It's for people with serious illness and is focused on relieving symptoms, pain and stress, regardless of the diagnosis. These doctors bring another set of skills in addition to the attending physician.  They can offer expert symptom control, develop and communicate outcomes and goals for the patient and family and help with referral to other resources, such as hospice.  As compared with hospice when curative treatment(1) has been suspended, palliative care is available at any age and any stage of a serious illness along with ongoing treatment.    

As a palliative care doctor at UCSF, Dr. B. J. Miller deals with patients who are navigating "when to fight and when to yield" and when to transition from treatment-oriented care to hospice.  I like when Dr. Miller says:  

"The body is going to do it's thing.  We have a choice, but one way or the another, the body will find it's way to death.  Depressuring the family, taking the onus off them.  Reminding them that there are things out of our care."   

Regardless of whether it's palliative care or hospice, an important aspect is not just the patient, but the family.  Most of us will help and support many people throughout our lives, not only our grandparents and parents, but often our children, neighbors and friends.  Dr. Miller offers some advice and compassion for the caregivers:

"The secret is being human, and all that entails, including suffering yourself. which, in turn, means you need to give yourself time and space to deal with all the fallout. and you need to look for things to 'take' from the exchange. it's a circle, a loop. not a pole (well person caring for sick person; instead two human beings dealing with a shared existence together)"  

I wish you all good health and wellness and if you're a caregiver, I hope this helped a bit. I really do recommend listening to Dr. Miller.(3)  He's  inspiring!

(1)  Curative care refers to treatment and therapies provided to a patient with an intent to improve symptoms and cure the patient's medical problem.  (http://patients.about.com/od/glossary/g/curative.htm).   In contrast, treatments that target the root cause of an illness rather than masking symptoms are curative in nature. While patients taking curative treatments may not always feel better during the course of therapy, such treatments have the potential to bring about lasting recovery.  (http://mpkb.org/home/patients/assessing_literature/palliative)

(3)  http://www.kqed.org/a/forum/R201407141000 

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