Palliative and Hospice Care

My father-in-law was dying. He’d had five years of remission from esophageal cancer, but the latest recurrence hadn’t responded to treatment. As he neared the end, he and his family decided to move him from the custom-built contemporary home he’d designed to a privately run hospice, just over a mile from his home.

I had taken some time away from work to support my husband, his father, and the family during those last days. My main jobs were to run support and errands as needed so the family could stay at his bedside.

It was an overcast Saturday as I made my way down the hall, examining one elderly patient after another at our in-patient hospice unit. Mr. G was alone, his room dark. He didn’t respond to my voice. I wasn’t surprised:  his nurse had told me he was close to death and appeared comfortable.

I reached for his wrist to feel his pulse with one hand while I placed my stethoscope at the bottom of his sternum. No radial pulse. But the sound of his heart was remarkable: a thrumming, a quivering, a vibration, a sound I’d never heard before but instinctively recognized. He was in ventricular fibrillation, his heart was flailing.

When she came, her legs were cold and her heart weak. The tracings showed flickering beats. She was confused and barely there. She was a ticking time bomb.

Sometimes I have to pinch myself. Is this really my twenty-fifth year of practice as a palliative care physician? My head is full of memories of caring for hundreds of patients as they navigate their final days of life.

I would not have survived caring for my parents at the end of their lives without the help of my hospice angels. Ma spent the final 10 days of her life in a palliative care facility; Dad endured the last three months of his life getting at-home hospice care. The individuals from hospice—nurses, occupational and physical therapists, counselors, and aides—not only supported my parents but also gave me the love and care I desperately needed.

Dear readers,

My thoughts and feelings about palliative and hospice care took hold during medical school and residency training.

I was a medical student during the AIDS epidemic of the mid-1980s, when our Bronx hospital admitted a succession of patients infected with HIV, a virus that compromised their immune systems and made them vulnerable to a host of infections.

They came to the emergency room short of breath, feverish, somnolent, unable to see properly, convulsing, soiling themselves with intractable diarrhea…The list of possibilities was long and scary.

These patients, invariably young, were all going to die.