When Compassion is the Cure

As I write this article, I am paged by the emer­gency department about a gentleman with advanced lung cancer who has developed wors­ening shortness of breath. He was on hospice at home but his family became overwhelmed and brought him to the hospital. I am asked to admit him to keep him comfortable as he dies. His fam­ily knows we cannot make him better … they were just afraid of him dying at home.
When I went to medical school, I had no idea that a major focus of my practice would be on help­ing patients die comfortably. Like most medical students, I came with the ambition of fixing and curing people, getting them bet­ter. As I went through my family medicine residency, I learned the reality was quite different.
Medical advances over the past few decades have dramatically changed how we care for patients. People live much longer with chronic illnesses and, indeed, a few can be cured from ailments that were once thought untreat­able. But despite this tremendous progress, patients still suffer. Sometimes their suffering stems from symptoms caused by their illness, but other times it’s from treatments we inflict upon them.
During residency, I remember caring for an 88-year-old man who came in from a nursing home with advanced dementia. He had been bed-bound and could no longer eat or speak.
He had multiple other medical problems and had now developed pneumonia. We admitted him to the intensive care unit to give flu­ids and antibiotics. He continued to get worse and was soon placed on a ventilator. His hands were tied to the bedrails so he could not remove any of the tubes or IV lines we had so carefully placed. After many weeks in this state, in which he had seemed to look uncomfortable most of the time, my patient died, leaving me won­dering if this was the best medical care we had to offer.
My medical education taught me to listen to patients’ symp­toms, perform an investigatory workup to make a diagnosis, and then treat the underlying illness. Sounds fairly straightforward. But what if we can no longer fix what’s broken: we have no more chemo for a patient’s cancer, no more surgery for their heart dis­ease, no more antibiotics for their overwhelming infection? Then physicians are often left struggling to know how to keep patients comfortable and guide them through the final part of their journey. This is not something that has traditionally been focused on in medical school.
During residency I became interested in medical ethics, and one of my mentors taught me that 90 percent of the ethics con­sults he did in the hospital were really difficult end-of-life issues that needed a skilled communi­cator to help guide patients and
families. Thus, I was introduced to palliative medicine. I had not heard of this medical specialty before starting medical school and it was barely even mentioned there. But in further exploring it, I found that it offered what I had found lacking in my medical education.
Simply put, the goal of pallia­tive medicine is to improve qual­ity of life and decrease suffering in those with serious, potentially life-threatening illness. You may ask, “Isn’t that the goal of medi­cine already?” Unfortunately, what I have seen is that our healthcare system treats diseases fairly well, but often neglects to care for the person with the dis­ease. Palliative care offers atten­tion to the whole person, not just their physical pain, but also their social, emotional and spiritual suffering.
After residency I was invited to join the Loma Linda faculty and helped start the Palliative Care Program. I am privileged to care for patients who have often been told by their physician, “I’m sorry, there’s nothing more I can do for you.” I am able to tell these individuals that actually, there is something more we can do. I do not offer false hope for a cure when medically this does not ap­pear possible. But I try to help them find other hopes … hope for a pain-free day, hope to be at home, hope to be with family, hope for peace and dignity. There is a tremendous amount of healng that can take place even when someone is dying.

Gina Jervey Mohr ’92, an English major, earned her M.D. degree from Loma Linda University School of Medicine. Board certified in family medicine and palliative medicine, Gina is an assistant professor at LLU and the director of the Palliative Care Program.

I am grateful for the lessons my patients have taught me. Lessons about love and forgiveness, cour­age and honor. And although my patients may be dying, they have taught me much more about living

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Last update on January 21, 2009