Cause for Some Optimism
As a palliative care specialist, Dr. Jessica Nutik Zitter has made a big difference for many of her dying patients brought to the ICU. For many years, she felt she was alone in the ICU, swimming against the tide. Zitter said, “I’m very optimistic—just watching the trajectory from 1980 to now and seeing the excitement even in my hospital that people have about enhancing communication and figuring out better ways to talk about advance care planning and talk about CPR with patients.” She added, “I’m feeling that there is a sea change beginning to happen both within the medical community and within the lay culture. And I think we’re at the point where we have to grab this and start making some exciting changes.”
One patient for whom Zitter’s intervention made a difference was Tess, a woman with stage four lung cancer. Tess had been treated by other doctors before being assigned to Zitter. Tess’s daughter Rebecca Mitchell says they were hoping to beat back the cancer with chemotherapy. “We always and she always felt too like there was a chance, that this is going to work, that this would fix it, so all this struggle would be worth it—to gain those extra five years or three years that we could get,” said Mitchell, “Every doctor we saw during that period of time, they seemed positive, encouraging—like okay, we’ve seen this before, we’re going to try this, we’re going to do this, this has worked before in the past.”
But Tess’s cancer had metastasized and was spreading everywhere. Her body was failing and she was in and out of the ICU. Despite evidence to the contrary, her doctors remained relatively optimistic and Tess held out hope that she could survive another five years. During her last visit to the hospital, Zitter was her ICU doctor. Rebecca was present when Zitter gave her mother an honest assessment. “I think that was what Dr. Zitter brought to her that day—okay, look, here’s what’s happened to you and here’s the path we’re going down and even at the end of that path, it doesn’t look too good,” said Mitchell, “Honestly, I think we all knew that. Even the doctors in the ICU knew that. It just took somebody to acknowledge that. It’s okay to say ‘there’s an alternative to this.’ ”
Tess made the decision to stop further treatments. She went home and with the help of Zitter and daughter Rebecca, received palliative care through hospice until she passed away a month later. Mitchell said, “I think she was just happy to be out of there and coming home and not have to find the energy to get dressed the next day and do some new procedure or to get treated for something else. That was a relief for her.”
Conclusion
Universal access to palliative care is still a long way off. Good communication between doctor and patient is the starting point for improving care at the end of life. But more is needed beyond that—a medical system that will support and honor patient preferences. That will require a paradigm shift—a change in the medical culture and a willingness to adopt a patient-centered model of care—a collaborative approach that addresses the needs of the whole person. If the patient-centered model takes root and expands beyond care for the terminally ill, it could one day transform the entire health care system and deliver medical services that are more affordable, compassionate, and sustainable.
“Palliative Care: The Search for Comfort and Healing in the Face of Death” was written, produced, and narrated by JoAnn Mar. It was produced at the studios of KALW in San Francisco. This program was written and produced with the support of a journalism fellowship from New America Media, the Gerontological Society of America, and AARP.