Reflection

This July, I will have worked in hospice and palliative care for 28 years. I have seen myself change from a young attending physician to a senior faculty member—gray hair, aching back, and a grumpy attitude. Many of the students on my service were not yet born when I discovered this field. It is hard to believe.

“Do you want to be the director?” Doctor Robert Wright, the residency program director, said to me when I mentioned the idea of working in hospice. I was only two years out of residency in 1995 and hospice was considered “fringe work” in Scranton, Pennsylvania. There was little risk to the institution in having an inexperienced physician running the program. For the first time, something stirred in me when I began working with hospice patients. Here mind, body, spirit, and community came together. One could use the skills of medicine with a focus on kindness and compassion.

What followed was years of clinical work, speaking, teaching—playing a small part in spreading the concepts of hospice and palliative care to students, residents, and attending physicians. I was blessed, learning from clinicians such as Charles von Gunten, Joanne Lynn, Eric Cassell, Susan Block, Andy Billings, and so many others. Each had a profound impact on how I think about care. My journey was not, however, without its pain. There were many times I became disillusioned, “burned out,” cynical, jaded. More than once, I considered leaving the field.

So as I enter the latter years of my career, what I have I learned? Are there a few pieces of wisdom I can impart to the next generation of physicians? If I had to sum them up, I think it is this:

At our core, we must remain physicians in the truest sense of the word. We are not communication specialists, nor are we “symptomatologists.” We perform a history, physical examination, laboratory review, and thoughtful assessment—using scientific principles to improve the well-being of our patients even if they are dying. This is what we do.

We must not lose sight of our original mission. It was to improve the care of those near the end of life by changing how all physicians care for them. We were meant to change the system, not create more fragmentation through specialization and academic departments.

This is dangerous work. One simply cannot engage in death and dying alone for years on end without paying a price. To be excellent clinicians we must find a balance between caring for the dying and celebrating the living.

One last piece of wisdom. At the end of his career, Aldous Huxley said this:

“It's a little embarrassing that after 45 years of research & study, the best advice I can give people is to be a little kinder to each other.”

In the end, I think this is what hospice and palliative care is all about. Trying to be kinder to people as they approach death. It is a worthy goal.