The need for understanding and triggering a palliative approach to care
As a palliative nurse, I understood how to initiate access to palliative care, but if I had not done so this story would have been very different. This story is about my father. He had end-stage prostate cancer, and was seeing an oncologist, a radiation oncologist, and a cardiologist as he was also having issues with his heart. (damage from the chemo and ongoing afib) He also had a family doctor who he saw regularly. He eventually developed vascular issues in his foot, with some gangerene noted in one toe and increased pain in the foot. He then was referred to a vascular surgeon. So, FIVE active physicians and not one of them looked at him as a whole person! Each had their focus, and nobody looked at the big picture or told him his prognosis was so grave.
After watching him become cachexic and lose 30 lbs in two months, I could tell he was moving towards end of life. He already had been diagnosed with bone mets. However, the vascular surgeon wanted to do a fem-pop bypass - which my father would probably not survive or recover from. I suggested to my mother - a retired nurse - to contact homecare to arrange for a palliative consult so my dad could have a good discussion about goals of care. He had to make his own decision about having the surgery, and I had to be the daughter in this case - not the nurse.
The NP from the community palliative care team was wonderful and although the discussion was difficult, she was gentle and clear about his prognosis and he could finally make some good decisions about what he wanted to spend his limited time doing. He chose not to have the surgery, nor any more invasive treatment. He lived two more months, eventually suffering a stroke and dying in hospice. He had a wonderful two months thanks to the open conversations and palliative expertise. The NP put him on dexamethasone which gave him his appetite and energy back for that limited time - something none of his physicians had suggested. The dex enhanced his quality of life immensely!
These were all great doctors, but obviously none of them were versed in understanding the nuances of palliative care or the importance of the palliative approach. We have so far to go in helping not only the public but the health care system understand about this wonderful field of medicine and why early intervention is so crucial. EVERYONE deserves to have access to good palliative care.
