Into the REAL Hospital

After three hours in strategic meetings this morning (an equal mix of boring and fascinating--just because the word "strategic" denotes secretive hospital planning), I slammed another diet Red Bull and joined Sister Monica for some immersion into Palliative Care. For those of you who don't know, Palliative Care takes over where modern medical science ends. It's often perceived as "end of life" care, but it doesn't necessarily mean that death is immanent when Palliative Care consults are requested. From what I can tell, the Palliative Care folks enact a dance with the patients and their families, helping them figure out what they want in the end. Do the patients want every single life-saving measure attempted? Do they just want the paddles used on them and if that fails, they're a DNR (do not resuscitate)? Do they want comfort measures only, so they can go when God calls them (but in as little pain as possible, as through Hospice)? It's a continuum, really.

And it's not an easy decision, because the patients are usually unable to speak for themselves, let alone make decisions in their comatose (or medication-induced) places. Families enter into the picture, as do out-of-town relatives, and other complex issues that arise in everyone's families when someone is sick. They want the best care for their relatives, without concern for cost. However, it's the grim reality in our south-Chicago payer mix, that most people have limited (if any) insurance. This part of Chicago serves three times the average urban Medicaid population in other U.S. cities. So it truly becomes charitable service.

I *knew* all of this, intellectually, before the day began. I now know all of this emotionally and spiritually, as I donned my own lab coat, scrubbed in, and visited four patients in the ICU. In all honesty, none of the four patients were alert, so I went with Sister Monica to speak with their families. In every case, the families were either in denial or experiencing terrifying fear of death for their loved ones. Only one family was open and talkative today…

It was a family of Mexicans. The patriarch was only 49 and dying from a terribly-metastaticized lung cancer. His son lives with him in the U.S. and the rest of the family had to fly in from Mexico. They arrived today and thankfully, understood that they had to do something to mitigate the father's suffering. They agreed to a Hospice consult, but not before shedding wailing tears and soft mutterings in Spanish. Sister Monica was an angel as she found simplistic words to explain life's most challenging options to the family (who had limited English skills). I could really feel her empathy and the authenticity with which she approached that situation. No wonder people trust her so implicitly. The nun habit only gets you in the door!

So we have a follow-up meeting with the family tomorrow. I'm tempted to cancel my noon lunch meeting so I can sit in and learn more about this family's story. They were gracious enough to not only allow me into the discussions, but to actively seek my advice and prayers.

It's been a fascinating journey through my maze of administrative meetings and decision-making. But it was very refreshing (and dare I say it, replenishing) to interact with patients. I realized that this hospital actually does make a difference in patients' lives.