Returning

If you look at the history of Palliative Care, it’s hard not to find a reference to Dame Cicely Saunders, the British physician who founded the first formal hospice in 1948 specifically to care for patients with terminal illnesses. The hospice concept though, spans centuries, and historical evidence dates back to the Roman Empire. Ancient texts make reference to herbs and narcotics like opium to alleviate pain and suffering. During the Middle Ages, emphasis was placed on spiritual care for the sick and dying... a belief in the interconnection between body and soul. In the Wild West folklore, Calamity Jane put aside her own interests and vices and reportedly cared for illness-stricken gold miners during a smallpox epidemic.

While the idea of taking care of a person in suffering is not new and has been practiced in a hospice like capacity for a long time, until much more recently, there wasn’t a need for a specialist in the area of palliative care. There is an argument to be made that there wasn’t a need for the concept of palliative care. This approach to taking care of people, focusing on alleviating pain and suffering, was implied. It did not have to be explained. It was assumed. It was human nature.

In my journey as a Palliative Care fellow, I’ve gotten a new perspective on the evolution of modern medicine. It’s come an unbelievably long way. The last 150 years has shown us the advent of anesthesia, germ theory and antibiotics, medical imaging, organ transplants, antiviral and immunotherapy drugs and stem cell therapy. Who knows where AI takes us.

It’s taken us far, yet that has come a price. As many of my colleagues in medicine would attest, it has come with the loss of the human connection. Many aspects of the practice of medicine have become mechanized and impersonal. The growth moved us forward in ways, but also has created some distance from it’s founding purpose, the art of medicine ... the part that makes us feel mortal.

Edward Albee, the American playwright, said “It's one of those things a person has to do; sometimes a person has to go a very long distance out of his way to come back a short distance correctly.”

For me, Palliative Care is the landing point of coming back correctly. It’s remembering the power of the doctor / patient relationship. It’s getting to know a patient intimately, learning things they may not have even shared with their most important loved ones. It’s allowing ourselves to be vulnerable, and the space for the patient to do the same. It’s being silent and embracing the uncomfortable situation. It’s learning who someone is before we decide where to go next. While the Palliative Care movement and philosophy was birthed more recently, I think it was inevitable that medicine would turn back to the principles on which it was founded. These are things in our DNA, that we have been doing intuitively for millennia. It’s who we are as humans. An interesting anecdote is that it’s sometimes a shocking thing for some patients, to learn this doctor isn’t in the room to talk about tests and results and complex medical problems, but who they are as a person. I think that’s the biggest validation that we have drifted too far off course. The patient is surprised when we take time to learn about them. We need more of that to get us back correctly.