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Thursday, May 28, 2015

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Palliative and end-of-life care

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Most health-care professionals who are involved in palliative and end-of-life care have chosen that aspect of health care because of a belief in or a personal and professional attraction to assisting those with some of the greatest needs that anyone receiving health-care services can anticipate.

For those health-care providers who have no interest in this aspect of care, there are other areas of health care that provide various degrees of personal and professional satisfaction.

From the early days of my training and career, when I participated in surgery and obstetrics and critical and emergency-room care, and during a period in military medicine, I realized that all of these aspects of health care bring something special to the patients who are cared for, while the families wait in fear, terror or guarded anticipation for the outcome.

There is a general congruence of health-care professionals between patients and families depending on the expected or hoped-for outcome, with the knowledge that sometimes things do not go the way hoped for or expected and that presents special challenges for those involved.

For mothers, fathers, grandparents and siblings and physicians and nurses, a successful birth is an unparalleled joyful experience. Those words, “It’s a boy… or girl… or twins,” are pure smile- and tear-provoking experiences. On the other hand, telling a family, as I have unfortunately done in my career, that a birth did not go well, and not only the baby but the mother has succumbed, is not matched in terms of tragedy and tears by many other happenings in the health-care world.

We know the kinds of challenges faced by those who focus on end-of-life and palliative care, whether in the acute-care setting, the home setting or hospice and palliative-care units, when patients haven’t come to terms with the seriousness and time-limited period of the life that is left for them. We have learned to address the discomforts, and I have learned to appreciate the unbelievable art and skill that are usually part of the repertoire of a team of dedicated health-care providers.

Sometimes, an event occurs that makes those practising palliative care proud of what lengths we are able to go in order to meet the extraordinary requests of a dying patient and his family.

One recent situation that occurred in the Baycrest Palliative Care Unit involved an elderly gentleman with advanced metastatic malignancy that required complex palliative symptom management. He always wanted to live and die in Israel. To arrange for him to die there became the dedicated mission of the team. On the surface, it seemed almost impossible to achieve. However, through the tireless efforts of the medical, nursing and social-work staff and a social-work student working with this patient and family, this goal was achieved.

Working with Israel immigration and an agency called Nefesh B’Nefesh (loosely “soul to soul”), arrangements were made through the generosity of El Al Airlines to transport the patient to Israel and then have him absorbed as an immigrant and admitted to a palliative-care program at the Hadassah Hospital in Jerusalem – a monumental feat.

The staff and patient celebration on the day of his departure was full of tears and smiles for a job very well done and poignantly and deeply meaningful for all concerned.



 Dr. Michael Gordon is medical program director of palliative care at Baycrest. His latest book is Late-Stage Dementia, Promoting Comfort, Compassion and Care. His previous book, Moments that Matter: Cases in Ethical Eldercare, follows his memoir, Brooklyn Beginnings: A Geriatrician’s Odyssey. All can be researched at his website: http://www.drmichaelgordon.com.

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