Tag Archives: Health

Becoming The Standard of Supportive Care

August 2, 2017

 Meet William Dale, M.D., Ph.D., the New Arthur M. Coppola Family Chair in Supportive Care Medicine
William Dale, M.D., Ph.D., recently joined City of Hope from the University of Chicago, where he was an associate professor of medicine and section chief of Geriatrics and Palliative Medicine. He completed his medical and graduate school education at the University of Chicago, and his residency in internal medicine and geriatrics fellowship at the University of Pittsburgh. He is a board-certified geriatrician and palliative medicine physician with a doctorate in health policy.

Q: What brought you to City of Hope?

I knew of City of Hope primarily through my association with long-time colleague (Vice Provost) Dr. Arti Hurria. We both have keen interests in geriatric oncology. I also knew of the well-respected Department of Supportive Care Medicine here, which is a rather unique model that doesn’t exist elsewhere. Here, the department brings together so many aspects of comprehensive cancer care under one umbrella: palliative care, social work, psychology, psychiatry, patient education, patient navigation, volunteer services, and the Positive Image CenterSM – 13 divisions in all. It is very rare to have so many disciplines working closely together under one roof. Most places have to pull together multiple providers from several different places, but it makes perfect sense to keep the patient at the center of your care and to know they have a team around them. We do that.

Q: Many think that “supportive care” and “palliative care” are interchangeable terms. Are they?

Palliative care is a holistic specialty that focuses on maintaining a patient’s quality of life and managing their symptoms. Its focus is on maintaining a high quality of life throughout the cancer care journey, including when therapies aren’t available to control the cancer and the patient is nearing the end of life. Hospice care – caring for patients in the last six months of life – is often confused with palliative care. While hospice care is part of excellent palliative care, they are not the same. Supportive care is a broad-based patient care approach, while palliative care is a medical specialty that focuses on preserving quality of life.  Our department is inclusive.

Q: Tell me about your role as chair. What would you like to accomplish?

I envision supportive care at City of Hope being the top program in the world. We already have a unique world-class clinical program. What we haven’t had enough of is scholarship in supportive care, which we are building. I want to bring researchers here, which we’ve already started by recruiting a senior-level director of research we’ll be announcing soon. Also, we’ll have a new concentration on geriatric medicine – the care of older adults. Finally, I have a great interest in models of cancer care. Creating programs for optimally caring for vulnerable patients on a financial foundation of personalized care, integrating oncology and supportive care that is sustainable.

I want City of Hope to be THE place, the standard for supportive care programs.

I want City of Hope to be THE place, the standard for supportive care programs.

Q: How did you come to choose a specialty in geriatric palliative medicine?

I’ve always liked older people! I remember caring for them when I was in an intern in internal medicine – when my colleagues avoided the complex older patients with multiple problems, I liked the challenge these patients presented. In my VA clinic in Pittsburgh, I loved hearing fascinating stories from the old World War II vets. Older people can have quite a few health problems already: They may have several diseases – hypertension, cardiovascular issues, diabetes – and then you add cancer on top of that – it’s a lot to deal with. There are unique challenges and considerations when taking care of this age group.

Q: How do you expect to be involved in research in your new role?

I have always been interested in medical decision making and health services research, which we will build at here. Much of the data we currently have from cancer treatment trials comes from a younger, healthier set of patients. While there are a few older patients enrolled, they are largely healthier patients who don’t represent the majority with cancer. So we often don’t know how a less fit older patient will respond to most therapies – we just have to guess, often causing lots of side effects. We need research that will allow us to make more informed decisions for our older patients, based on better data, and to using interventions and a system of care tailored for them. If we can target interventions that get results that truly improve their functioning and quality of life, then they aren’t in the hospital as often. The older, sicker patients are the ones who currently use the most resources, and tend to be the most expensive – for them, us and society. How can we better care for them? Often, supportive care interventions are the answer.

Q: Is there research you are leading now related to this?

Arti (Hurria) and I are continuing to collaborate on several studies, including a recently submitted National Institutes of Health grant that would build a nationwide research infrastructure for older patients, which also includes my City of Hope colleagues in supportive care (Executive Director Matthew Loscalzo, L.C.S.W., the Lilliane Elkins Endowed Professor in Supportive Care Programs), nursing (Nursing Research Director Betty Ferrell, Ph.D., R.N.), and aging science (Population Sciences Professor Mark LaBarge, Ph.D.). We want to get better, more representative data for these patients who have the highest burden of cancer and other diseases, as well as mentor young researchers to enter the field. Along with the new Center for Cancer and Aging here, which Arti, Mark and I lead, we want City of Hope to be the national leader in this type of research. They can come to City of Hope, and we would have some national level resources we can give them access to.

Q: Did you always want to be a doctor?

As a kid growing up in rural Illinois, with animals always around both inside and outside the house, I wanted to be a veterinarian. But, I’m ultimately a people person, and I wanted to make a difference in people’s lives, so I became a doctor. I’m also a bit of a policy wonk about health care, so I earned a Ph.D. in health policy. Melding my clinical love of older adults with my research love for medical decision making and health services, I look forward to building a department that brings this together.

Q: How are you liking LA so far?

Although I’ve spent my entire adult life in the Midwest, almost entirely in Illinois, I am loving Southern California! My very first job as a 16-year-old in Illinois was as a lifeguard. I loved being at the pool all summer, and spent seven years doing that. During that time, my favorite bands were The Beach Boys and The Eagles, and I fantasized about living in LA!  When this job came open at City of Hope, it was a dream come true from my youth.

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Filed under City of Hope, Decision Making, Geriatric Oncology, Geriatrics, Health Policy, Palliative Care

“Geriatrics Saved His Life!” A True Story of Geriatric Heroism

“What are we going to do with him?”

Dale scope 2

I couldn’t help overhearing the oncologist talking to his team across the small space in our provider’s work room. An unusual work room, not because of what it looks like, but because of who’s in it. I am a geriatrician, and I work directly alongside my oncology colleagues in this room. I’m “embedded” in the oncology clinic, a bit like a medic among the soldiers in a war zone. They are constantly “fighting” the War Against Cancer—and I am always caring for the patients who are damaged in the fight. They are “saving lives” and I’m “saving” the quality of those lives—often even helping bring those lives to an appropriate close. I had created this clinic just for this reason.

My colleague went on …

“I don’t know. He needs treatment … his prostate cancer is metastatic … he’s losing a lot of weight … but he’s homeless. How do we treat a homeless guy? In the middle of a Chicago winter? On a Friday? Even if we admit him to the hospital for a ‘social admit,’ what are they going to do with him on a weekend? And then, he’ll be back out on the street, anyway.”

I listened while pretending not to. I have learned not to jump into the fray when oncology is wrestling with a problem. To avoid the “what do you want” look, complete with the eye-rolling. I kept listening, but without even looking.

“It’s a crazy story! He is an educated guy, married, recently retired, and then he got cancer. While he was trying to figure out what to do, his wife took most of his savings and left. He was hospitalized, placed in an assisted living facility afterwards for rehab, but hated it and left. Then he was in a shelter, and he left that because of the food. Now he’s homeless, with no money, and he’s got metastatic cancer. And his other family members don’t help out.”

“So what do we do?” asked the physician assistant. Long pause—nobody had an answer. “Why don’t we ask Dr. Dale? I think the patient’s kinda old—maybe geri can help.”

An opening. An opportunity.

“Is there something I can help with?” I asked.

Although I knew the story already, I patiently listened to it again.

Then, despite my hopelessly full clinic schedule, I went to see Mr. Lessman (not his real name). A thin, bony African American man sat there, with a bushy afro-style cut, shading from dark at the skull to white at the tips. He was disheveled, his clothes were torn and dirty, and his dentition was terrible. He smelled awful, as one would expect from a man with metastatic cancer living on the streets of Chicago’s South Side in the middle of the winter.

But he spoke carefully, articulately and precisely—no evidence of cognitive impairment. In fact, he talked exactly like my university colleagues; which was appropriate for a man with advanced education. And he took careful notes in a spiral binder he carried, asking me for clarification for the pronunciation and spelling of all the medical terms. I felt a bit like a student in a seminar.

I went back out to see my oncology colleague in the work room, and I told him I thought we could help. I was met with a wry, skeptical shrug.

But I knew something he didn’t: I had Erica on my side, who I was sure could help us. Because she’s a geriatrics hero.

———————–

I met Erica Riley when I decided to work at our inner city long-term care facility. She worked there, as a nurse, serving as the university liaison for our patients discharged from the hospital onto one of the floors. During my fellowship training in geriatrics, I found working in nursing homes bureaucratic, intimidating, and frustrating—and I vowed at graduation not to do it again. But when the faculty member serving as the medical director of this facility left precipitously, largely in response to being unable to effectively change the facility’s care quality, there was nobody else to step in. So, even though I was a researcher and the section chief, I decided to jump in myself.

Temporarily, I thought.

This particular nursing home is located in the middle of one of the poorer neighborhoods on Chicago’s South Side. Like many such facilities, it struggles financially, trying to survive on a combination of patients covered by Medicare, Medicaid, or no insurance at all. Most of the patients here don’t have other choices, and, like the people living in the neighborhood, almost all of the patients are African American. It is the kind of facility health policy experts like me write about—in the abstract—all the time, and usually in a vaguely negative way. Like many such experts, I had actually never worked in such a facility. And, I was sure, the people who worked there would recognize this right away. Erica Riley, LPN, certainly did.

When one meets Erica, one is immediately struck by her intensity. At the time I met her, she had been at the facility for two years. I have rarely met someone who is as committed to the care of older adults as Erica. She worked for five years in a surgical unit—but she loved working with older adults so much that she quit that comfortable job to work in long-term care.

She once told me, “I always desired to take care of geriatric patients. It reminds me of taking care of my mom when I was young and she was sick.” She was recruited to this particular facility specifically to run the University Program we were building, brought on board by an administrator who knew how dedicated and hard-working she was.

Erica is one of the most genuine healers I’ve seen; she has remarkable instincts for knowing just what a patient needs. She describes her own motivations this way: “Helping someone to get stronger mentally, physically, and emotionally when they can’t help themselves” is what drives her. “In school, we were taught not to get emotionally attached to patients, but for me that’s hard to do,” she says. “When I take care of patients, I feel like they are my family. Being there to listen, nurture, and provide excellent care means the world to patients—just to have someone that genuinely cares.”

Caring for the patients at our facility, one is constantly struck by how many of them count on, believe in, and trust “Miss Erica” to make sure they get the best care.

She also reflexively embodies the ethos of team care. She describes how much she enjoys working with our university team this way: “Coming together to provide consistency and continuity of care is great. Knowing that we can work together to provide exceptional care means everything to me. My being able to change the lives of our patients means a lot.”

The only way a nursing facility can maintain a constant culture of caring is through its nursing staff. Erica is the spiritual center for the facility; she ties the patients to the physicians and the rest of the care team, making it possible for us to provide excellent care in difficult circumstances.

As I said, I had a “secret weapon” for our fight against cancer. Erica, a geriatric hero.

—————-

Back in clinic, I told my oncology colleague, “Don’t worry. Let’s get Mr. Lessman admitted to our long-term facility. We’ll get his situation stabilized, straighten out his medications, get him eating, and then have him come back to clinic in a few weeks. Then you can decide if he can be offered treatment for his cancer.”

“Don’t we have to admit him to the hospital first? Isn’t that the rule?”

“Not necessarily. I’ll talk with the administration. I think it’s better to get him into the facility and get this started immediately. A weekend in the hospital won’t be as helpful.”

“Can he get some IV fluids there?”

“Sure.”

I texted Erica on my phone, told her about Mr. Lessman, and explained what I had in mind. “What do you think?” I asked.

“Of course! No problem.” No hesitation. “Give me a few minutes.”

Sure enough, within the next 30 minutes, an admission was arranged. I turned to my oncology colleagues and told them what was happening. They were impressed, bordering on amazed. They hadn’t seen anything quite like it. I could tell they were skeptical about what could actually be done. But I knew I had Erica on my side.

————-

Our multidisciplinary team in the nursing home met for rounds the following Monday. It’s led by Erica. For appearances, the team pretends I run the meeting, but everyone knows Erica really does.

“How’s Mr. Lessman?” I asked.

“He’s OK,” Erica reassured me. “Except for one thing. He won’t eat anything.”

“Why? Is he nauseated? Or does he have abdominal pain? Or constipation? What’s the matter?”

“No, none of that. He just doesn’t like any of the food. He’s very…” Erica had a funny grin on her face. “… particular.”

I frowned. “What does that mean?”

“He only wants grilled cheese sandwiches. No butter. White bread only. Nothing else. For every meal. And I’m being told we can’t do that here.”

“Let me talk with him. Then let’s talk with the kitchen and administration.” I talked to Mr. Lessman; the nutritionist talked with the kitchen; Erica talked with administration. As usual, Erica was exactly right, mostly because she had worked much of the weekend, although she wasn’t scheduled to do so. Without giving lots of details, Erica let us know that Mr. Lessman had quite a few of these personality quirks. And he had a long story to tell about his personal situation. He also had a notebook full of questions. And all of it fit together, in the way individual lives do, full of personal nuance, touched with tragedy, and played out over a lifetime to reach this point. A full life, lived fully. Learning about such lives is one of the joys of geriatrics. It’s also essential to helping patients improve.

As Erica tells it, Mr. Lessman “is one of the patients that’s dear to my heart. His appetite is extremely poor due to his diagnosis, but by sitting by his side, communicating with him, and encouraging him not to give up, it has made a tremendous change. The smallest acts of kindness can mean so much. … He has now started to consume more food, his appetite has increased, and he has gained weight. He has become a lot stronger.”

Which he has. We give him grilled cheese sandwiches all day long. He takes meticulous notes in his notebook, and he asks me questions each week. We have helped him straighten out his finances, and he has decided to stay at the facility long-term. We provide him transportation to his oncology appointments. And Erica makes sure everything is taken care of.

——————–

A few weeks later, Mr. Lessman returned to our Friday clinic is see the oncologist. I heard about it from my colleague, who came into the workroom, laughing and carrying on.

“Hey, Mr. Lessman is back. He looks fantastic! We’re going to treat him!”

“Great!” I said. “I thought he was a goner. You did a great job with him.”

“Not really me. The people in the facility are responsible, especially our nurse, Erica.”

“You know what?” My oncology colleague was laughing.

“What?” “Geriatrics saved his life!” More who-would-have-believed-it laughter.

I never thought I’d hear that phrase, especially coming from the mouth of an oncologist.

————————-

I’ll give Erica the final word: “This warms my heart; this is what nursing is about. Healing the sick and making the weak stronger physically, emotionally, mentally, and spiritually. This is what our program’s about. To have such dedicated physicians to care for our patients is unknown in our community. Our patients deserve better, and this program is a great start.”

This essay won the John A Hartford Foundation‘s “Heroes in Geriatric Care” essay contest in 2013. 

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Filed under Aging, Chicago, Geriatric Oncology, Geriatrics, Heroism

John Adams on Aging, Illness and Death: A Geriatrician’s Unusual Book Review

“My House is a Region of Sorrow, Inhabited by a sorrowful Widower…The bitterness of death is past. The grim spider so terrible to human nature has no sting left for me.”

–John Adams to his son, John Quincy, upon the death of his beloved wife, Abigail.

A Geriatrician’s Perspective

In First Family, Pulitzer-winning historian Joseph Ellis elucidates the character of our least-venerated, least-appreciated Founding Father, John Adams.  He brings Adams to life by presenting his life appropriately intertwined with one of our most-beloved First Ladies in history, Abigail (Smith) Adams.  As with all Ellis’s books, it is written with clarity, verve, and eloquence, mixing the Adams’ remarkable public career with his no-less remarkable marriage and personal life. How many people can claim that they effectively chose a country’s founding document (Jefferson), Military Commander (Washington), and Chief Justice (Marshall) and to have fathered a future President (John Quincy)?  And these are merely sidelights to a remarkable life of achievement. Rather than discuss the usual political topics, I focus here on a favorite topic of mine: aging.  Among the gems of insight scattered throughout this book are Adams’ (and Jefferson’s) thoughts on getting older, failing health, and death.  For a man who lived past the age of 90, at a time when life expectancy was closer to 40, his thoughts sound remarkably modern, hinting at the universality of these issues.

Adams and Jefferson on Aging

In the twilight of their lives, John Adams and Thomas Jefferson famously corresponded, reflecting on their lives and debating their political differences.  The correspondence had ended when Jefferson and Abigail Adams — John’s lifelong partner in all things domestic and political – exchanged letters, unbeknownst to John.  Jefferson denied paying a known “journalist” scoundrel, James Callendar, to libel John – which was a lie.  Abigail directly called Jefferson out on this lie, writing that, after their many years of friendship, “the Heart is long, very long in receiving the conviction that is forced upon it by Reason.”  After noting that Jefferson’s critics had accused him of being a disingenuous and dishonorable, steely-eyed Abigail says, “Pardon me, Sir…I fear you are.” Nobody he admired had ever been so direct with Jefferson on this point.  The result was that no further correspondence between households occurred for nearly a decade. Wouldn’t we all love to have such eloquent, steadfast support from our partner! After many years of bitter silence over such issues, Adams reignited a conversation, writing to Jefferson that, “You and I ought not to die before We have explained ourselves to each other.”  The resulting correspondence between the two, 158 letters worth in total, memorably did just this, as each posed for posterity, knowing their letters would be read by History.  While most discussions of this correspondence focus on the political ideas between the two, such abstract thoughts were interwoven with other topics.  This included sublime thoughts on aging, health, and death. In one exchange, Jefferson offers (p. 238): “But our machines have now been running for 70 or 80 years, and we must expect that, worn as they are, here a pivot, there a wheel, now a pinion, next a spring, will be giving way. And however we may tinker them up for a while, all will at last surcease motion.”  In my clinic, helping my older patients navigate through issues of their “machines” running down, dealing with multimorbidity, frailty and polypharmacy, I often feel just like some mechanic, “tinkering” with their delicate “parts”, hoping to keep them moving as long as possible.  Many patients of mine, especially the men and the engineers, complain about their declining abilities like cars springing leaks, rusting through, and falling apart. In response, Adams worries about something slightly different: “I am sometimes afraid that my ‘Machine’ will not ’surcease motion’ soon enough; for I dread nothing so much as ‘dying at the top,’ and thereby becoming a weeping helpless object of compassion for years.”  Adams’ had an ongoing fear of losing his mental faculties. As Ellis notes, Adams had seen the mental deterioration of his cousin, Sam Adams, and John “feared dementia more than death.”  This is the sentiment I so often hear from my patients, that their greatest fear is getting Alzheimer’s disease. My own experience with patients confirms this as one of their greatest fears as they grow old.

Literary Illness

Among the literary gems unearthed by Ellis are Adams’ colorful descriptions of his various ailments.  He creates a lovely neologism to explain one particular problem:  the “quiverations” in his hands.  These tremors prevented this inveterate, lifelong writer from doing so effectively.  He had to resort to dictating his ideas to whatever grandchild he could convince to listen.  I love this term, which captures the spirit of how tremulousness must feel from within. I’ve had patients say how they simultaneously don’t notice their tremors, but how annoying it is when they have to deal with it.  I’m likely to adopt this term for my patients, as I love the verve it imparts to the condition. In another case, he complains that his “constitution is a glass bubble or a hollow icicle”.  He worries that, “A slight irregularity or one intemperate dinner might finish the catastrophe of the play.”  He was on the brink, in which a new stressor might push him over the top.  I can think of no more poetic expression of Fried’s Frailty, which is a physiological vulnerability to stressors which predisposes older adults to morbidity and mortality.  Thinking of my frail patients as “glass bubbles” is a perfect metaphor for those struggling through another Polar Vortex in Chicago.

Death, Dying, and the Spirituality

When Abigail died, as the quote above indicated, Adams was grief-stricken for nearly a year.  After 54 years of marriage, he was lost without his lifelong confidant.  Grief at the death of a spouse or other loved one is a constant risk for older adults, especially if it leads to on-going depression.  It is a wonderful reminder of the blow such events can deal to our older patients. Adams despite a having a Deacon for a father (whom he deeply admired), had skeptical views of religion and the afterlife. In his later years, when asked about the Christian view on life after death, he jokingly responded that he assumed God would allow him to further debate Benjamin Franklin as part of the experience. Nevertheless, he did assume there was some sort of afterlife: “If it should be revealed…that there is no future state, my advice to every man, woman, and child would be…to take opium.” On the day of the 50th Anniversary of the Declaration of Independence, which Jefferson was chosen to author by Adams, the two Founders died within hours or each other, on July 4th, 1826.  Adams famous last words, “Thomas Jefferson survives,” were incorrect; Jefferson had passed shortly before his colleague.  Like two intertwined spouses, the two friends left their earthly lives together.

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Filed under End of Life Care, Geriatrics, History, Palliative Care, Uncategorized

History Lessons: General Ulysses S. Grant on a Palliative Care Approach for Terminal Cancer

Ulysses+S.+Grant Memorial Day famous war heroes

History is a great teacher.  Whenever I start to believe that our contemporary issues are new to humanity, I seem to immediately encounter a historical example.

I just finished reading a biography of Civil War General and President Ulysses S. Grant.  A lifelong cigar smoker and moderate imbiber, he died of head and neck cancer.  Memorably, he wrote his autobiography, encouraged by his editor Mark Twain, which is considered perhaps the best presidential example of the genre of all time, while consciously dying from his cancer.

Unbeknownst to me, he also took time out from writing his memoirs to write some personal thoughts into a diary, including about his cancer.  The insights into palliative medicine are remarkable, especially given the continuing ignorance of them in our own day.  He writes in a remarkably clear-headed way.

Treating the Pain

Describing the pain and symptoms he was having he says, “…I have watched my pains and compared them with those of the past few weeks. I can feel plainly that my system is preparing for dissolution in three ways: one by hemorrhage, one by strangulation, and the third by exhaustion.”  This is a stunningly prescient and dispassionately clinical description of his prognosis, and one that I would be delighted to hear from an intern on my service.

Then, for his doctors, he makes crystal clear his care preferences, “I have fallen off in weight and strength very rapidly for the last two weeks.  There cannot be a hope of going far beyond this time.  All any physician, or any number of them, can do for me now is to make my burden of pain as light as possible.”

A clearer description of the desire for a palliative approach at the end of life couldn’t be made.

He worries openly about his current family doctor insisting on bringing in more specialists, “I dread them…knowing that it means another desperate effort to save me, and more suffering.”

As he weakened, he recorded his reactions to his pain medications.  As his doses of morphine escalated, outlines a distinction between addiction versus normal escalating needs for pain relief, “…when I do take [morphine], it is not from craving, but merely from the knowledge of the relief it gives.  If I should go without it all night I would become restless…from the continuous pain I would have to endure.”  My patients worry all the time about “becoming addicted” to pain medicines – it would serve me well to simply read this passage in reply.

Existential Suffering…and Triumph

One strategy for normalizing end-of-life situations, as difficult as it is to note at times, is to use humor, something Grant does expertly, “The fact I think I am a verb instead of a personal pronoun.  A verb is anything that signifies to be, to do or to suffer.  I signify all three.”

Yet all was not seen as bleak.

He appreciated all the more the trials and tribulations the country had endured through that horrible war, and he was glad to have seen it through. “It has enabled me to see for myself the happy harmony which has so suddenly sprung up between those engaged but a few short years ago in a deadly conflict.”

And he was appreciative of the sympathy he received from his recently united fellow citizens. “It has been an inestimable blessing to me to hear the kind of expressions towards me in person from all parts of the country; from people of all nationalities, of all religions, and of no religion, of Confederate and National troops alike, of soldiers’ organizations, of mechanical, scientific, religious and all other societies…They have brought joy to my heart, if they have not effected a cure.”  Reflecting on one’s life, even when not as eventful as the general’s, is often cathartic for patients.

And he had the occasional  “good days” that I urge my patients to embrace, sitting on his porch, “I feel pretty well…I am as bright and well now, for a time at least, as I ever will be.”

Engaging with Loved Ones to the End

Unable to talk, he wrote a loving farewell to he beloved wife, who was wracked with grief.  “With…the knowledge I have of your love and affections and the dutiful affections of all our children, I bid you a final farewell until we meet in another, and I trust better, world.”  Like many, he had spiritual needs to satisfy at the very end.

Having finished his memoir and sent it off to the printers, he signed off. “There is nothing more I should do now.  Therefore, I am not likely to be more ready to go than at this moment.”  He had shrunk down to under 100 pounds; too weak to sit, he retired to bed.

Three days later, his family gathered around him, he died.

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Filed under End of Life Care, Geriatric Oncology, History, Palliative Care

“Geriatrics Saved His Life!”

Heard in my SOCARE geriatric-oncology clinic this week, by an oncologist, “Geriatrics saved his life.” He was being honest and correct.

The patient was an older man with metastatic prostate cancer that was no longer responding to hormone thereapy. Although educated and accomplished, he had become homeless after having his assets stolen by a relative. There was no way to give him his necessary medications under the circumstances.

I pulled some strings to get him directly into a nursing home under my care. He reliably got his medicine, was fed, and received physical therapy. His cancer regressed, he gained weight, and he got stronger. A month later, he looked different enough for my colleague to make the above statement.

Unfortunately, like most hospitals these days, mine has almost no appreciation for what we do in geriatrics, believing things like chemotherapy are more important. While they won’t appreciate this story, I know you all will.

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