Series of free community events slated for May
RANDOLPH, Vt.—Bethel resident John Young was working full-time as a blacksmith when someone close to him said he would make a good nurse. He agreed, earned his nursing credentials at age 38, and for 27 years and counting has made a career in health care, first in hospice—“Taking care of people who were dying was very meaningful to me”—and now in palliative care.
It’s the latter service that Young wishes more community members knew about, and that the World Health Organization reports “40 million people are in need of” annually, worldwide. Yet “only about 14 percent of people who need palliative care currently receive it.”
Palliative care improves quality of life, managing and relieving symptoms and suffering for patients who have been diagnosed with a life-threatening illness. It addresses not only physical symptoms but also psychosocial and spiritual issues, and can provide support to caregivers and other family members. Unlike hospice care, which is provided to patients thought to have a six-month or shorter prognosis, palliative care is for anyone who has been diagnosed with a serious illness, at any stage. Palliative care patients also may simultaneously receive curative treatment.
“Palliative care is for anyone who has a serious illness,” said Young, who provides care to inpatients at Gifford Medical Center. “It doesn’t matter how old you are. If you are struggling and have problems in your life related to your illness, that is when I usually come in. During a consult, we help a patient, along with their family members, understand where the patient is now and how they would need to move forward to stay comfortable and safe.”
Gifford colleague Dr. Cristine Maloney, who sees patients both in the inpatient setting and at their homes, said all providers should be able to offer some degree of palliative care. She and Young may be called in for a special consultation when a disagreement or other conflict develops between a patient and their family or their provider, or when a significant decision needs to be made, such as whether to enter a nursing home or start hospice care or begin complex symptom management.
Trained as a physician in both primary care and palliative care, Maloney was drawn to the work, in part, after witnessing the serious illness and subsequent death of two people close to her.
“I saw firsthand that things could be better for patients and families,” said Maloney, who also took a circuitous route to palliative care having formerly served with AmeriCorps, then as the housing director for Randolph Area Community Development Corporation, and as a longtime emergency medical technician (EMT) with a local ambulance service.
Still, patients may resist palliative care for a variety of reasons.
“I think there’s a lot of fear,” Maloney said. “That if we’re coming, it means you’re close to death. Or it means, ‘I have to have a conversation that I am not ready to have.’ But, at the end of a session, I feel like I’ve done a good job if I hear, ‘This was actually really helpful.’”
Questions to Consider
When someone we love is diagnosed with a life-threatening illness, we may experience fear, anxiety, depression, and confusion. Such a devastating diagnosis, whether for a parent, a child, or oneself, also brings to the forefront questions about our values, about how we want to live, about what things we are willing to compromise—and what is nonnegotiable.
Seemingly in an instant we are faced with questions we never before considered.
Maloney said too few of us give them much advance thought.
“I think it’s good for all of us to think about how we want to be taken care of,” she said. “There is almost always several different ways, and that depends on what is important to you.”
Ideally, “people would spend a little time thinking, if I got sick, or sicker, how would I want to spend my time? How would I want to be cared for?” she said. “So that when they get sick, it’s not the first time people are thinking about” these issues.
Palliative care helps patients answer those questions and make decisions that will shape their quality of life.
Patients and their family members participate in a “goals of care” discussion that includes determining their understanding of their illness—and helping to improve their understanding; identifying their values and what things are most important to them, such as being able to continue a favorite hobby; and creating a list of tradeoffs as well as nonnegotiable items.
“For example, a patient may make it clear that she does not want to die in a nursing home,” said Maloney. “Then, as a medical professional, we’re trying to match, balance goals, and help with the decision-making process.”
Because there can be disagreements among family members, having a palliative care provider present “can help patients and families express their concerns and potentially come to a place of understanding,” she said.
Young said disagreements may arise when a family member is from out of town, for example, and only recently getting involved, or when a family member simply wants to see their loved one live longer. When there is a family conflict, he said, “whether a patient is cognitively intact makes a big difference.”
“We see a lot of family members of patients who are really sick, or have dementia,” Young said. “Family members may have a lot of questions. The information needs can be really different between patients and their caregivers.”
Communication is key throughout the process.
“We create a space where people feel like they can talk about things,” said Maloney.
Free Community Events
To educate the local community about the benefits of palliative care, Gifford will present the following free events in May:
1 p.m. Monday, May 6: “Palliative Care and Hospice: The Difference Between Them and How to Be Prepared” with Dr. Cristine Maloney, at Northfield Senior Center.
6:30 p.m. Tuesday, May 7: “End Game,” screening and discussion of Netflix documentary with Dr. Cristine Maloney, at Kimball Public Library in Randolph. This 2018 film by Rob Epstein and Jeffrey Friedman is about terminally ill patients in a San Francisco hospital who meet medical practitioners seeking to change the perception around life and death. Light refreshments.
12:45 p.m. Wednesday, May 22: “Palliative Care and Hospice: The Difference Between Them and How to Be Prepared” with members of the Gifford Palliative Care team, at Randolph Senior Center.
2 p.m. Tuesday, May 28: “End Game,” screening and discussion of Netflix documentary with Dr. Cristine Maloney, at Strode Independent Living, Morgan Orchards, in Randolph Center. This 2018 film by Rob Epstein and Jeffrey Friedman is about terminally ill patients in a San Francisco hospital who meet medical practitioners seeking to change the perception around life and death. Light refreshments.
For more information, visit giffordhealthcare.org/service/palliative-care-and-end-of-life-care or email .
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Gifford is a community hospital in Randolph, Vt., with family health centers in Berlin, Bethel, Chelsea, Randolph, Rochester, and White River Junction; and specialty services throughout central Vermont. A Federally Qualified Health Center and a Top 100 Critical Access Hospital in the country, Gifford is a full-service hospital with a 24-hour emergency department and inpatient unit; many surgical services; a day care; two adult day programs; and the 30-bed Menig Nursing Home, which was named by U.S. News & World Report as one of the best 39 nursing homes in the country in 2012. The Birthing Center, established in 1977, was the first in Vermont to offer an alternative to traditional hospital-based deliveries, and continues to be a leader in midwifery and family-centered care. The hospital’s mission is to improve individuals’ and community health by providing and assuring access to affordable, high-quality health care in Gifford’s service area.
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