U.Va. center stresses
patient comfort and dignity in the final stages of life
Carlos Gomez, medical director of the Center for Hospice and
Palliative Care, talks with a patient. The center's aim is
relieving suffering and making dying better for the patient.
quietly, the nurse updates the rest of the health care team. After
describing the patients' conditions -- all six have terminal illnesses,
some are close to death -- she adds her personal observation about
their emotional state, the state of their soul even.
woman looks frightened. When I go in, she's lying there with her
eyes closed, but whenever she sees the hospital staff, she seems
frightened. She may need some spiritual support," says nurse
The meeting was typical for medical rounds at U.Va.'s Center
for Hospice and Palliative Care, located in University Hospital.
team consists of Dr. Carlos Gomez, the center's medical director
since it opened in 1995; another nurse, Karen Boyle; social worker
Bonnie Stewart; a research assistant and a respiratory therapist.
Although the center is small, with only six private rooms, it
has helped about 2,000 patients in those five years.
The U.Va. Center for Hospice and Palliative Care When faced
with a terminal illness, many patients want to make the
remaining days of life as comfortable and dignified as possible.
this point, medical treatment cannot improve the disease,
and a special kind of care is needed.
Care that focuses on relieving pain and discomfort.
Care that addresses the feelings and issues that arise when
a loved one is dying.
Care that is specially tailored to each patient's and family's
needs and beliefs.
recognize dying as part of the normal process of living.
Our program affirms life and neither hastens nor postpones
death. We're working together to provide compassionate care
in the last stage of life.
For information, call 982-0555.
has emerged as a national leader in palliative care. He includes
the spiritual dimensions," says David Cattell-Gordon, director
of community relations for the U.Va. Cancer
Center, of which the hospice center is part.
who recently appeared in a segment of Bill Moyers' PBS special
on dying in America, "On Our Own Terms," says that he
is interested in all of the questions that surround the dying
constitutes a good death? What language do people use from the
cultural and religious beliefs they bring?" he asks.
is part of a growing, but still small, group of medical personnel
who are embracing care of the dying -- with honesty and with,
Gomez says, "whatever it takes."
Addressing and managing pain is a big component. It might seem
a simple equation that if someone is suffering, you start by employing
the arsenal of drugs that researchers and companies have developed.
But that is not something doctors have been trained to do, Gomez
admits. It's one of the things he's working to change for those
with terminal illnesses.
residents now must go through a rotation on this unit. "The
difference is night and day in their being comfortable with pain
management, with death and dying," says Boyle.
discomfort with the dying process is partly a cultural problem.
"Americans, and hence physicians, act as if death were an
option," Gomez says. "They're trained to treat every
problem as if it's fixable."
everyone, he says, it's important to talk with your family ahead
of time and while you're healthy about your wishes for care at
the end of your life. His group would like to establish a transition
house for individuals near death whose care is too complicated
for families at home but not as acute as intensive care. It would
also be an alternative to nursing homes.
"The facility would be part respite, part residential,"
and staffed by professionals who could give a high level of care,
Boyle says. "The community would do well to have free-standing
houses for patients where family members could come at any time,"
she says. "It breaks your heart to send someone out to a
"We all die in our own unique way, as we have lived in a
unique way," says Cattell-Gordon. "The patient and family
drive what support is needed."
there's no family to go home to. Family members can't get time
off work, or they live hundreds of miles away.
care is not just about the last few days of life. It can continue
for a few years. "People come in and out for symptom management,²
Gomez explains. "I like to say that hospice and palliative
care is not about dying; it's about living well until you die."
The center has made all the difference in the lives of John Daniel
Scott and his wife, Anya. She was appalled by the care -- or lack
thereof -- that her husband, who has throat and tongue cancer,
was receiving elsewhere, and a friend told her about Dr. Gomez
and the center.
was in so much pain. He hadn't eaten in almost eight months,"
Anya Scott says. Her husband got an appointment at U.Va. within
a day of her first call and was admitted to the palliative care
unit about 24 hours later. In only a few days, his pain was under
control and he was able to eat solid food again. The couple, who
have a young child, recently even went on a vacation.
"When you're in the kind of pain Dan has been in," she
says, "everything is affected -- it's emotional. You lose
faith, hope. ... We were afraid Dan's death would be horrible.
Now he's more relaxed, because he's in great hands.
U.Va. center is committed to exploring medical options and taking
advantage of the medical expertise close-at-hand.
patient's primary doctor stays on the medical team. Not only does
Gomez call on the specialists in the Pain Management Center, he
can find out about clinical trials and see if his patients are
"We are rich in human resources here at U.Va.," Gomez
points out. The University, for example, is building an impressive
team of bioethics specialists. Before the TV series, U.Va. sponsored
a town meeting to discuss barriers to -- and opportunities for
-- support and dignity in end-of-life care, with Gomez and Cattell-Gordon
on the panel. They were joined by Jonathan Moreno, director of
U.Va.'s Center for Biomedical Ethics; Cindy Westley, a nurse who
is community care manager at the U.Va. Health System; and Susan
Goins-Eplee, director of patient support services at the Cancer
Center, who appeared with Gomez in the Moyers special talking
with medical students. She is also U.Va.'s chaplain.
The center staff acknowledges that that their work is not easy.
But every morning they have a chance to discuss cases, and that
helps. They also go to the memorial services.
think keeping in your feelings is unhealthy," Gomez says.
"Some people just wrap themselves around your heart, and
you can't help but be affected."
staff turnover is low, according to Cattell-Gordon.
stay working here because it's hopeful." They feel they're
making a difference in people's lives. It's a special privilege
to be invited into one of the most intimate times of people's
lives, he said.