PALLIATIVE CARE ELECTIVE: Getting Comfortable Being Uncomfortable

What is palliative care? I started my palliative care elective this week without fully understanding the field and what it entails. On paper, palliative care is medical, psychological, and social care that is directed towards comfort, not cure. In practice, it is much more than that.

I started the first day with the pediatric oncology team and a patient who was actively dying and needed better pain control. Actively dying. It’s a weird phrase, and it’s hard to really know what that means in terms of my role as resident. I’ve gotten more used to the idea as I’ve moved through my training, but I am certainly not comfortable with it. In fact, the palliative care team had been called in for an oncology patient because most members of the team (especially nurses and residents) felt uncomfortable.

What were we uncomfortable with?

· Extremely high doses of pain medications.

· The concept of turning off monitors and not checking vital signs strictly every 4 hours.

· Allowing more visitors than hospital policy dictates.

· The concept of allowing this patient to die on our watch.

The list goes on…

After speaking with some residents, it became clear that most of us had never been in this type of situation before and we had a lot of questions. How much pain medication is too much? What if the next dose of pain medication that we order stops his breathing? Does the family know that he is suffering? What if the nurse refuses to give a pain medication that we order? What if the patient refuses? What if…

There were SO MANY QUESTIONS. Most of them had no real answers. The answers that did come up (“It’s okay if he dies”) left me uncomfortable.

I chose this elective so that I could “get more comfortable with it,” but I am quickly learning that I should be shifting my mindset to “understanding how to manage" these patients. I don’t think I will ever be comfortable with it.

As my palliative care attending has now said multiple times this week,

“I don’t care if you’re comfortable. I care that you know what to do.”

Have you had any experiences on a palliative care team? Let me know what you’ve encountered and what you've learned about this aspect of medicine!