This episode is the first of a 4-part series that introduces you to the members of a palliative care team. Today Dr. Colin Scibetta discusses his role as the physician on the team and how palliative care differs from hospice care. In future episodes you’ll hear from the team nurse, social worker and chaplain.
As this episode airs I am enjoying a trip through Spain, including cycling in the Andalucia region! I’ll be back home in a few weeks to report on the trip. Follow me on Instagram to see my photos at kwyattmd or this link: https://www.instagram.com/kwyattmd/
This interview will cover:
What palliative care consists of
The difference between palliative care and hospice
The benefits of palliative care for patients
How the whole-person approach of palliative medicine also benefits care providers
Why Providence Institute for Human Caring (et al) was awarded the Circle of Life Award from the American Hospital Association
Colin Scibetta MD is a fellowship-trained palliative medicine physician who complete his undergrad in neuroscience and biology at Wesleyan University. He then moved to Ecuador where he worked on a health initiative for indigenous communities impacted by oil development. Dr. Scibetta did his undergraduate medical training at the University of California, San Francisco School of Medicine, where he also completed an internal medicine residency and a fellowship in hospice and palliative medicine.
Remember to tune in next week for Part 2 of this palliative care series! If you enjoy this content be sure to share it with others who might find it helpful and consider leaving a review on iTunes.
Learn about the life of Cicely Saunders and what we can discover from her quest to change the way that people died.
In this episode, recorded just after the celebration of what would have been Cicely Saunder’s 100th birthday, I talk about how she became interested in caring for the dying, what inspired her to create St. Christopher’s Hospice, and what we can learn from her determination to improve care at the end of life.
Read more about the life and work of Dame Cicely Saunders at:
If you’d like to join A Year of Reading Dangerously, our online reading group for 2018, there’s still time! Check out the reading list here and start reading along with 1,000 other people around the globe!
Cicely Saunders first began working with dying patients when she was training to be a nurse in the early 1940’s in London. She went on to become an Almoner (medical social worker) and a volunteer nurse at a hospice for the dying poor where she recognized the great need for better pain management and comfort care at the end of life.
When she was told that the medical system would not be interested in her ideas because she wasn’t a physician she accepted the challenge and went to medical school. One revolutionary contribution to end-of-life care was her concept of “Total Pain,” which included emotional and spiritual pain as well as physical.
As a doctor Cicely received a research grant where she studied pain management and wrote many articles. She took “before and after” photos of each patient so that she could show the transformation that occurred when pain was alleviated. Eventually her dream of creating a hospital dedicated to care of the dying was fulfilled when St. Christopher’s Hospice opened 10 years later.
From her story we can take much inspiration for today’s ongoing struggle to improve care at the end of life:
Follow your heart – Cicely stayed true to her heart and passion throughout her career as she dedicated herself to care of the dying, even when others discouraged her.
Be willing to change course to achieve your dream – Cicely was unable to pursue her original dream of being a nurse after a back injury and shifted to medical social work as a way of continuing her work with dying patients.
Be persistent – Cicely’s determination to do whatever it took to bring her dream to fruition led her to become a doctor.
Patience is essential – Cicely had to wait for many years to see her dream of a hospice become a reality: first while she studied to be a doctor, then did several years of research, and finally raised the funds to build St. Christopher’s. Change rarely happens overnight so stay the course!
Be credible before you can be incredible – Cicely demonstrated this throughout her career as she diligently worked through her own education and her research to gain credibility in the eyes of the medical system she was trying to change
The importance of teamwork – Cicely found likeminded individuals in her community and in the U.S. to sustain her inspiration and her enthusiasm for her goal. We can accomplish more as a team than as individuals.
Flexible models are necessary for optimum care – Cicely resisted standardizing her model of hospice care and instead chose to help others create their own unique solutions for the needs of their communities.
Have a big vision but humble expectations – Cicely sought to change care of the dying across the world with her vision of hospice but was content to make a difference to just one patient at at time.
“If one man from a poor village in India dies without pain because of what I have done, it will all have been worthwhile.” – Dame Cicely Saunders
Today we would be advised to remember her Total Pain concept as we struggle to deal with an opioid crisis in the U.S. Neglecting the contribution of emotional and spiritual pain to physical pain has led to over-reliance on drugs as the answer to suffering.
Happy Birthday Dame Cicely Saunders!
Thank you for inspiring us to carry on your big vision of helping every person find comfort, peace and love at the end of life.
Tune in every Monday for a new episode! If you enjoy this content please share with others and consider leaving a review on iTunes. Until next week:
Learn how pet therapy with a trained animal companion can benefit hospice patients physically and emotionally.
In this episode I share a “legacy interview” from the archives with Magnum – a trained facility dog – and his handler Carol Mestemacher about the benefits of pet therapy for hospice patients. Magnum recently “retired” from his volunteer position so I decided to honor his work by featuring this interview today. Thank you for your service Magnum and Carol!
A huge thank you to my new supporters on Patreon.com/eolu: Susan Clark and Howard Bryant! Your contributions help me keep this podcast and the End-of-Life University Interview Series on the air. If you’d like to join us for as little as $1 a month and receive special bonuses go to Patreon.com/eolu to learn more!
Hear my far-reaching dreams and ideas for changing the way people die in the U.S. in 2018.
In this episode I talk about some of my own personal goals for the New Year and then discuss a list of ideas for ways in which we need to improve all aspects of the end of life. Get some inspiration for steps you can take within your own community and in your own personal life to “Be Good at Death.”
I’ve started a new year-long reading group called A Year of Reading Dangerously for 2018! We’ll be exploring death and the afterlife through books that hopefully will inspire us and stretch our boundaries. Sign up to receive a monthly email with the book selection for the month and a downloadable reader’s discussion guide. Join the fun!
A HUGE thank-you to my latest supporters: Claire Turner and Dr. Leslie Robinson. Your contribution is greatly appreciated as it helps defray the costs of producing and broadcasting this podcast and the End-of-Life University Interview Series, but it also provides me with much-needed emotional and spiritual support! To donate as little as $1 per month go to Patreon.com/eolu.
There is a new pledge level on Patreon-the Platinum level-where for a donation of $5 per month you’ll receive replays of ALL of the End-of-Life University Interviews for 2018. So check it out now!
What we need to do to “Be Good at Death” in 2018″:
Policy Level changes needed:
Improve reimbursement for Palliative Care
Stabilize and improve reimbursement for Hospice Care
Establish a system for paying family caregivers
Medical System changes needed
Integrate Palliative Care into Primary Care and therefore …
Increase home-based palliative services
Rank hospitals according to the quality of end-of-life care provided (based on an article by Dr. Haider Warraich from Duke University). Dr. Warraich’s criteria for this ranking include:
“percentage of patients with a documented health care proxy
percentage of patients who receive heroic measures like cardiopulmonary resuscitation or cardiac defibrillation
appropriate use of hospice and palliative care
the likelihood of a family recommending the hospital for end-of-life care
whether patients’ location of death was concordant with the place in which they had wanted to die
availability of around-the-clock spiritual resources
the training the medical team receives for dealing with the medical and psychosocial issues that arise when death is imminent” ((Thank you Dr. Warraich for this fabulous idea!))
Medical Education changes needed
Train all medical providers in palliative care (at least a one-month rotation) regardless of specialty
All medical students work with dying patients in at least one rotation
Teach better conversational and listening skills to medical providers
Help medical providers process their own fears and biases toward death and their repressed grief
Learn about my Top-10 picks for people, events and trends that have changed the end-of-life movement in 2017.
In this final episode of 2017 I take a look back at the previous year and share my thoughts on some of the events and people that I believe will have a big impact on how our society deals with the end of life.
You can support this podcast by making a small donation of $1 or $2 at Patreon.com/eolu.
Here are my picks for the 2017 Game Changers in the Death-Positive Movement:
The documentary film “Extremis” was nominated for an Academy Award for Best Documentary Short. The film was also picked up by Netflix in 2016. It is a powerful depiction of end-of-life care in the ICU staffed by Dr. Jessica Zitter, which should serve as a wake-up call to people about the need to do end-of-life planning before a healthcare crisis occurs.
Dr. Jessica Zitter’s book Extreme Measures was also released this year. In addition she wrote an article for the N.Y. Times (“First Sex Ed Then Death Ed”) calling for death education classes for all high school students. This novel idea has the potential to change our society’s perception of death and dying by introducing the subject to young people. Dr. Zitter is truly a game changer!
In March and May of 2017 the organization The Dinner Party (a movement to provide community for millennials dealing with loss) convened meetings with business leaders from some prominent US corporations to discuss loss and the workplace. They emphasized the importance of developing workplace policies and protocols for managing bereaved employees and offering them assistance. These conversations are just the first step in changing how grief is recognized and supported in the workplace rather than being ignored.
In April 2017 the 1st International Death Doula Training was held in Maui for the purpose of teaching people from around the globe to serve others as death doulas. This event was a game changer because it validated the death doula movement, increased the number of qualified doulas who can serve their communities, and provided a networking platform for death workers, which helped strengthen and expand the movement. The 2nd International training will take place in 2018!
Also in Apri the National Rx Drug Abuse and Heroin Summit was held to address the epidemic of opioid addiction in this country. Measures have been taken to limit the number of pain pills that can be prescribed and dispensed at one time. This is an important and game-changing step to deal with the overwhelming public crisis of opioid deaths but caution is necessary. We must be vigilant to ensure that all hospice and palliative care patients have access to the medications they need for pain and symptom management.
On June 27, 2017 Jon Underwood, founder of Death Cafe, died suddenly and unexpectedly at a young age. Jon has been a game changer from the beginning by creating the Death Cafe platform for conversations about death that has spread around the world. But the tragedy of his death is also a potential game changer because of the powerful legacy Jon leaves behind and because of the potential for tragedy to inspire growth, creativity and healing. The entire death-positive movement is indebted to Jon for his inspiring and gentle leadership and may his death be a catalyst for transformation.
In July a new smart phone app named WeCroak was introduced. This app is a game changer because it helps people to think about death in a positive manner by sending reminders (“You will die one day”) and quotes on their phones 5 times a day. Technology has the potential to revolutionize our approach to death and dying and this simple $.99 app is just one small step toward the change that is needed.
The film Coco was released in the US by Disney and Pixar in November. Coco tells the story of a 12-year old boy who is transported to the land of the dead on Dia de los Muertos. There he receives help from his departed great-great grandfather to return to his family in the land of the living. The film depicts joyful skeletons who dance and sing and it portrays a positive image of life after death. While it is a children’s movie Coco has a powerful message for adults and is likely to stimulate much conversation in families about death and departed ancestors. It is exciting to see Hollywood begin to address death in a positive manner and this film is a game changer that will hopefully lead to more such productions in the future.
In December the first EndWell Symposium, created by Dr. Shoshana Ungerleiderand her foundation, was held in San Francisco. This groundbreaking symposium brought together thought leaders from healthcare, design and technology to share ideas on how to improve end-of-life care. The synergy of this collaborative event will have a ripple effect across the country and should lead to innovation and creativity around death and dying in the months to come. Dr. Ungerleider is a game changer for her forward-thinking generosity and ingenuity!
Also in December the Northpoint Expeditionary Learning Academy in Prescott AZ held a class for students in grades 9-12 on “Death and the Meaning of Life.” School Director Charles Mentken taught the class, which provided a comprehensive look at death and dying from various cultural and religious perspectives. The elective class also introduced the students to options for hospice and palliative care, death doulas, home funerals, cremation, and traditional funeral and burial services. This may be the first “pilot project” course of the type Dr. Jessica Zitter called for in her NY Times article and it is definitely a game changer. The students in the course have reported that their attitudes and fears about death have been totally transformed, as well as their approach to life, as a result of what they learned in the class. (I’ll be featuring an interview with Charles Mentken and 3 of his students on the End-of-Life University Interview Series in early 2018. Sign up if you’re not already on the list!)
I hope your holiday celebrations have been filled with joy and light and that you feel ready to embark on a brand new year next week! There will be a new episode on New Year’s Day where I will share my “wish list” for 2018.