Issue link: https://viewer.e-digitaledition.com/i/862068
Q : You have written about your desire to lead a cultural revolution in end- of-life care. Can you elaborate? A: As a writer, radio host, educator or physi- cian, transforming the taboo around talking about death is at the core of the work I do. By practicing hospice and palliative medi- cine at an academic institution, I teach medical students, residents, fellows and my colleagues — as well as patients and families — how to be curious and how to ask questions that are ultimately the deepest expression of love and respect. Q : What can physicians learn through conversations with patients? A: For people to die in a manner consistent with their values and preferences, it is essential that healthcare providers know what matters the most to them. When we limit conversations to what procedures patients wa nt or don't wa nt without understanding the "why" behind those choices, we fail to provide the best support for someone living a life that matters to them. If I say: "I want to avoid dying on machines," there is no context as to why I feel that way. If instead, I say: "I love the sound and feel of a purring cat on my chest and the warmth of the sun on my skin," then medical care can focus on making these things accessible to me. Q : Do you believe doctors sometimes struggle with knowing when to transition patients from cure-directed to comfort-directed treatments? A: Yes, medical training has positioned doctors to frame our work such that sav- ing life is the measure of success, that anything less is failure. However, this is inherently f lawed. You cannot possibly care for a whole person, for their whole life, if you leave out the detail of mortality. The patients and families I get to care for continue to reinforce this truth: that I have no idea what someone wants unless I ask. Q : There is often a reluctance to talk about the reality of our mortality. Can you comment about this? A: Death is sad. If you love someone, that is simply so. Yet, silence is worse, because it leaves unanswered questions. I recall my first experience with death as a young child. It was the day our beloved family cat died. He was an outdoor cat, a nd my father eventua l ly found him curled on our doorstep after we had been sea rching for hours. He gathered my brother, mother and me into our family room. The words he spoke that day have since infused my experience of being with people at the end of life. He sa id we were blessed that our cat chose to come home and to die with us. That we should experience this as an honor not to be ta ken for granted. Q : What lessons have you learned from people who are dying? A: Stay ca lm a nd be prepa red to be amazed. Like young children, people approaching the end of life are often the most courageous a nd clea r thinking, vibrant and alive people I have known. W hen people are intimately aware of death, the sma ll stuff melts away and what matters most rises to the top. They have also consistently demonstrated the difference between wanting something and needing something. When people really need something, the human spirit consistently demonstrates f lexibility and astonishing resilience. Dr. Dawn Gross is Attending Physician, Dept. of Hospital Medicine, at University of California, San Francisco, and host of a live call-in radio program, "Dying to Talk." She will present at Hospice of the Western Rese r ve's 21st Annu al P rofess io n al Conference sponsored by The Hospice Institute on September 14 at Corporate College East, 4 400 Richmond Road , Warrensville Hts, OH. The theme of this year's conference is "A Well-Planned Life: Preparing for the Transitions Ahead." ■ Leading a Cultural Revolution in End-of-Life Care: A Q& A WITH DAWN GROSS, MD, PHD, FA AHPM 1 2❱❱❱❱❱ C L I N I C A L S E C T I O N : H O S P I C E