Philadelphia Medicine Summer 2018 - 27

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Feature

The Heart & Healing of
Palliative Care Providers
By: Stanley J. Savinese, DO, FAAHPM HMDC

M

any palliative care providers will tell you that they are
not just doing a job - they are following a vocation. A
Child Life Specialist with personal experience being the
scared child in the hospital bed became a social worker, passionate
about assisting children to cope with loss. A local pastor became a
chaplain after volunteering to pray with patients at a cancer center,
conscious that when his father died, there was no one to help his
family understand their grief. Former primary care physician Stanley
Savinese became a Geriatrician and then a palliative care specialist,
realizing that the elderly patients who visited his practice often had
not received appropriate care elsewhere.
A social work student watched her grandmother slowly fade away
in a hospital because no one thought to say, "Enough." We all have
stories of how we came to be palliative care providers, and this is
mine. My experience of my grandmother's illness reminds me that
every patient and family has the right to make informed choices. I
wish that a medical provider had sat down with my family and told
us the truth - that my grandmother would die from the effects of a
devastating neurological injury. We might have made different choices
if we had known. I am conscious that every family has a different
story and its own worldview. However, I carry these lessons with me
as I meet with patients and families as a palliative care social worker
for the Visiting Nurse Association (VNA) of Greater Philadelphia.

At its center, palliative care is a service about quality of life.
VNA palliative care physician Elizabeth Reimet began her career as
a physical therapist, drawn to helping people who were suffering
from spinal cord injuries. This helped her develop an understanding
that much of medicine is helping patients to live with and cope with
their illnesses. "I am trying to help (patients) live better within the
context of their diseases," says Reimet. "Hopefully, to help them live
in less pain and with less anxiety, so that they can accomplish those
things that are most important to them." Dr. Savinese, also now a
palliative care physician with the VNA, agrees. "Very sick people
found me," says Savinese, "and I realized I could do more than help
them lower their blood pressure."

The goal of palliative intervention, whether it comes late in a
patient's illness, or increasingly, soon after a diagnosis of serious illness,
is to match patient's and family's goals with the treatment options
that are available to them. In the process, patients can receive expert
symptom management and psychosocial and spiritual support to
help them cope with the adjustments that come along with serious
illness. Unlike hospice, palliative care can begin at diagnosis and
follow patients as they undergo treatment.
Inpatient palliative care teams can be consulted to assist patients
who are hospitalized with life-limiting illnesses, such as the VNA
teams at Temple and Hahnemann University Hospitals. Increasingly,
patients also can access palliative care services in their homes. With
a physician's order, a palliative care nurse can make home visits to
ensure that symptom management needs are met. This may especially
benefit patients undergoing treatments such as chemotherapy that
may worsen symptoms. Nurse practitioners and social workers may
also be part of home palliative care teams and can assist patients and
families to clarify their goals for care or to complete advance directives.
VNA palliative care nurse practitioner Stephen Clark appreciates the
focus on educating patients about ways to live with a better quality
of life. "I wouldn't do anything else," says Clark of his profession.
Palliative care providers enter the profession for many reasons,
with the common thread that our highest goal is to provide the
best care possible for patients and families. Whether patients are in
the hospital or at home, the Visiting Nurse Association of Greater
Philadelphia is passionate about doing just that. *
Stanley J. Savinese, DO, FAAHPM
HMDC is Chief Medical Director
of Hospice at VNA of Greater
Philadelphia and Co-Director,
Temple University Hospital
Palliative Care.

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Table of Contents for the Digital Edition of Philadelphia Medicine Summer 2018
