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Ever Wonder What Metastatic Pancreatic Cancer Means?

F. Amos Bailey, MD | July 28, 2020

WA recent study in JAMA Oncology demonstrates once again “If you want people to understand their cancer is serious and that what you are giving them is “palliative chemotherapy” you are going to have to talk with them. A recent study in JAMA Oncology demonstrates once again “If you want people to understand their cancer is serious and that what you are giving them is “palliative chemotherapy” you are going to have to talk with them. I get it. I did a Medical Oncology Fellowship in the 1980’s and worked as a Medical Oncologist for another 12 years before transitioning into Palliative Care full-time.

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Because You Still Listen

F. Amos Bailey, MD | July 21, 2020

Often, Palliative Care, just doesn’t seem that complicated; but exhausting. Frequently, patients and family say something like “We really need to talk about this. We didn’t want to talk about it but now we know what we are facing.” We have spent an hour, our little IDT group, talking because as Adrienne Rich says, “It’s necessary.”

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We are thrilled to announce that the new HPM Fellowship developed by Dr. Amos Bailey was announced on the CAPC website!

By F. Amos Bailey, MD | July 14, 2020

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Meaning and Doing

F. Amos Bailey, MD | July 7, 2020

What is important, and what gives meaning to life? Often families are most distressed that their loved one will not eat! It would be fine if the loved one could not get out of bed, but he/she must clean their plate. Healthcare providers must ask and record the pain score every shift, at least! Or get their knuckles wrapped and bad evaluations. What about the person who is the focus of these concerns? What is important to them? Moving around and being active

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Essential Workers

F. Amos Bailey, MD | June 30, 2020

What is an essential worker? Yesterday, I went to my first post-COVID dental appointment. The dental hygienist was wearing the equivalent of a HazMat suit. She struggled to do her job, which required finesse through all these different layers.

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Moral Determinants of Health

F. Amos Bailey, MD | June 23, 2020

When I saw this article and title I was intrigued. This could be very political, and this is in JAMA? Well, it is political, but isn’t everything? Don Berwick is the author; I met him over 20 years ago. He started the organization Institute for Healthcare Improvement (IHI). He popularized Continuous Quality Improvement and the omnipresent PDSA (Plan Do Study Act) programs. He has been sounding the alarm on the plague of iatrogenic harm and death patients experience from the health system, which is now estimated to be several 100,000 deaths a year. Now he is turning his attention to not just what we do within the healthcare system but what we are and are not doing out in our community.

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Life Might Not Be Fair but We Can Be Fairer

F. Amos Bailey, MD | June 9, 2020

COVID is not fair to anyone but is less fair to many in our society who have the least resources to cope. Those who get really sick and die are more likely to be poor, to live in communities with fewer resources, have less access to health care, and other supports that make up the Social Determinants of Health and are people of color.

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Denial (D’ Nile) Is More than a River

F. Amos Bailey, MD | June 2, 2020

I think I learned this joke from the famous Dolly Parton, and it works better in my Southern accent. At least once a week I would hear someone say this in relationship to a patient or family member who seemed to have unrealistic expectations.

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Congratulations, Dr. Regina Fink!

Nancy Robertson, MSN, ANP-BC | May 26, 2020

At the University of Colorado’s Graduate School 2020 graduation, Dean Engelke announced the exciting news that Dr. Regina Fink has been bestowed the Outstanding Dean’s Master’s Mentoring Award for 2020. Nominated by multiple students, Dr. Fink was described as “generous with her time” and “listens to students as individuals”.

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Unintended Consequences

Amos Bailey, MD | May 19, 2020

Recently, while on a clinical service for the Inpatient Palliative Care Consult Service we remarked on all the patients we were seeing who had COVID-19 but what about those folks we usually consulted on? Those being considered for a destination LVAD, or living with metastatic and progressive cancer, being considered for, or recovering from a Bone Marrow Transplant…where are these people? Many are at home, impatiently waiting for things to get back to normal. They will not have the time, the months and maybe years that it will take to get back to normal; there will be no normal without COVID-19.

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COVID-19 and going to LTAC

Amos Bailey, MD | May 12, 2020

“Well, if I am able to eat chocolate ice cream and watch football on TV, then I’m willing to stay alive. I am willing to go through a lot of pain if I have a shot at that.” Jack Block PHD father of Susan Block MD regarding his goals of care as retold in Being Mortal by Atul Gawande.

I remember this passage in Atul Gawande’s book as Susan Block tells her story of being her father’s surrogate and realizing she had not asked him what she needed to know; his values and what was a successful outcome for a high risk procedure.

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Getting Back to “Normal”: Privilege in the Time of COVID-19

Melissa C Palmer, LCSW, ACHP-SW, APHSW-C, JD | May 5, 2020

I have heard many times how those around me are looking forward to getting back to “normal”. When I have asked people to clarify, “normal” means being able to go out without worrying about being careful, not having to wear protective equipment, taking a bike ride at a moment’s notice, or heading out for Saturday evening dinner and movie. For others it is travel to Hawaii for spring break.

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Rip Van Winkle: My COVID-19 Surprise

Amos Bailey, MD | April 28, 2020

I was alarmed in late January and February as I started to see the news from China. A great city on lock down and then a country with a medical system that was overrun. Could this happen here? I was concerned. I had learned about the Spanish Flu of 1918-1920. This was a once in a century catastrophe and it had been a century.

I took the unusual step of alerting my family of my concerns. Never, a “prepper” I shared my concern that we needed to be ready for a month in quarantine, take steps to protect Granny, who would be considered at high risk. Palliative Care has taught me to “hope for the best; prepare for the worse”. I even developed a plan to move into the pop-up travel trailer, in our backyard when I started to go to work at the hospital so as not to bring the virus in with me.

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A Peaceful Death? Is it possible in the time of COVID 19?

Nancy English PhD, APRN, CS, CHPN | April 21, 2020

I keep remembering the words of Cicely Saunders spoken to her young patient as he lay dying. “You matter because you are”. This became the mantra of Palliative Care and began a world movement and a new paradigm in caring for the dying. Death is regarded as a sacred rite of passage. To care for a dying patient became a privilege and honor.

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Can We Talk? Yes, We Can!

Amos Bailey, MD| April 14, 2020

There is a push to have more discussions with more people about their values and goals. Particularly, as it relates to the use of Life-Sustaining-Treatments in the time of COVID-19. We will run out of hospital resources. We may run short of ventilators. And due to the nature of the illness if you get intubated you are likely to need MV support for not days but 2-3 weeks to give time for the lungs to heal and to be weaned off to oxygen. Then the long road to recovery begins.

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Loss in a Time of COVID

Kelly Arora, PhD & Kate Jankousky | April 7, 2020

During this pandemic experience, we’re all adapting to new rules and restrictions. These changes often mean the loss of meaningful everyday activities. A few weeks ago, we could hug a friend, browse books at the public library, shop at the mall, or enjoy a sit-down meal in a restaurant. It’s easy to brush off our feelings about losses that seem trivial when compared to the loss of life some people are facing with COVID-19. But our grief about losses of any type is real and needs to be acknowledged.

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New Things to Consider as Risk Factors for Complicated Grief

Amos Bailey, MD | March 31, 2020

Dr. Deborah Birx said she remembered the guilt borne by her grandmother who caught the Spanish Flu at school and brought it home. Her grandmother’s Mom fell sick and died.

"My grandmother never forgot that she was the child who innocently brought that flu home from school and passed it to her mother," Birx said. "My grandmother lived with that for 88 years ... this is not a theoretical. This is a reality."

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Die At Home?

Nancy Robertson, NP | March 24, 2020

Reading Nathan Gray’s recent opinion piece Op-Ed: Think you want to die at home? You might want to think twice about that hit a nerve. In this piece, Mr. Gray highlights the very real distress of caregivers as they attempt to care for their ill and dying loved ones. This is not new information. Though care of the dying has improved significantly since Congress passed the Medicare hospice benefit in 1982, the infrastructure of home services continue to hold chasms of gaps in support. Caregivers continue to struggle under the enormous burden of attempting to care for their dying loved ones without any financial, social, psychological and physical support. Read more...



COVID 19 Tsunami

Nancy Robertson, NP | March 17, 2020

I heard her through the phone. A distance linked only by a cellular connection. But I felt her deep-ly in my being. “My daughter is coming home from college”, she whispered. “They closed her University. She has a fever and a cough. What I am I going to do?”. Her lung cancer was progressing. Her immunotherapy wasn’t working. And now she was facing another more serious threat. What if her daughter had COVID 19?

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Message from the MSPC Director

Amos Bailey, MD | March 16, 2020

We are now working and living through the most serious public health crisis of our lifetime and careers. This is and will be physically, emotionally, spiritually, and ethically challenging. You know that sounds like what Palliative Care is all about. We have committed ourselves to caring for the whole person and family, to transform our healthcare systems and to transform ourselves though study and reflection. Read more...




Intensive Caring Unit

Amos Bailey, MD | March 10, 2020

What a quandary! Family members in a recent study rated the quality of end-of-life care in ICU as higher than other parts of the hospital for their family members who has recently died. In our palliative care work we are struggling to help people who are at EOL to avoid or to get out of the ICU.

Are there some things about the ICU which may improve family members ratings? I can think of a few.

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Why???

Kelly Arora, PhD | March 3, 2020

Diagnosis with an incurable health condition often prompts people to ask Why is this happening to me? During the early phase of tests and diagnoses, we often rely on understandings of illness inherited from the familial, social and cultural contexts of our childhood and youth. Over time, we’re better able to make sense of illness using core values, beliefs and meanings we’ve chosen as adults.

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Standing in the Door

Amos Bailey, MD | February 25, 2020

Zeke Emanuel, recently wrote in The Atlantic about the care of his 92-year-old Father. His dad, a physician, fell in his home and was taking to the ED. A CT Scan, while still in the ED, revealed a primary brain tumor and started a cascade of medical care that he describes having to fend off. On a Sunday morning, after his Dad was admitted on Saturday night, they meet with a neurosurgeon and neuro-oncologist.

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A Shift

Erin Drake | February 18, 2020

Working on the inpatient palliative care service, I heard people repeatedly reference “a shift” that had occurred — whether it was during a one-on-one conversation with a patient, a family meeting, or while discussing a patient’s care with her primary provider. I didn’t expect how powerful these shifts could be until I started witnessing them firsthand. I especially didn’t expect to see a shift within myself.

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Hope Springs Eternal

Amos Bailey, MD | February 11, 2020

Mr. B is excited to go home today. This past month has been difficult for him. He was admitted to the hospital with pneumonia that turned into sepsis. Later it became clear that the infection resulted from a newly diagnosed lung cancer that had blocked his airways. Initially on a mechanical ventilator, he could not talk, and then when delirium set in he was very confused.

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The Price We Pay

Amos Bailey, MD | February 4, 2020

When you tell people you work in hospice and palliative care, common responses are perhaps admiration and condolences. Often people say in their expression if not in their words, “I could never do that!”. In reading Rebecca Synder’s recent essay This Quiet Lady in JAMA, I was reminded of “painful” lessons we learn. Dr. Synder recounts her experience of training as a surgical oncologist when her mother is diagnosed with metastatic lung cancer. This cancer is not amenable to surgery and treatment with both the new and old types of cancer treatments are not helpful but also have disabling side-effects.”

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Caught in the storm

Kelly Arora, PhD | January 28, 2020

I survived two powerful tornadoes in my lifetime. When I was a kid, a violent tornado devastated my hometown in Kansas. Ironically, our family lived in “tornado alley” without a basement or storm cellar. On that fateful night in 1973, our family ran out into the spiralling wind and pelting rain toward hoped-for safety in our neighbors’ basement across the street. My palms still sweat when I recall banging my fists frantically on their front door to wake them.

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"I Wonder as I Wander Out Under the Sky"

Amos Bailey, MD | January 21, 2020

“I wonder as I wander…..” This fragment of an Appalachian folk song would become a Christmas carol. I heard this song again this year and it reminded me of an important lesson a hospital chaplain once taught me. “What do you say when people say they wonder why all this has happened?” he asked me. I stumbled but had no answer. He continued, “They seem to be wandering in a wilderness. They may seem lost and they wonder why. You need to be out there with them, wandering too and naturally you will wonder. At least they’re not alone.”

He then sang this song “I wonder as I wander out under the sky.”

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At times I just pray...

Amos Bailey, MD | January 14, 2020

How exhausting it must be; to know that others that love you and that you love worry about you as the serious illness progresses! There is nothing you can do. You have no agency except… perhaps to die. This is the sentiment that I hear, “At times I just pray, if I die they will at least stop worrying about me.”Read more...


Dying at Home

Jean Abbott, MD | January 7, 2020

“If time were short, where would you want to be?” This is a question that we often are taught to ask patients as we try to put the “person” back into end of life plans. And I know in our own minds we think we know the answer. Getting people home to die in the place most familiar to them is often one of our priorities in end-of-life care. I learned the lesson of needing to broaden my perspective from one family early in my career. It was many years ago, in those days when my answers were clearer and I knew a lot more than I do these days. My education came one weekday morning in an ED in Maine. Read more...


Happy New Year from the MSPC team!

December 31, 2019

From all the MSPC team, thank you for including us in your lives this past year. We look forward to an exciting year ahead. We are taking a short respite so please enjoy this post from the archives of the MSPC blog. Read more...

Happy Holidays from the MSPC team!

December 24, 2019

Our MSPC team is taking deep breaths, working on resilience and leaning into the season to refresh. We are so grateful to you for inviting us into your lives each week. We look forward to re-engaging in the new year. We wish you all a peaceful, joyous season. Read more...

Burial

December 10, 2019

Mr. K had been sick for a long time. Although he had dementia and thought Nixon was president, he did remember that he has had Multiple Myeloma for 14 years. That is a long time for a disease where the average life expectancy is 3-4 years. Few people live more than 5 years. Read more...

Hospice Early-Early Hospice

December 3, 2019

The Safe Harbor Palliative Care Unit at the Birmingham VAMC had been open for a few years when Carol was admitted. Donna, “We just got a call from the Medical Oncology Clinic. They say that they want to admit someone straight to Safe Harbor?” The Palliative Medicine Fellow was dispatched to check this out while we made ready for an admission. Read more...

Number to the Pain

November 26, 2019

I clicked on the link. A photo of a man, clearly chronically ill, but in a safe and clean environment. Chuck is the feature of the article. He had been homeless or incarcerated most of his adult life. Now with a terminal illness, he has hospice care in supportive housing. Read more...

Cancer Narratives

November 19, 2019

MD Anderson Cancer Center has changed its branding to scratch the word Cancer out of their name. I don’t begrudge them. They have done amazing work as have many others with developing treatments for cancers that once routinely killed. However, Cancer still Sucks and will lurk in almost all of our lives as either someone living with cancer or a family or friend with the disease. Read more...

You Did Not Teach Me What You Thought You Did

November 12, 2019

Carlson’s recent essay in JAMA, “You Did Not Teach Me What You Thought You Did”, reminded me of all the times my words and actions had unintended consequences. I had been seeing Tricia for about a year. She had been referred to me for ITP, Immune Thrombocytopenia, (a low platelet count) back in the mid-1990’s. In the history I elicited that she was sexually active and had unprotected sex with several partners over the last few years. Her platelets were low but not dangerously so. I recommended no immediate treatment but rather that we should do some workup. That included an HIV test. Read more...

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