Las Vegas May 2024: Part 2

 

The main purpose of this trip to Vegas was the conference. The topic: End of Life Care!!

A rather sobering topic. And to think of this topic being discussed in the heart of Las Vegas seems quite discordant! In fact the conference room on the second floor sat right above the casino !! Yet, the organizers were not there to fool us. They had very thoughtfully carved out the agenda and the line up of speakers, some of the best in the field from within the country and beyond. 

I had attended this conference for the first time last year in January. That same year in March I attended the Annual Assembly of Hospice and Palliative Medicine in Montreal. It was then that it impressed on my mind how special this entire community was. There were doctors, nurses, social workers, doulas, volunteers, educators and many more professionals who had chosen this path to care for people in their last phases of life. This year again I was reminded of the special character of this community that sets them apart from most of the other health care systems. In general medical care is about caring for people in their sickness. But the dying need something more than ordinary care. They need a person with more than simple will to do good. They need emotional investment of a different degree. They need people who have a lot of patience combined with compassion. They need people with an extraordinary capacity to listen. 

Having attended these conferences a few times now I am beginning to get a better idea of the skills needed to provide care for the dying and for their families. I am not sure I have even a fraction of those skills. The pace of medicine in the field where I spent my career( internal medicine/ primary care) is quite in contrast with hospice and palliative care. There is compassion in the heart for every patient we see in primary care yet we do not have the privilege to spend much time with each patient during the day. We try to deliver the best possible care in the short time at hand. And as a result of many years trying to keep up with this pace the brain entirely lacks the ability to spend longer time with a single patient. 

Hospice and palliative care requires much more skills besides the capacity to spend more time with the patient and family. It calls for much more human interaction at every step. Just being exposed to professionals in this field of medicine can gradually make anyone a better human being with more sensitivity to the needs of others and more understanding of finer things that matter at the end of life’s journey. To listen to the discussions on the subject opens the mind to ponder upon end of life itself. 

There were many such points that struck the cord for me during this week’s conference. I am making an attempt here to summarize some of these.

The keynote speaker Dr Stephen Forman, a hematologist from City of Hope in Duarte, California shared “ Reflections on Trust”. Amongst the many wise lessons from his career he shared one of them was “ power balance needs to be leveled”. Subtle things like wearing a white coat or stethoscope or even standing and talking to a patient can be a barrier for human to human communication and building trust. He spoke about how our role is to be of help to our patients yet at the end of the day our patients enrich our lives with their experiences and stories. 

Dr Forman touched upon another subject that is on the horizon. Artificial intelligence or AI. There are reports of recreating the voice or videos of dead people with the help of AI. It opens an entirely new set of questions before us. Is this going to prolong or eliminate the normal process of grief ? Is it going to sow seeds of delusion? Or is it going to be a positive experience?

There was a panel of experts who spoke about Medical Aid in Dying( MAID) which is gaining momentum in more and more states across the USA. One particular case history that was presented about a patient who accepted MAID gave me insight into how even death can be beautiful. Something that I had never thought about before. 

There was a presentation about Death Doulas. The speaker was a birth doula serving in midwifery earlier. The comment she made was how there is a certain mystery and anxiety surrounding both birth and death. We don’t know what to expect during both these important events in our family circle. Preparing for death for ordinary people is a concept that hadn’t been given much thought until more recent years. If someone is lucky to get a trained doula to coordinate the events surrounding imminent death that’s wonderful. But even without the help, it was an eye opener to think deeply about how to be better prepared for such life changing events. 

And then the grief itself. How to process and facilitate it, whether in your own life or help the patients with it. 

A lot of thought provoking issues that make you realize the need to be more human than we normally tend to be. Needless to say it was a very fulfilling experience to attend to these sessions for the last three days. The lessons will take time to percolate and sink deep into the psyche.

Featured saree in this post is my favorite silk ikat from Meera Mehta. Talking of being human, Meera is one of the finest humans I’ve met in my life.