Palliative Care

The Last Days: Cash or Credit?

How often do you hear the following: the average senior utilizes  25% of their lifetime health spend during their last six months of life.  Too much. All that service use in such a concentrated period suggests possibilities. ICUs and inpatient care have great costs.  Our acute and post-acute institutions also do not hold up as models of efficient care delivery.  Most of them at least. What to do? I see the above observations as something akin to an emperor with no clothes. Because leaders with checkbooks have a focus on areas that will generate cost reductions, they seek opportunities they can wrap their arms around.  The more disadvantaged and disjointed ambulatory practices cause too many headaches.  Hospitals then seem like the right place.  Hospitalists and inpatient practitioners seem like the right people. The logic goes, with advanced directives and creative thinking, the right docs and facilities can make a dent…

Reflections on Palliative Care: Uncomfortable

By: Dr. Allison Schneider Throughout my Palliative Care rotation during this last year of medical school at UCSF, I began turning to writing as a way to both process and remember some of my patients and the intimate moments we shared. This is the second pair of poems I’ve written as a small way to pay tribute to them. (For the first installment in the series, click here.) Uncomfortable Where is your pain? Everywhere. Please give me something. I just want to sleep. It’s okay not to fight anymore. Thank you. But will he wake up? My kids are in school. They'll be here at five. Can you be here? Thank you. Thank you so much. Mr. L, metastatic nasopharyngeal carcinoma, age 49 45 Liters I led 1000 men into battle. Most of them didn't make it to 93. Isn't that right, Bruce? It's been a good life. So can I go…
Dr. Allison Schneider grew up in Washington, D.C., and received a BA in Public Policy and American Institutions from Brown University. She then worked for the Kaiser Family Foundation Commission on Medicaid and the Uninsured prior to entering medical school at the University of California, San Francisco. She graduated this month and will be starting her residency training in Obstetrics and Gynecology at Kaiser Oakland Medical Center in July.

Reflections on Palliative Care: Clinging to Life

by Dr. Allison Schneider
By Dr. Allison Schneider My first day on the Palliative Care service ended with me in a heap on my couch sobbing into my husband’s shoulder. That day I attended family meetings for two patients in their 40s dying of cancer and leaving young kids behind. I also sat at the bedside with the mother of a young man dying of AIDS. As a fourth year medical student, I had experienced hard days; that day was one of the hardest. Yet, it was also beautiful. The interdisciplinary palliative care team navigated each conversation with inspiring empathy and grace. They worked together seamlessly to support and honor the goals of each patient and their families. The team also made it a priority to support each other. Through frequent check-ins, debriefs and formal talks about self-care, the rotation created a truly safe space to express and work through the raw emotion that…
Dr. Allison Schneider grew up in Washington, D.C., and received a BA in Public Policy and American Institutions from Brown University. She then worked for the Kaiser Family Foundation Commission on Medicaid and the Uninsured prior to entering medical school at the University of California, San Francisco. She graduated this month and will be starting her residency training in Obstetrics and Gynecology at Kaiser Oakland Medical Center in July.

Finding Hope When There Is None

Young and in pain, she came to us from another country for a repair of a fracture. It wasn’t repaired at home because of the complexity of the fracture. There was some question that it may be a pathologic fracture due to a cancer, but nothing definitive. There were two biopsies in-country. One that was equivocal, one that said it was “consistent with” cancer. Our charge was to fix her fracture and diagnose her cancer. I was to medically optimize her for surgery. She did not believe the doctors in her home country who told her she had cancer. From our first meeting it was apparent she probably wasn’t a surgical candidate. Her thin frame had already shed nearly half of her weight, causing her skin to be stretched thin over her bones. The albumin level in the blood (a marker of nutrition) was half of what it should be,…

Balancing Act

My father died of Mantle cell lymphoma 12 years ago. He was only 60 when he succumbed, and despite being involved in the business and brouha of medicine literally since high school, I was so unprepared for his illness. It started when he came to visit me from his home in St. Louis.  He had a cold you see, and his cough after the cold was nagging and persistent.  I brought him over to my office and listened to him, looked in his ears, and gave him a course of antibiotics. A few weeks later he told me he thought his spleen was swollen and that he felt "full" after he ate. I told him to head to a doctor right away. He did, but was told he had "stress". The following weekend I came to St. Louis, made him stretch out on the sofa. Yep. Giant spleen. This was…