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[music]
Hello, I'm Rich Peterson. As a health care community, we strive always to deliver excellent
care, centered on our patients and their families. One of the most powerful ways to do so is
clarifying the wishes of patients, as they prepare for the end of life, and then respecting
their choices. The video presentation which follows will introduce you to some of the
concepts and tools used to support patients through this important phase of life. Dr.
Jim Wasserman is a nephrologist, who has practiced in Maine over 20 years. Excellent care at
the end of life has become central to his practice.
I was first attracted to nephrology, not really for patient care, or advanced care planning,
but I was really a math and science kid. Initially, I liked to apply all the science I knew, and
all the math I knew, to helping to get patients better. But I then came to realize that I
didn't think it was about the math anymore, it wasn't about the science, but it was more
about developing important relationships with the patients, particularly the patients that
I was serving. The patients that I'm serving are people who have chronic illness. And I
subsequently went on a course where I did different efforts and different methods to
have people try to live well with chronic illness. Whether that be exercise, eating
right, alternative to practices such as meditation. With the idea being to have people be as independent
as they could because I tend to define health as being independent. But one area of the
practice or one area of my practice that I neglected was empowering people to be independent
all the way through their life and I mean to the very end.
[music]
There's a program where it was made known to the population, the population participated
in it, and then when the advanced care planning was needed, it was accessible as the caregivers
under emergent and non-emergent situations, and they've gone on to publish all their data
showing how this is not only a great benefit to people's lives there, but it's also a great
benefit to the health care systems in many different ways. After speaking to people,
I said, well why can't we do this here? So with the help of the Ethics Committee, with
Kitty Garland, we started to do some projects with this. Specifically for me, I started
to do it in the dialysis clinic where I work. So that when people come to the dialysis clinic,
one of the first things that we do is we have a sit down with them. We find out if they've
done advanced care planning, if they even know what advanced care planning is, and if
not to begin an education process and begin the process of advanced care planning there.
Since that time two or three years ago, about 80 percent of the people in the dialysis clinic
where I work, now have had discussions about advanced care planning. With these discussions,
it has gotten back to where people are independent, and empowered, not only on the part of their
life where they're more well, or doing well, but also the part of their life where they're
becoming sick and might not be able to speak for themselves. Its been a great thing, not
only for patients, but patients families because it not only empowers patients, but it lets
patients and families sit down together, and say to each other what they want, and what's
meaningful in their life and how they can best achieve this meaning, not only when they're
well, but also when they get sick. It's been an important bonding process for patients
and families, and also for patients, families, and myself. It's really added to my practice
as a physician, and I think what I'm able to offer people as they move through chronic
kidney disease and into dialysis, into places where they're not well any longer.
[Music]
My mother was just a great person. She loved life, and she loved her family. She loved
Elvis, and most importantly, her grandchildren and her children.
I got to know Ms. Newman and her family very well as her family always came on her visits
too. At one point, Ms. Newman didn't have enough kidney function to allow her to be
who she was or to do the things that were meaningful for her. And although she told
me she would never, ever, ever get renal replacement therapy, the point came where after many discussions
she came to the realization that she still had a lot of things that she wanted to live
for.
During the four years that she was on dialysis, she would have bouts of energy, she would
take trips, she got to enjoy grandchildren, two additional grandchildren that were born
during that time, a lot of time with her family, with all of her children and her grandchildren,
but once she had that decline from the heart surgery everything else started shutting down.
We saw the deterioration. We saw that things weren't working. We saw her trying to go to
dialysis every day and still not having the results that she needed.
At one point she finally said, this isn't worth it to me anymore. It wasn't a shock
to myself, or her daughter, or the rest of her family because this was something we had
talked about for a long time. Is this meaningful for you? Does this allow you to do what you
want? Does this allow you to be Mrs. Newman? And at one point I just think she didn't feel
like she was Mrs. Newman anymore. Or what use to matter to her so much just didn't matter
to her anymore. So we then had conversations, again, another sit down with the social workers
and myself, nurses, for quite a period of time, and saying, what can we do? What do
you want out of the health care system? And what can we do to make you well, or as well
as you can be? And she said, well I'm just ready to stop. There's nothing you can do
to help me anymore. I'm tired and I'm ready to stop now.
Of course its like, a little bit of getting kicked in the gut when you hear something
that you know to be true and factual, but now it's right there and you can't ignore
it anymore. So, it was hard, and I took a deep breath, but I knew it. It wasn't a surprise.
It was not a surprise. Once her decision was acknowledged, and you know, we knew where
it was going anyway, everything was just so love filled. And it was just the most beautiful,
compassionate experience. We played a lot of scrabble, and it was very interesting that
her mind worked right up until the end because she taught me how to play scrabble, and I'm
very hard to beat. We got the most out of the last few days or few weeks with my mother
and I think she got the most too. She had an amazing support system from everyone. From
her clinic, who were so kind, so caring, and so wonderful. And she use to joke around that
her primary doctor there, she's like "he treats me like I'm his mother!" Who can sit here,
who truly loved a parent so much, and sit with a giant smile and talk about their death?
I never thought id be able to. It was just, again, I can never from the bottom of my heart
thank the care team that made that happen.