How Intern Year Helped Me Take Palliative Care to Heart
Next Generation is a Brigham Clinical & Research News (CRN) column penned by students, residents, fellows and postdocs. If you are a Brigham trainee interested in contributing a column, email bwhclinicalandresearchnews@partners.org. This month’s column is written by Lindsey Ulin, MD, who just finished her residency in internal medicine.
Lindsey Ulin
Many clinicians vividly remember their first days of residency. Their excitement, juxtaposed with fear, the camaraderie with other co-interns, and the first orders they placed (mine was Miralax). My intern year began on our heart failure team, a busy service with sick and medically complex patients. Trying to stay afloat amidst a flurry of pages, orders to place, and families to update, a text about someone with heart failure stopped me in my tracks. Except it wasn’t about any of my patients. The text was from my mom saying, “Your grandpa is in the hospital again.”
Sixteen hundred miles away in Gonzalez, Louisiana, my grandpa was readmitted for the fourth time this year with a heart failure exacerbation. The hospital wasn’t a familiar setting for him or the rest of my family until now. As the first person in my family to work in health care, I alternated between answering questions from my patients, and over the phone from my family.
“They took an x-ray. Why does he have fluid in his lungs?”
“Why does this keep happening?”
“What do these lab results mean?”
“Will he have to bring the oxygen machine to Mass?”
“I’m worried about him coming home and this happening again. What if he gets worse?”
“I’m just so tired.”
“Where do we go from here?”
On-Call for My Family
I didn’t mind being the on-call physician for my family, but I wondered what conversations were or weren’t happening between my grandparents and his care team. Even over the phone, I could hear the uncertainty, exhaustion, and worry in my family’s voices. The shortness of breath was loud and clear as my grandpa told me he’d be back to fishing again by tomorrow. Growing up on a farm as one of 10 kids, my grandpa went from learning English as a second language to building a successful fencing company. Asking for help or appearing weak was unfamiliar territory for him.
I quickly learned the demands of this job could distract me from feelings of wishing I could do more to help my family. These feelings resurfaced during rounds one morning as I shared the same concerns a patient and his wife had that I also heard about from my grandparents. What I thought may be met with empathetic silence was instead my resident suggesting we consult the HeartPal team.
Learning from the HeartPal Team
Click the image to enlarge
As a Brigham trainee, I’m lucky to work with and learn from our HeartPal team. This innovative palliative care model improved the quality of life for many of my patients by helping them treat their symptoms, understand their illness, and partner in making treatment decisions that align with what’s most important to them. Although heart failure is one of the most common reasons why adults are hospitalized, embedded palliative care team models, like our HeartPal program, only exist at a handful of other institutions.
While I wish my grandpa could have had a HeartPal team, I suggested he see if his hospital had any palliative care clinicians to speak with. Like many people, my family initially dismissed the idea, mistakenly thinking it was hospice since they had never heard of palliative care. Over the phone, I helped address these misconceptions about palliative care which gave my family hope and direction for what to do next. Sitting on the floor of my apartment, I wrote a letter explaining what palliative care is and why I thought it could be a good idea for my grandparents to share with my aunts, uncles, cousins, and other extended family. Thankfully his team was able to consult palliative care, and their continued outpatient support positively impacted my family, as I’ve seen it do time and time again for my patients.
My family isn’t alone in not knowing what palliative care is. Palliative care unawareness and stigma are so widespread that sadly 60 percent of people who could benefit from this specialized care do not receive it. Palliative care’s benefits for heart failure are well-studied; the American College of Cardiology and American Heart Association’s Joint Committee even recommends that all patients with heart failure receive palliative care. A state-of-the-art review from JACC notes that palliative care for heart failure improved symptom control, quality of life, communication, and caregiver satisfaction as well as reduced caregiver anxiety.
I’m thankful to train at the Brigham where I’ve had exposure to innovative palliative care models like our HeartPal team. Seeing the difference palliative care made for my grandparents and working with our palliative care teams have inspired me to pursue the Havard Interprofessional Palliative Care Fellowship. My passion for medical journalism led me to enroll in Harvard Medical School’s Media and Medicine Certificate Program, where I’m currently using social media interviews to improve the public’s awareness and understanding of palliative care. I hope that one day, HeartPal programs will be widely accessible, and we will see palliative care fully integrated into the recommended standard of heart failure care.