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A Palliative Care Doctor Reflects On The Role Of Medicine In The 'Eleventh Hour'

March 5, 2019 1:28 p.m.

GUEST: Dr. Sunita Puri, author, "That Good Night: Life and Medicine in the Eleventh Hour"

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You're listening to K PBS mid-day edition. I'm JD Hindman and I'm Maureen Cavanaugh. In the famous Dylan Thomas poem Do Not Go Gentle Into That Good Night the poet urges his father to rage rage against the dying of the light and in many ways that's how the American medical establishment views the end of life. A vast amount of our medical resources are spent in the final months and weeks of life and when the inevitable occurs we often say the deceased lost his battle with a disease but a new model for approaching chronic illness and death is emerging.

And it's outlined in a memoir by Dr. Sunitha Puri medical director of palliative medicine at the Keck hospital and Norris Cancer Center at the University of Southern California. Her book just released today is called That Good Night Life and medicine in the 11th hour and she joins us by Skype. Dr. Puri welcome to the program.

Thank you so much for having me Maureen.

Now you grew up in a household you tell us in the book where your parents were not afraid to talk about death and the impermanence of life. But you write that you felt pulled into this fight against death mentality as a medical student. How did that happen.

That's a great question and you're absolutely right that I grew up with very deeply spiritual parents who were also scientists. My mother is an anesthesiologist and my father's an engineer and they were able to to have science and spirituality sit side by side. So my mother as an anesthesiologist very much focuses on life saving interventions and on seeing patients through surgery but she would also pray with her patients. And I grew up with that model that you can both do everything within the technological possibilities of medicine but you can also have a really healthy respect for the sacred limits of nature.

And when I went into medical school you know we're very socialized as doctors to Rage Against the dying of the light right that we are mobilized to think that survival of our patients is what we're aiming for without necessarily attention to their quality of life. And once I was socialized that way I very much focused on doing just that which was really using all the technological tools and scientific knowledge to make sure I kept my patients alive. But at a certain point I couldn't reconcile what I was doing with what I had been brought up to believe and what I'd seen my mother do so nicely which was battle for her patients lives but also really deeply understand that at a certain point allowing for that sacred passage of death doesn't mean giving up.

It means respecting the limits of nature. And I lost my way in my training until I did my palliative care rotation where I found that and took both sides of myself where I came from and what I was being trained to do could really coexist beautifully.

You work in palliative medical care which many people associate with hospice. How are the two different.

That is the question I have to answer almost every day not just with my patients and their families but even with my colleagues in medicine and nursing. So palliative care medicine is a newer subspecialty that focuses on tending to the physical emotional and spiritual aspects of suffering that come with living with an advanced or terminal disease. And you can get palliative care services right alongside for example chemotherapy or dialysis or other interventions intended to prolong your life and you can get palliative care at any age and at any stage of a diagnosis. I think of hospice as a type of palliative care that attends to them very different ways that we suffer physically emotionally and spiritually.

But it's really for patients who are in the last six months of their life and generally at that point we have stopped interventions like chemotherapy or dialysis in favor of letting quality of life over quantity of life kind of be our main focus. So that's really the distinction.

Dr. Perri within the medical profession do you find that there is resistance against the idea of treating as you say the symptoms of chronic and terminal illness and not just trying to cure the disease.

I think that there is resistance to palliative care because many people assume that taking a palliative approach means quote unquote giving up or giving in to the disease and palliative care is the furthest thing from giving up. In fact it is an approach that allows people to live the best lives they can with the best quality as they're getting treatment for a disease.

Can you tell us how one of your patients changed from fighting to living with the disease.

Absolutely. So I very recently had a patient actually in the last few weeks who's a lady who has a form of leukemia. And she had been through multiple different forms of treatments and I think one of the highlights of my job is to help people process what they're going through and verbalize their suffering and verbalize what they really want for themselves in the time that they have left. And she very bravely said to me in front of her family you know I know one of the things that's keeping me alive is continuing to come in and get blood transfusions and treatments for my infections but I don't know that I want to do that with those precious short amount of time that I know at a gut level that I have left.

And her family had a very hard time hearing this. And my role was really to help her understand the many things we could do for her instead of doing the transfusions and the antibiotics and the trips to the hospital and the ways that we could help her dying and living. She still had left to do comfortable and dignified and meaningful. And so she's a very recent example of somebody who really did some soul searching about what was most important to her and faced the end of her life with quite a lot of bravery and insight.

Do you like your mother ever pray with your patients.

I do yes. I asking about their spiritual or religious inclinations is a part of my conversations with patients because I really want to understand how do they what language and tools do they have to make sense of their lives and to find solace. And many of my patients find solace in spirituality and faith and I have been asked by my patients to pray with them or to pray with their families. I've had families ask me to pray for their loved ones and since I have a spiritual practice it's very natural for me to say to them of course I'll include them in my prayer.

And sometimes we're not of the same faith but I believe that every faith is a different pathway to the same place. So even though I may not share their formal faith tradition I think we're all praying to the same thing and then we're all hoping that something beyond something beyond medicine can help to ease suffering if not to cure I've been speaking with Dr. Sunita Puri.

She will be speaking about her book that good night life and medicine in the 11th hour. That's tomorrow evening at war weeks in LA HOYA. Dr. Perry thank you so much.

Thank you so much for having me.