Last week the Institute for Palliative Medicine, part of San Diego Hospice, marked its 20th anniversary. And one of its doctors was honored with a national award. Jeff Stoneberg was one of four physicians to receive the first ever Hastings Center Cunniff-Dixon Physician Award. He was recognized for bringing some fundamentals of hospice care, which provides aid to the dying, to a hospital that seeks to cure people.
When you meet him, there's nothing forbidding or even terribly impressive about Jeff Stoneberg. He's a calm, clean-shaven man, with blue eyes and a necktie, who speaks in a soft voice. That may be why he's been so successful treating people in the grip of great pain. He became interested in hospice care while he was a medical resident in a small, poor Pennsylvania town where he treated many very sick patients.
"When we are required to continue very aggressive care on someone who is dying in an intensive care unit it was not rewarding for me," he said. "And in fact I felt like I was prolonging their suffering. And so I asked myself there's got to be another way to treat these patients."
Stoneberg works for San Diego Hospice but he also runs the Palliative Care Consultation Service at Scripps Mercy Hospital. Palliative care is the medical specialty of keeping patients happy and comfortable physically, spiritually and psychologically. It's a fundamental part of treating dying patients.
Stoneberg says that in the hospital anybody with serious pain or difficult symptoms can be a patient of his. While other doctors look at the root of disease, Stoneberg deals with its expression. He says he tries to help patients make sense of what they're going through.
"They may have a cardiologist and a pulmonologist, and a kidney doctor and an infectious disease doctor and a surgeon. And it's very, very difficult to get a complete story when you have so many doctors focusing on so many different things. So I can come in and put all the pieces together," said Stoneberg.
Communicating with patients and families may be the most important part of his job.
"Many physicians don't have the time to sit down and have half an hour, an hour a two-hour conversation with a family throughout their day. And I'm able to do that," Stoneberg said.
Scripps Mercy has had a palliative care program for about six years. Bill Stanton is medical director of the Scripps Cancer Center. He said shortness of breath, nausea and constipation are just a few of the symptoms palliative care doctors are expert in dealing with. He said drugs treat physical pain and palliative care doctors must deal with that. But they also treat what Stanton calls existential pain.
"Sometimes people feel an enormous pain that's really not so much in the nerves but in the spirit," Stanton said. "And Jeffrey and his team have ways of mostly listening to patients. Listening turns out to be very therapeutic. And simply sitting at the bedside and letting the patient express their frustration, and making some practical suggestions as to how to deal with that frustration is enormously empowering to the patient."
Neurologist Kathy Foley, a New York physician, was one member of the panel that awarded Stoneberg his Hastings Center prize. She said about a third of hospitals now have palliative care teams. She said hospital care isn't just about saving people and curing them. It's dealing with symptoms.
"Cancer patients have seven or eight major symptoms that interfere with their quality of life when they have advanced disease. Patients with HIV-AIDS have up to twelve major symptoms that might interfere with their quality of life," said Foley.
She said very often, for better or worse, hospital beds are also death beds.
"The reality is in the United States the majority of people still die in hospitals. In my home state, about 60 percent of people die in hospitals," Foley said.
Most patients, the vast majority in fact, say if they had a choice they would die at home. But many people don't have family at home, so dying at home means dying alone, and one of the hallmarks of palliative care is not letting people suffer and die by themselves.
