When living with a serious or life-limiting illness, having the support to cope with the associated challenges can make all the difference. Empath Health’s Palliative Care services meets patients and families wherever they are to provide comfort care that reaches their goals.
This Doctor’s Day, palliative care physician Daniel Thorngren, M.D., often known to patients and colleagues simply as Dr. Dan, discusses what palliative care means and how connecting to patients and families on a deeper level ensures the best care possible.
What led you to becoming a palliative care physician at Empath Health?
I completed medical school in Chicago and from there I found a residency working with adults and kids in a hospital setting. As a part of that I spent a lot time in intensive care units and found situations where the medical team was coming up with plans that weren’t necessarily going to reach the goals of the family. This led to an interest in patient communication and ultimately a fellowship in palliative care, which I completed before joining Empath Health last September.
Palliative care is often a concept that people may not fully understand. How would you describe it?
People often assume hospice care and palliative care are the same thing. Hospice is a plan of care that is appropriate for patients with a life expectancy of six months or less. Palliative care is for any patient with a serious or life-limiting medical condition regardless of their prognosis. For example, someone who is diagnosed with cancer and has a lot of pain related to a tumor is a great person to have palliative care involved because we can manage pain and have discussions about advance directives. They might go on to have chemotherapy and surgery and eventually be cured. Pain and symptom management and communication about advance care planning are at the core of palliative care.
How do you help people find comfort in the face of a life-limiting illness?
These conditions can flip a life upside down. Our team is very actively involved in managing the physical distress such as pain, nausea, and trouble sleeping, as well as the emotional distress that comes with people facing their own mortality or realizing the plans they made for the future may not happen.
The team is made of several disciplines: a palliative care physician, nurses, a spiritual care coordinator and a social worker. We all work together to identify the most important issues for each patient and family. When there is distress, worry or feelings of emotional devastation we develop plans to help the patient and the family cope.
How do you approach difficult conversations, such as care planning, with patients and families?
This is probably the most challenging thing we do. When you start asking questions about advance directives and planning for future care people get uncomfortable, especially when they may already be thinking they aren’t going to live as long as they want. Some people will embrace the discussion, others will be sad and some get angry.
We try to have these conversations in a way that normalizes it – it’s not just about the illness, it’s about having a plan just in case you can’t make your own decision about care. I compare it to putting on a seatbelt or having a fire extinguisher in the kitchen. You want it available even if you may never need it.
These conversations are also about giving people the opportunity to be in the driver’s seat. When you have a serious illness, often someone is telling you what to do as far as medications, appointments and procedures and there is not a lot of opportunity to personally direct what is going on. Advance care planning is the chance to discuss preferences for care so your choices will be honored when the time comes.
What is it like working with a team and how do you support each other?
Once a week our whole team, including the program director, meets to review a subset of patients including any new admissions from the past week. Every patient gets reviewed every 60 days. We touch on what the updates are, medication management, review what we have learned about how they are coping emotionally and discovering other opportunities for how we can help support that patient and family.
We also have dedicated time where the spiritual care coordinator leads a discussion for staff. It’s a time to share about what is weighing on us, what has inspired us and the victories we had that week. Every meeting ends with time to reflect on people who have left the program, whether it was because they died, left to connect to hospice care or they recovered from their illness.
Can you share a story of a patient/family you helped?
This past Thanksgiving we had a patient with cancer who had a lot of pain. She complained that the pain medication was making her very drowsy and she wasn’t able to spend time with her family like she wanted. So, we changed her to a different pain medication. I called to check in on Thanksgiving and she was so grateful that she felt sharp and clear and was able to be present with her family.
How has your work changed your life?
It’s a privilege to accompany people and their families during this time in their lives and often make their experience better.
Regularly I have moments of gratitude after doing routine things, like climbing the stairs or eating a good meal, where I appreciate it a little extra because of people I know who can’t enjoy these same things.
I also have a special ritual where I pick up behaviors from my patients and I take them with me. Usually these are things I don’t ordinarily do that they casually mention really enjoying. For example, eating black olives on pizza. I generally wouldn’t order black olives on a pizza but if I see a slice with olives I’ll eat it as a tribute to a particular person. Same for drinking a rum and coke or a collection of other things I’ve picked up over the years.
What else would you like people to know?
The time to think about advance care planning is today. These are conversations we should be having all the time. You can change these plans as you get older and your health changes. It’s really important to have these plans in place before something happens and you can no longer make decisions for yourself.
Learn more about how Empath Health Palliative Care services can provide comfort and care to you or a loved one with a life-limiting illness.