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Michael E. DeBakey VA Medical Center - Houston, Texas

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Palliative Care, Not Just About Dying

January 9, 2008

HOUSTON - When the World War II Navy veteran died in May, his daughter felt at peace. That was largely because of the support of the Palliative Care Team at the Michael E. DeBakey VA Medical Center (MEDVAMC) during his last months of life, she says.

“The (Palliative Care) Team became part of the family,” the daughter said. “We looked forward to seeing them, not just for their care, but also for the conversation, the companionship. If I ever had a bad day and wanted to talk to someone, I could. And I did.”

Palliative or hospice care is not just about death. That is a misunderstanding many people have, says Joel Salazar, M.D., M.C.G., staff physician, Extended Care Line and Palliative Care Consult leader.

“Many people see palliative care as something negative because it can be associated with imminent death. But really, it is about celebrating life: the life the patient has left and how they can enjoy it to the fullest,” said Salazar.

The Palliative Care Team at the MEDVAMC provides outpatient services and five inpatient palliative care beds. The interdisciplinary staff consists of the Extended Care Line executive, two physicians, and a nurse practitioner with expertise in geriatrics and pain management, a social worker, a chaplain, a rehabilitation therapist, a nutritional dietitian, and the Extended Care Line nursing staff.

Consequently, the mission of the team is to improve quality of life for veterans near the end of their lives and to provide comfort, spiritual, and emotional support to them and their family members.

The services provided include medical care to relieve pain and suffering; spiritual care to enable patients to draw on their spiritual resources as they seek to understand the meaning of life and death; grief and bereavement counseling; comfort procedures such as paracentesis and thoracentesis; and recreation activities like bingo and domino groups, a hand-chime band, music therapy, art therapy, horticultural therapy, recreational therapy and physical therapy.

The Palliative Care Program at the MEDVAMC also includes a “Butterfly Wish,” an initiative developed by Nurse Practitioner Matthelon McNeil. This program provides financial support for a veteran’s special wish, as feasible. Examples of wishes come true include flying a loved-one from Dallas to spend the weekend and four days of 24-hour nursing home care so a veteran could spend some time watching TV on his favorite couch.

“We believe palliative care is important because we focus on quality of life to improve the veteran’s mental, emotional, and spiritual wellness,” said Beulah Hadrick, Extended Care Line executive. “Palliative care strives to prevent suffering, maintain comfort, and preserve dignity.”

Patient choice is fundamentally the most important belief of palliative care. Furthermore, it is important for each person to document his or her wishes in writing prior to serious illness or physical or mental disability. Otherwise, those wishes may not be known and cannot be honored.

Advance directives are written instructions in the form of a living will and/or durable power of attorney for health care which do not go into effect until the signer loses decision-making capacity.

The VA has advance directive forms that are honored in any VA setting.  For more information, talk to your health care provider or contact the Chaplain Section at (713) 794-7125.