Hospice, Palliative Care, and the Healing of a Life

With the recent holiday season, I’ve been taking a much-needed break from my research and writing work. To recharge my energy and ideas, I’ll be off from writing new pieces for this blog until January 14th. In the meantime, I thought I’d share this shorter piece on Gary Pasternak — medical director at Mission Hospice and Home Care, a local hospice organization — and his visit to a group of palliative care-minded medical students at Stanford. I wrote the original piece for Scope, the blog of Stanford Medicine.

Happy New Year!

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“I do know how to pay attention, how to fall down…
Which is what I have been doing all day.
Tell me, what else should I have done?”

– from Mary Oliver’s “The Summer Day”

The silence was poignant, and powerfully so. Gathered together in a small seminar room, medical students and seasoned physicians alike were processing the intimacies of a dying patient. He was a man in his mid-sixties, laying stalwart in his bed, projected into the room on a video screen. “I have no fear,” he said simply, with eyes resolute.

The man had been, at the time of the video’s recording, suffering from terminal metastatic bladder cancer. He was a longtime quadriplegic who in the midst of hospice care. He would eventually pass away, in peaceful and meaningful comfort, before anyone in that room would hear his name. Save for Dr. Gary Pasternak, of course, who would bring him to life again and again.

Throughout the Spring quarter, a group of first-year medical students – Paul Horak, Henry Bair, and Kevin Sun – has been enriching end-of-life education at Stanford through a student-run seminar course, Being Mortal, where seasoned physicians lead discussion on end-of-life care. On the evening of Tuesday, May 1, that same group hosted Dr. Pasternak – an experienced palliative care physician and medical director for the local Mission Hospice and Home Care – to speak about medicine and the end of life. For ninety minutes, Pasternak framed illness, fragility, and mortality within the living, breathing human experience. “It’s not really about death,” the hospice doctor said of dying, “it’s about life.”

Intentionally broad and inviting, Pasternak’s session was an exploration of sorts. Throughout the night, the doctor meandered through medicine, meaning, and the mundane practicalities in end-of-life care. “ care has to do with narrative,” he noted sincerely, explaining the inherent humanism of his specialty, “and with story, with the nuts and bolts of a life.”

To be a hospice or palliative care physician, he implied, is to be a steward of stories. It is to understand the fears and desires of other human beings, guiding narratives to their comforting conclusions. “Stepping into that role,” Pasternak remarked, “takes perspective and heart.” When mortality is no longer an abstract concept, healing becomes a creative act, a reimagining of life amidst the reality of suffering. In Pasternak’s profession, that deeper healing first involves hearing.

Indeed, so many of Pasternak’s insights hinged on a simple idea: patients, especially at the end of life, want to be heard. That idea leapt into reality, as a roomful of medical students hung on each word of a dying and paralyzed man: “I’m speaking to you as a person experiencing comfort,” the patient said towards the end of the video, which was recorded to empower patients suffering through similar trials, “not great pain.” As those words passed posthumously through the room, they seemed to trace a life’s narrative to its peaceful conclusion.

Yet for all the talk of stories, the night was truly made lucid by one simple poem. As the evening finally dissolved into the world outside, Dr. Pasternak finished taking questions and put forth an inquiry: “Do you like poems?” he asked, and read aloud from Mary Oliver’s “The Summer Day,” reflecting the poem’s presence and childlike wonder. The evening had, ostensibly, been all about ends; but this poem, and indeed the night itself, burst forward with life.

“Doesn’t everything die at last, and too soon?
Tell me, what is it you plan to do
With your one wild and precious life?”