Page 9 - Delaware Medical Journal - April 2017
P. 9
PRESIDENT’S PAGE
PRAYUS TAILOR, MD
MSD President Prayus Tailor, MD is a Nephrologist who practices with Nephrology Associates in Newark and Wilmington.
How do we initiate these conversations?
Recently, I read a very interesting article in The New York Times Magazine entitled “One Man’s
Quest to Change the Way We Die.” The article describes Dr. B. J. Miller, a triple amputee and palliative care physician at University of California San Francisco, and his work with a unique local hospice facility. The article also featured a
young man named Randy Sloan, recently diagnosed with aggressively metastatic mesothelioma. The following passage, I feel, very eloquently describes the mental exercise that goes into having end-of-life discussions with patients ...
Still, Sloan talked to Miller about “doing battle” with the cancer and “winning
this thing”; about getting back to work at Scuderia ... He also wanted to go to Tokyo Disneyland, he said. Miller looked at Sloan (and his friend Baldwin), ... trying to intuit who knew what and who might have been pretending not to know and how best to gently reconcile everyone’s hopes with the merciless reality.
Good palliative-care doctors recognize there’s an art to navigating clinical
interactions like this, and Miller seems particularly sensitive to its subtleties. In this case, Miller realized, his job was to “disillusion” Sloan without devastating him. Hope is a tricky thing, Miller told me. Some terminal patients keep chasing hope through round after round of chemo. But it’s amazing how easily others “re-proportion,” or recalibrate, their expectations: how the hope of making it meaningful. “The question becomes,” Miller says, “how do you incorporate those hard facts into your moment-by- moment life instead of trying to run away from them?”
Providing good palliative care is a subject with which many doctors struggle. The struggle occurs in many different ways. When do we initiate these conversations? Newer cancer chemotherapies and advanced heart failure therapies have changed the way in which we prognosticate our patients. someone has to live until they are indeed at the very end of life. This particular
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