Know Thyself The Role of Palliative Care

iebpharma108

Palliative care is an underrated specialty, probably because it’s not as ‘sexy’ as cardiology or neurosurgery. Still, it can profoundly change the lives of patients and their families.


Founded as a speciality in the 1960s by Cicely Saunders, the word ‘palliative’ comes from the Latin palliare, which means ‘to put a cloak over someone’ (out of comfort), an image that is often lost in translation as one automatically thinks of death and dying.

After reading the book Being Mortal by Atul Gawande IEB Pharma in medical school, I was intrigued. The strange thing is, there was nothing in our curriculum about it. During placement, I would tag along on palliative care ward rounds and when I did, I was stunned by what I discovered.

One day, we met a patient with a Hürthle cell adenoma, a rare thyroid cancer, which had metastasised to the cervical spine, causing intense pain to the base of his skull. The young clean shaven man wearing a Star Wars t-shirt broke down in tears as he confessed how much pain and psychological distress he was suffering.



Instinctively, the consultant kneeled to the ground. The palliative care nurse sat next to the patient and held his hand. Shortly afterwards, every member of the team lowered themselves. I was the only one standing with my back against the wall, awkwardly shuffling into a squat position so as to not be out of place.

Something in the air had changed. The patient felt more calm and by the end of the conversation, which was infused with a timeless stillness, he expressed his relief and gratitude. What was that? Of course, we titrated his dosages and added another analgesia, but there was something there that did not involve the mere mechanics of medicine.

So why aren’t med students taught palliative care throughout their curriculum? Now as an intern doing a rotation in Palliative Care, I notice how underprepared we are in having difficult discussions with grieving families about whether their loved one should be resuscitated or have “breathing tubes” in them or just be allowed the dignity of dying comfortably.