BIDMC PHYSICIAN STRESSES NEED FOR BETTER END-OF-LIFE CARE
"Daily, physicians strive to comfort, diagnose, treat, cure, and extend life with quality. Yet, we must recognize when to shift to palliative care. Patients expect, hope, and trust that their physicians are versed in dealing with end-of-life issues, but physicians need to learn and practice these skills. How ironic it is that as physicians, we rarely talk about dying amongst ourselves - even though our patients expect us to be in expert in such care." - Richard Parker, M.D.
In his 12 years as a primary care practitioner at Beth Israel Deaconess Medical Center, Parker has been chronicling the deaths of nearly 100 patients, gaining insights into the importance of palliative care. He focuses on the end-of-life experiences of six of these patients, describing his reactions to each of these cases, in the January 2002 issue of the Annals of Internal Medicine.
"Very early on, even as a medical student, I saw that many patients suffer at the end of their lives, and I didn't understand why," says Parker, who has made a conscious effort to find ways to alleviate the indignities so often associated with the end of life. "I've come to the conclusion that any resistance to taking action (to ease patients' end-of-life experiences) comes from a doctor's purely human impulse to avoid death and dying."
The need to address this issue is growing: According to the American Medical Association, 78 percent of people in the U.S. live past their 65th birthday, of which more than three-quarters will contend with cancer, stroke, heart disease, obstructive lung disease or dementia during their last year of life.
"I have learned that good palliative care usually circumvents requests for euthanasia or assisted suicide," Parker writes. This perception is supported by a study in the November 2000 issue of the Journal of the American Medical Association (JAMA), which found that of 1,000 terminally ill patients questioned about physician-assisted suicide, only 10 percent said that they would seriously consider it an option, although they supported the idea in theory.
To help doctors and medical personnel in approaching this subject, Parker recommends that we take a look backward. "One hundred years ago, death was a different topic. People were born at home, and they died at home, and as a result, doctors were good at keeping people comfortable in their final days. We can learn how to do this better by emulating these practices.
"In order to perform end-of-life care, I have had to explore my own feelings about death so that I could be open to my patients' anxieties, ideas, and questions," he says. "When doctors are willing to confront the subject, and are willing to do the hard work that goes with it, the experience can be very rewarding for them and for their patients."
Parker's article can be found at www.annals.org/issues/v136n1/toc.html
BIDMC RESEARCHER TESTS MICROGRAVITY'S EFFECT ON CELLS
An experiment currently aboard NASA's International Space Station could yield important information about the effect of gravity on the body's immune system, as well as on the bloodstream and bone marrow. The experiment, conducted by Beth Israel Deaconess Medical Center (BIDMC) hematologist Arthur Sytkowski, M.D., is expected to return to Earth on the Space Shuttle in late April.
"We've known for some time that astronauts become anemic when they're in space," explains Sytkowski. "We're hoping that by studying cells growing in a microgravity environment, we will learn more about human physiology and disease."
Microgravity is the low gravity environment inside spacecraft orbiting the Earth - commonly referred to as "weightlessness." This environment offers an important advantage to scientists because unlike on Earth - where cells that are cultivated outside the body form flat, thin specimens - cells that are grown in microgravity can be cultivated into healthy, three-dimensional tissues that closely resemble our bodies' own cells. Consequently, microgravity research provides scientists the opportunity for important findings in the study of human diseases, including various types of cancer, heart disease, and AIDS.
"The goals of this experiment are three-fold," explains Sytkowski. "First, it could have an impact on human factors of space travel. If you fly a person to Mars, will their bone marrow and immune system become suppressed during the journey?" Second, he adds, "we hope to answer questions of fundamental biology. Living things have evolved on our planet in the presence of gravity, light, and oxygen. When light and oxygen are removed, life doesn't do well. But what if gravity is removed? This experiment charts the effect on individual cells to help determine if they have a means of 'sensing' gravity.'" And last, he explains, microgravity research shows promise in the eventual development of new therapies.
The experiment was completed during 12 days in December, and has been in refrigeration. After its return to earth in late April it will be compared with a control experiment conducted at Johnson Space Center in Houston. Sytkowski's research is funded by a grant from NASA's Office of Biological and Physical Research - Physical Sciences Division.