Midland Health Launches Center for Serious Illness and Supportive Care
Dear Fellow Midlanders,
Hello! My name is Kathryn Lagus. I am an APRN at Midland Memorial Hospital. My family and I moved to Midland in the summer of 2022, and have since fallen in love with your town. Not long after the move, I was given what was truly a life-changing invitation to develop a palliative care program for Midland Health. I was ecstatic, and I did not even know how much better it was about to get.
With deep thanks and appreciation to my family, who have allowed long days, late nights, many weekends, and a lot of big emotions, and to my entire work family at Midland Health, I am so proud and grateful to announce that the Center for Serious Illness and Supportive Care at Midland Health is open as an in-patient specialty palliative care service. The purpose of this letter, which I hope is the first of many, is to explain what palliative care is, who we help, and how we help.
As football season quickly approaches, the best way to describe what a palliative care team is might be comparing it to a local football team. The past 10 or 11 months have been dedicated to drafting the team, from the smiles you see when you walk in the front door to housekeeping, from medical staff to nursing, IT, case management, and everyone in between. Like our own local football teams, this program is intentional and has Midland grit. It is designed with flexibility, adaptability, resilience, and strength, in hopes to be victorious for the “coach-“ anyone and everyone who needs our services.
The name of our game is palliative care, or specialized health care for people living with serious illnesses and their families. It is an extra layer of support, provided through collaborating with the patient’s primary care team, including specialists. Our focus is on providing relief from the symptoms and stress of serious illnesses to improve the quality of life for the patient/family unit, extend life, and/or achieve a cure. What is most important to you? is the most important question we ask. The response to this question forms the basis of patient-centered care and dictates how the “game” is played at any given time- that is, how we align our services with what a person states they want and need. Just like in football, patients can call a time-out any time they wish and reserve the right to make a different choice. The only difference in this game is that there are unlimited time-outs.
How do you win? The win occurs when patients feel they have the right information at the right time and receive the right care in the right way from the right person. When the team wins, the coach wins, and the when the coach wins, the team wins. While this seems easy on paper, the opponents are not easy. Sometimes, the choices a patient has are between worst and worst, but patients cannot coach a winning team if they do not know who their opponents are. Providers are humans, too, and sometimes, the hardest part of our work is simply telling someone the most painful truth. Saying anything less, however, sets everyone up to lose- patients and providers alike. We cannot expect patients to make the decisions we think would be in their best interest if we do not begin by telling you everything you need to know about your diagnosis and prognosis, as hard as it is to tell and harder still as it must be for someone to hear. Having said that, there are good ways to tell the truth and bad ways to tell the truth. As palliative care specialists, we want to know how you best receive information, when the best time of day would be to discuss new information, and who you would like to be present for those discussions. Some of us like to know everything, all at once, right now, with or without anyone else to hear it. Others like it in more measured doses. What is so difficult about serious illnesses is that they rob us of control; the more we can do to help patients feel in control of whatever it is they can control, the better the outcomes are for everyone involved. Once a coach knows what they can and cannot do and who the opponent is, we are better able to help patients set realistic expectations for what “winning” looks like. Now we have a coach, a team, and an objective. Next, we need to know how we win.
The playbook at the patient’s disposal includes the following options:
- Symptom management: the alleviation symptoms such as pain, nausea, fatigue, and shortness of breath
- Emotional and psychological support for patients
- Caregiver support for those who take care of them
- Facilitation of communication between patients, their families, and their providers
- Shared decision-making assistance
- Coordination of care
- Caregiver support and support for families
The selection(s) made by the “coach,” determine which member or members of our team play quarterback- if it’s symptom management, our providers will run the play. If it is spiritual distress, the chaplain is in. Designating someone to make decisions for you if you cannot or find a primary care provider? Case management. Anticipatory grief or caregiver support? Social work. It is this multi-disciplinary team approach that allows the right play at the right time by the right person for you, coach.
It is my hope that after reading this, you better understand what palliative care is and support its need in the Permian Basin. We look forward to further developing this program into one that extends beyond the hospital, and your questions, concerns, and feedback are most wanted and welcome.
Until next time and with sincere thanks,
Kathryn Lagus, APRN, FNP-C, MSN
Program Director, Center for Serious Illness and Support
Midland Health