Where is My Toolbelt?

From the 5/15/2020 newsletter


Where is My Toolbelt?


Wendy Peltier, MD - Section Head of the Palliative Care Center


In normal times, palliative care team members work up-close with patients and families, offering clinical expertise, goal discernment, and support at a patient’s most challenging life transition. Our “tools” include our hands-on clinical expertise where we touch and listen to our patients as we diagnose and treat symptoms, while focusing intently on empathic communication – both verbal and non-verbal – to provide support and to encourage understanding.

We sit together with families to link them to nursing, spiritual, community, and child life support services. We share long intervals of silence in close proximity, permitting time for everyone to process difficult news while allowing for deep- seated emotions to emerge. We gather weekly for our interdisciplinary team (IDT) conferences to debrief cases and develop care strategies as a group.

Our toolbelts includes an abundance of team approaches to manage conflict, coping strategies, corridor conversations, group meetings, and hugs. It is how we work.


Isolation has a Profound Impact on End-of-Life Care and Planning

As the risks of COVID-19 became evident, our hospital changed overnight. Patients facing this frightening, new disease with uncertain outcomes needed more support than ever, but the dangers of viral infection forced us to prohibit our dying patients from having visitors. We limited our own contact with patients to conserve personal protective equipment and held our IDT meetings by conference call. Dynamic changes evolved, such that we wore masks and eye protection even for patients without the virus. We sought ways to link to families remotely for goal setting. Our team, like so many others, worked in scrubs that we removed and washed as soon as we got home. Any time we spent working from home was filled with virtual meetings, and constant worry of what was to come. This was a time to pull out ALL our tools, but our toolbelts were out of reach.


Things Have Evolved

As our hospital activated video visits and encouraged connecting patients to their families via iPads, we learned the power of these connections, although we also witnessed the shock families experienced when finally seeing a sick loved one for the first time in days or weeks. Emotions ran very high, as we wished we could place a hand on a shoulder or even assure families that the visiting rules would soon be lifted.

Our team at Froedtert & MCW is not alone. We are partnering with other palliative care providers locally and nationally to develop and implement new strategies. It has been daunting, yet inspiring. Everyone misses the close contact upon which we depend. We partnered with hospital administration and nursing leadership to develop visitation protocols that accommodated end oflife visitors, albeit far from our ‘normal’.


End-of-Life Care is Best When it is “Low-Tech” and “High-Touch”

Everything came into focus for me recently when the mother of one of my colleagues was admitted to our unit nearing the end of her life. Caring for the relative of one of our own, amplified our desire to make the patient’s and family’s last moments as fulfilling as possible.

Despite the limitations, we created meaningful experiences. Since my colleague’s loved one did not have the virus, she was able to spend time with her mother – a gift that our other patients do not share. She had the technology resources and creativity to connect her mother with all of her grandchildren via Facetime. A few cherished items from home warmed the room. Relatives were able to safely travel from out of state for support. As I sat in her room, hearing stories of her mother and family in happier times, I felt a sense of grace and peace despite my mask and goggles. I realized how much I have missed these bedside conversations and long for the day when the COVID-19 danger has passed.

We who practice palliative care and hospice are commonly asked, “How can you do this work, day in and day out, and stay afloat?” My response is often that I can’t imagine NOT doing this job and have always viewed it a special privilege to provide guidance and comfort at such a sacred time. Although we often deal with intense emotions, we also witness true love within families, facilitate ways to stay in the moment, and celebrate life even as death approaches. This present challenge has only intensified the value and richness of what we do.

Practicing in the COVID pandemic has included new work rules, PPE, computer meetings, and a longing for the day when thing approach normal again. We have developed a new appreciation for our old high-touch, up-close, sitting- together toolbelts. The day we get to strap them on again can’t come soon enough.


Wendy Peltier, MD is an Associate Professor of Medicine and Section Head of the Palliative Care Center in the Division of Hematology and Oncology at MCW. She is a member of the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.