Lessons Learned While Caring for Dying Veterans

Originally published in the July 22, 2022 issue of the Transformational Times (Focus: Geriatric and Palliative Medicine)

Lessons Learned While Caring for Dying Veterans 

Adrienne Klement, MD

Dr. Klement, who completed a fellowship in Hospice and Palliative Medicine, cares for Veterans at the Zablocki VAMC in Milwaukee. As we approach Veteran's Day, she shares two stories from the COVID-19 pandemic that show some of the lessons she has learned caring for her patients…

“These doctors have the hardest job in the world.” It was a cold January evening during the pandemic, and the Milwaukee VA ICU was buzzing with a symphony of ventilator alarms, bedside monitor alerts, the closing and opening of isolation carts, and staff conversing about patient care needs. 

Visitor restrictions were in full force. Despite the noise, the unit felt empty and stark with closed doors and without families at bedside, except for one room. I gowned up and greeted our dying patient, Mr. D, and his family. 

There were several grandchildren joining on Facetime. We (they) had twenty minutes. We all had to speak loudly through our N95s to be heard over the Vapotherm. Mr. D acknowledged he was very sick. We talked about his hopes and wishes, and he gave his loving family all the appreciation he could muster. He just wanted to hug his grandchildren. At the end of the conversation, his son hovered in close to him and said, “Dad, these doctors have the hardest job in the world—they have done everything they can to help you. You are going to die soon, we are here now, and we love you.”

Lesson number one: Sometimes, the best way to reach a patient is through a trusted and familiar face.

I could tell Mr. D was holding back tears throughout our conversation. I wondered if this suppression of emotion was something he had learned in the military, and what trauma he had been through in the past. Was it a sign of weakness to admit feelings of fear or sadness? Was he trying to stay strong in front of his family as a way to bear their grief? I noticed a few quiet tears of my own while in the room, and I couldn’t help but wonder if my reaction was acceptable, or if it was detrimental to my roles as comforter and healer. 

When I got home later that evening, I started to unpack my (unexpected) reaction further, realizing that my tears were complex. They were a reflection of empathy, as I recalled holding my mother’s hand as a teenager when she took her last breath. They embodied frustration with the end-of-life isolation protocols. And they were tears of immense gratitude for the life of service Mr. D gave to our country, and for the care given by his Oncology and ICU teams.

Lesson number two: Showing emotion in front of patients, colleagues, or families is part of healing, for all of us.

The appreciation given to us by our Veterans and their families is transformative. Medical training is a long road that comes with many sacrifices, but also deep bonds and human connection. 

I had the privilege of helping to take care of Mr. R, who had end-stage leukemia, in both a consultative role, and also as his primary Medicine attending. It was so special to me as a teacher, to witness my resident-in-training also provide exceptional care and supportive listening. Mr. R and his wife expressed their deep appreciation for the unique care that he gave, and all that our VA providers gave through to his dying day. 

As an educator, I felt fulfilled in witnessing our team experience the most rewarding aspect of practicing medicine, relationships with patients. Mr. R’s military and life stories were therapeutic for all of us, and he reminded us daily that we are caring for some of the most selfless and resilient servants in the world.

Lesson number three: Reflecting on our Veterans’ acts of service and life experiences through attentive listening and presence cultivates gratitude for our work.

I am grateful every day for the meaning that my work brings me. I am most thankful for our Veterans who have served our country, and from whom we have much more to learn.

Adrienne Klement, MD, is an Assistant Professor in the Department of Medicine, and is a faculty member in the Division of Geriatric and Palliative Medicine at MCW. She attends on the inpatient Internal Medicine and Palliative Care consult services at the Zablocki VAMC, where she was recognized in 2022 as "Employee of the Year."

Sometimes You Gotta Put Your Big Girl Pants On

From the September 1, 2023 issue of the Transformational Times

"Sometimes You Gotta Put Your Big Girl Pants On," and Other Favorite Teachings From My Summer in SPARCC

Mary Hegeman, SPARCC Scholar 2023 

Student-centered Pipeline to Advance Research in Cancer Careers (SPARCC) is a program designed to prepare underrepresented minority students to pursue medicine and biomedical research, and ultimately, pursue careers in clinical cancer research ...

 

 

I was lucky to participate in the SPARCC program at the Medical College of Wisconsin this summer. It allowed me the incredible opportunity to learn about clinical trial research and explore my interests in medicine by shadowing at Froedtert and Children’s Wisconsin hospitals while an undergraduate at the University of Wisconsin.  

 

Recently, as I was paging through my notes from the past two months, it struck me that what I’ll remember from this experience is not the statistics on pancreatic cancer or the steps for obtaining IRB approval, but the personal and professional advice from various educators. 

 

I describe my three favorite pieces of advice here, with gratitude to all the advisors who took the time to share their wisdom with me and my peers: 

 

Nobody is immune to, "Hi, I think your job is cool and I’d love to talk with you about it."  

– Jessica Olson, PhD, MPH, Assistant Professor of Community Health, MCW 

Although Dr. Olson’s presentation to my cohort was officially titled “Sequencing and Biomarkers in Cancer Research,” a more accurate title might have been “Putting Yourself Out There 101,” because this is exactly what she encouraged us to do during our time at MCW. It is advice that I will take with me into my senior year of college and beyond, because she’s right—it is better to take a risk than regret not taking one at all, and in most cases, the worst thing that a person can tell you is “no.” 

 

Kids are the best patients because at the end of the day, they just want to play. So, if you can, make them feel better so that they can play? That’s the best feeling in the world. 

– Nathan Schloemer, MD, Assistant Professor of Hematology and Oncology-Pediatrics, MCW 

 

Ever since I was old enough to know what a doctor was, I’ve said that I want to be a pediatrician when I grow up. However, had you asked me before this summer if I’d ever consider a career in pediatric oncology, I probably would have said something along the lines of “Heck, no—kids dying? I couldn’t deal with that.” 

 

Now, after having had the opportunity to listen to Dr. Schloemer’s talk on pediatric oncology and shadow him in clinic, I am changing my tune. I learned that the five-year survival rate for pediatric cancer is now close to 85 percent, thanks largely to major treatment advances from clinical trial research in recent decades. 

 

Death and dying is extremely difficult to cope with in cases of childhood cancer, but Dr. Schloemer explained that having conversations with families regarding multiple relapses doesn’t mean that a child’s care team plans to give up:  

 

“I sometimes tell families that we have all of these buckets, and that each one contains love and caring for their child and managing their pain, but some buckets are more cancer-directed, and others are not. It’s okay to pick the bucket that’s less cancer-directed because we know that they have their child’s best interests at heart,” he said. 

 

I loved this language so much that I wrote it down, along with his final encouragement to pursue a career in pediatric oncology: “If you can make [kids] feel better so that they can play, that’s the best feeling in the world.” 

 

Caring for someone is not an In-&-Out Burger.  

– Wendy Peltier, MD, Associate Professor of Medicine and Neurology, Division of Geriatric and Palliative Medicine at MCW; Faculty Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education 

 

When Dr. Peltier first introduced herself to our cohort, I didn’t even know what palliative care was. I thought that perhaps it had something to do with nutrition. Once I did a quick Google search for the definition, I had the same knee-jerk reaction that I did to the field of pediatric oncology: No way.  

 

It’s safe to say that I have also changed my tune toward this specialty, so much so that I now hope to work in palliative care in the future.  

 

Dr. Peltier addressed the misconception that palliative care is hospice care, explaining that her team focuses on improving the quality of life of patients and their families during illness. The support that they provide can begin as early as diagnosis and doesn’t necessarily end immediately upon the passing of a patient: “Caring for someone is not an In-&-Out Burger,” Dr. Peltier said with a smile. 

 

Just like in the field of pediatric oncology, Dr. Peltier noted that it can seem overwhelming at times to maintain professionalism or positivity. 

 

She shared one of her first patient cases — a young man with a devastating neurological disorder — that she took on as a provider, and how the experience led her to call her parents and tearfully admit “I can’t do this.”  

 

As Dr. Peltier stood in front of our cohort describing this moment, she reflected on how that phone call led her to realize: 

 

“Sometimes, you gotta put your big girl pants on to face death and dying in medicine."

 

Of all the lessons learned from my summer in SPARCC, however, the most revelatory one was that I should not fear the unknowns in my future. Every single presenter emphasized the non-linear trajectories that led them to their current roles as educators or providers, and it was just as comforting to hear their stories of setbacks as it was to hear about their successes.  

 

I don’t know if patient care is in my future, and if it is, whether I will go into pediatric oncology or palliative care, or something else entirely. However, I hope that if I am lucky enough to go into medicine, I will remember the wisdom of Dr. Olson, Dr. Schloemer, Dr. Peltier and so many others during my time in SPARCC. 

 

 

For further reading: 

 

1. American Cancer Society (2023). “Key Statistics for Childhood Cancers.”

 

Mary Hegeman is a SPARCC Scholar and incoming fourth-year student at the University of Wisconsin. Under the guidance of Elizabeth Ellinas (MD) and Abby Haak (MA) within the Center for the Advancement of Women in Science & Medicine, she presented her work on the project “Restorative Justice & Promoting Professionalism in Medical Education” at the SPARCC Culminating Research Summit in August 2023.