Some years back, Dr. Stacie Bering made a heartbreaking visit to a hospital to see a friend who was dying of cancer.


It wasnt just the friends terminal condition that made Bering feel sad; it was that he was all alone, with nurses scurrying by his room frequently, but paying little attention to him.


At that time, she wasnt very familiar with the field of medicine, called palliative care, but thats when she first became interested in it.


Palliative care is known as end-of-life care in some circles, but more broadly refers to a multidisciplinary approach to pain-and-symptom management for any patient diagnosed with a life-limiting illness.


Its a burgeoning field, says Bering, who is director of the recently established PathWays palliative-care consulting service at Deaconess Medical Center. It probably will be its own medical field in a couple of years. Right now, its not, but were headed in that direction.


Bering began seeking training in palliative care in 1999, when she was diagnosed with multiple sclerosis and quit her obstetrics-gynecology practice. Deaconess launched its PathWays palliative-care consulting service earlier this month. Bering currently is the only person working exclusively in Deaconess program, but plans to add either a physicians assistant or a nurse practitioner soon.


Other professionals are trained in palliative care and work together with Bering to help each patient. Those professionals include pharmacists, nurses, physical therapists, and social workers, as well as chaplains.


While the Deaconess program is just getting under way, Bering says, My colleagues tell me Im going to have more work than I know what to do with. Be prepared to be inundated, they say.


Dr. Jim Shaw, medical director of the Providence Center for Faith and Healing, at Sacred Heart Medical Center, says Sacred Heart has offered palliative-care services for a few years and has established a pair of comfort-care rooms, where patients who are expected to die in the hospital stay for their last few hours or days.


Recently, he says, Sacred Heart has expanded its services to include what it refers to as perinatal hospice, which is care for pregnant women whose fetuses have life-limiting conditions.


We try to provide a much more satisfying experience in the midst of a tragedy, Shaw says. You cant change the tragedy of it, but you can make it more comfortable.


Later this year, the Sacred Heart Childrens Hospital hopes to have a pediatric palliative-care program. Shaw says about a dozen pediatricians and pediatric nurses have received palliative care training thus far, and a comfort-care room likely will be established in the Childrens Hospital.


Kootenai Medical Center, of Coeur dAlene, recently teamed up with Hospice of North Idaho to bring on board a palliative-care specialist, Dr. Robert Ancker. The hospital says it has four patient rooms set aside for people who are going to die in the hospitalit calls those Circle of Life roomsbut until recently, it didnt have a physician who was focused on treating terminally ill patients.


Pain management


Generally speaking, palliative-care specialists say, palliative care starts with pain-and-symptom management.


Weve found that pain-and-symptom management in some patients requires an expertise beyond what the average physician is prepared to deal with, Shaw says.


Bering cites a report published recently by the Joint Commission for Accreditation of Healthcare Organizations that says the health-care industry needs to do a better job of pain management.


Most physicians, she says, are wary of drug seekerspeople who want drugs for their mind-altering effects, rather than to gain relief from painand are slow to prescribe opiates and other pain killers that are habit forming. Those types of drugs, however, can be instrumental in making a terminally ill patient more comfortable.


One of the biggest things palliative care has to do is to convince docs that pain is what the patient says it is, she says.


Due to the multidisciplinary approach, palliative care is equipped to address other types of pain, such as spiritual and emotional pain. With the inclusion of a chaplain and social worker, a patient can gain help to address unresolved issues before dying.


In palliative care more than in other areas of medicine, Bering says, treatment varies widely depending on the wishes of the patient and his or her family. One patient dying of cancer, for instance, might want to stop taking chemotherapy treatments that have harsh side effects so they can enjoy their last remaining days more. Another person might want to fight the disease with every available option until the end. Either way, Bering says, a palliative-care specialist can help clarify those wishes.


In some instances, the wishes of a patient might conflict with the desires of family members, and members of the palliative-care team can help iron out those conflicts as well.


Currently, physicians can receive palliative-care certification through the American Board of Hospice and Palliative Medicine. The American Board of Medical Specialties doesnt recognize palliative care as a specialty yet, though such recognition could be in place by 2008, according to the boards Web site.


Bering expects that eventually, palliative care will be a subspecialty for family physicians and internists.


Shaw says one encouraging sign is that the University of Washington Medical School began offering classes in palliative care recently, and he and Bering are working with UW medical students who are performing residencies in that field.


Its great for patients and families that this is moving ahead, Shaw says. Its going to improve the overall level of care in Spokane.


Contact Linn Parish at (509) 344-1266 or via e-mail at linnp@spokanejournal.com.