Cabernet Over Chemo: 4 Physicians, 4 Lessons

March 21, 2017

Dr. B.J. Miller of UCSF Medical Center spoke at the Coalition for Compassionate Care of California conference about how palliative care can go deeper. Photo: Owen Egan

By Matt Perry

“Medicine is not a science,” said Dr. Eric Cassell to a packed room at the annual Coalition for Compassionate Care of California conference in Sacramento last week. “Clinical medicine, the care of the sick, takes place between the doctor and patient in an almost magical, interpersonal relationship.”

Medicine as magic?

During his keynote speech, the long-time palliative care physician lamented the loss of a founding principle in American medicine: the intimate relationship between physician and patient.

“We’re seeing a generation of physicians who have lost its sense of being a doctor,” said Cassell. “Most of them have forgotten how important it is to have a relationship with the patient … We understand less about people than we did in the 1970s.”

A fearless, old school physician unafraid to toss out casual obscenities, Cassell echoed a lost generation of physicians who still made house calls and offered their full attention during office visits.

Long considered the step before hospice, palliative care can actually be offered at any stage of a serious illness and focuses on humane treatment. It is sometimes called “comfort care.” It’s quickly becoming mainstream just as hospice – unknown before the 1970s – has now become standard medical procedure for those with fewer than six months to live.

Cassell – author of the 1980s classic The Nature of Suffering and the Goals of Medicine – spoke about different approaches to palliative care, inspiring this question:

Which would you want at your bedside during a serious illness?

Grassroots care

Dr. Michael Fratkin evoked a wholly different vibe when talking to the breakout session “Grassroots Palliative Care.” Easygoing and casually dressed with an unmistakable hippie-physician personality, Fratkin spoke reverently about Humboldt County where he’d lived and practiced medicine in large health systems for decades.

“Everywhere I go in Humboldt County are ghosts and friends of ghosts,” he said.

But practicing medicine took its toll.

“Fried to a crisp,” in 2014 Fratkin left medicine and hit the road on a personal journey of discovery.

Soon after, three seminal events brought him clarity: the publication of Atul Gawande’s best-selling book Being Mortal; the report Dying in America from the National Academies of Sciences, Engineering and Medicine; and the death of former California resident Brittany Maynard who moved to Oregon to take advantage of its assisted dying law, spawning nationwide legislation including California’s own End of Life Option Act.

Back home, Fratkin used social media to quickly discover what was missing in the community he loved: palliative care.

In response, Fratkin launched an Indiegogo fundraising campaign.

“Forty days later I had raised $140,000, more or less to create a palliative care team,” he said. Today he heads a staff of 17 that cares for 118 patients.

“And it happened because I asked the community what they needed,” said Fratkin. “I turned my attention away from big systems and health plans and turned it towards neighbors and the people I cared for.”

‘The groundwork is empathy’

The third physician, Dr. B.J. Miller of UCSF Medical Center, spoke about how palliative care can go deeper.

Missing three limbs (all but his right arm) following an accident as a Princeton sophomore, the affable Miller talks like a man thankful for being alive with his distinctly humanist approach to death and dying. His TED talk, “What Really Matters at the End of Life,” has been viewed over 5 million times.

“If our subject matter is suffering and death, then the groundwork is empathy,” said Miller. “Staying inspired, loving the people you love, that’s your job.”

While palliative care has traditionally addressed physical pain and emotional distress, Miller hopes to further expand its definition to embrace deeper social, intellectual and spiritual aspects as well.

“Where I’d love us to progress is existential distress,” said Miller. “Maybe death has a lot to do with how we experience everything.”

A better path?

A fourth physician is the only one attached to an Academy Award nomination — Dr. Jessica Nutik Zitter.

An ICU physician specializing in palliative care at Highland Hospital in Oakland, Zitter is featured in this year’s Oscar-nominated short documentary Extremis.  

Zitter also has a new book, Extreme Measures: Finding A Better Path to the End of Life, blogs for the Huffington Post and will soon be featured on the Dr. Oz television show.

During the conference, Zitter called for a “new kind of heroism” in which doctors eschew life-saving measures for more thoughtful, compassionate care.

She recounted her own hard knock lessons: being told by a hospital-patient liaison that she was “torturing a patient” and hearing the bones of a frail elder crunch as a team attempted to resuscitate her unsuccessfully for 30 minutes.

Zitter then described a new approach to death and dying – her “new heroism” – recounting the tale of a colleague and patient who finally stopped invasive cancer treatment in favor of a celebration with wine and cake.

Cabernet over chemo.

8 Responses to Cabernet Over Chemo: 4 Physicians, 4 Lessons

  1. Michael Drummond Reply

    March 22, 2017 at 7:10 am

    We’re finding that thoughtful, compassionate care means more to most patients than intensive, high-tech medical assaults at the end of life. Thank you for this summation of the conference for those of us unable to attend.

  2. Lisa LaMagna Reply

    March 22, 2017 at 7:47 am

    Thank you for higlighting these heroes of California.

    Years ago in Trader Joe’s in El Cerrito, California, I stood behind an elegant mature woman.

    In her cart was 2 bottles of wine, chocolate bars and smoked oysters.

    I started chatting with her, and looked at her basked then commented, “looks like a good party.” “Not a party you’d like,” she said, “I have terminal cancer and I’m not doing chemo.”

    Another Cabernet over Chemo moment.

  3. kathy kastner (@KathyKastner) Reply

    March 24, 2017 at 9:52 am

    In addition to the excellent line-up of speakers, the Coalition – funded by PCORI-Patient-Centered Outcomes Research Institute – selected 17 patients to attend the Summit. This is such a leadership move that (as one of the 17) it warrants a shout-out. The benefits of having patients and palliative healthcare providers in the same room cannot be overstated: learning from eachother, the amazingness that is palliative care will be spread exponentially. My blog from the Summit:

  4. Bruce Atterbury Reply

    March 25, 2017 at 4:31 pm

    ‘Hippie physician mentality’? You don’t even know this doctor and you throw a casual diss on Dr. Fratkin? Seriously makes you look like a caustic jerk… tossing off a slightly mocking description of a man who actually cares deeply about what he and his staff can do for the terminally ill. Maybe you should offer him an apology for your badly framed portrayal of a good man and doctor. Shame. ON. YOU!

  5. Kathleen Rhodes Reply

    March 28, 2017 at 10:24 am

    How can we expose the palliative care option and its’ benefits to more people so that they know it is out there to ask for it rather than hoping their own doctor will suggest it? As a hospice nurse I’m seeing so many more patients come into hospice in their last few weeks of life as hospice isn’t offered at the start of their terminal illness, but at the very end, if even then.

  6. Gay Miller Reply

    March 28, 2017 at 3:06 pm

    I am so happy to see sensible discussions on “end of life” issues. Having been involved in the medical field for over 35 years, I have experienced it all. Good deaths and bad. As I age into my 70’s I have decided that my final bow, if I am able to pull this off, will be a fun-er-al, instead of a funeral. Friends, food, music, and fun. Remembering all of the crazy things I did in my life, the serious part of gifting “stuff” so my family doesn’t need to do it, and enjoying a beautiful last day with friends. Then on to the “great beyond”, satisfied that I said my goodbyes with style and grace. After all, that’s what it’s all about for me!!

  7. Mary Adams Reply

    April 4, 2017 at 8:06 am

    I’ve always said that I want lobster swimming in butter & don perinawn champagne for my last meal.

  8. Jennifer Ball Reply

    April 5, 2017 at 7:42 pm

    I have read an article that Dr. BJ Miller wrote and Thank you for sharing this Coalition of Compassionate Care. I read an article by Dr. BJ Miller and have read A. Gawande’s “Being Mortal” within the last 6mos. They are on the mark. I faced my death at 36yrs old, twice in a year and a half…dealing with chemo, ICU, in and out of the hospital for 3mos. each time, hemorrhaging with an auto-immune disorder. Therefore when I was able to get back in the game of life, nine years ago, I did my Hospice Volunteer training, nurses assistant training and massage therapy training. I truly enjoy being a care giver…living and dying consciously is what is most important to me now. Thankfully there is a growing percentage of health care providers, staff and private sector care givers that “make the time to foster good relationships” with their clients and family members.

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