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Hospice, palliative care, and the healing of a life

At a recent seminar hosted by Stanford medical students, hospice physician Gary Pasternak discussed his work and the importance of listening and storytelling.

The silence was poignant, and powerfully so. Gathered together in a small seminar room, medical students and seasoned physicians alike were considering the case of a dying patient. He was a man in his mid-60s, lying stalwart in his bed, projected into the room on a video screen. "I have no fear," he said simply, with eyes resolute.

The man had been, at the time of the video's recording, suffering from terminal metastatic bladder cancer. He was a longtime quadriplegic who was receiving hospice care. He died peacefully, before anyone in that seminar room would hear his name. Save for Gary Pasternak, MD, of course, who would bring him to life again and again.

Throughout the spring quarter, a group of first-year medical students -- Paul Horak, Henry Bair, and Kevin Lee Sun -- have led a seminar course, "Being Mortal," that featured seasoned physicians leading discussions on end-of-life care.

Recently, they hosted Pasternak -- a palliative care physician and medical director of the local Mission Hospice and Home Care -- to speak about medicine and the end of life. For 90 minutes, Pasternak framed illness, fragility, and mortality within the living, breathing human experience. "It's not really about death," the hospice doctor said of dying, "it's about life."

Intentionally broad and inviting, Pasternak's session was an exploration of sorts. Throughout the night, the doctor discussed medicine, meaning, and the mundane practicalities in end-of-life care.

To be a hospice or palliative care physician, he implied, is to be a steward of stories. It is to understand the fears and desires of other human beings, guiding narratives to their comforting conclusions. "[Palliative care] has to do with narrative, and with story, the nuts and bolts of a life," he said. "Stepping into that role takes perspective and heart."

When mortality is no longer an abstract concept, healing becomes a creative act, a reimagining of life amidst the reality of suffering. In Pasternak's profession, that deeper healing first involves hearing.

Indeed, so many of Pasternak's insights hinged on a simple idea: patients, especially at the end of life, want to be heard. That idea leapt into reality, as a roomful of medical students hung on each word of a dying and paralyzed man: "I'm speaking to you as a person experiencing comfort," the patient said towards the end of the video, which was recorded to empower patients suffering through similar trials, "not great pain." As those words passed through the room, they seemed to trace a life's narrative to its peaceful conclusion.

Yet for all the talk of stories, the night was made lucid by one poem. As the evening finally dissolved into the world outside, Pasternak finished taking questions and read aloud from Mary Oliver's "The Summer Day," reflecting the poem's presence and childlike wonder. The evening had, ostensibly, been all about ends; but this poem, and indeed the night itself, burst forward with life.

Doesn't everything die at last, and too soon?
Tell me, what is it you plan to do
With your one wild and precious life?

Photo by Aaron Burden

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