At a young 73 years of age June G. was active in her local little theater and very involved in her grandchildren's lives. When she accidentally inhaled chlorine gas while working on her swimming pool, her lungs were permanently damaged. Frequent episodes of chest pain and extreme shortness of breath forced her into the hospital several times a year. The fear of another episode contributed to constant anxiety, which seemed to increase her breathing problems. June gave up all of her previous activities and became increasingly housebound due to her fear of an attack.

While her pulmonary specialist continued to work with her to improve her symptoms, he referred her to a palliative care team during one of her hospitalizations. There the physical and occupational therapists taught June how to preserve and conserve her strength. The nutritional therapist helped June to design an improved eating program. A social worker and chaplain spent a great deal of time with June talking about her dreams and wishes for the future. The palliative care physician collaborated with her pulmonologist to prescribe medications to relieve June's anxiety and chest pain, and a respiratory therapist worked closely with June's homecare therapist to regulate her home care program.

While June's lungs will never be restored to their previous function, she is now able to manage her symptoms more effectively, and she can comfortably travel outside her home with a compact, portable oxygen supply. She was able to watch her granddaughter perform in the annual school play, and she spent Christmas afternoon with her family.

Although the damage done by the chlorine has not been reversed, June's physical and emotional pain have both improved significantly since she began the palliative care program.

The goal of palliative care is to improve the comfort and quality of life of those with serious, complex and debilitating illness. While palliative care is medical treatment dedicated to relieving the discomfort of disease or treatment, rather than to curing an illness, aggressive medical treatment may continue at the same time the patient is receiving palliative care. In fact, good palliative care is often the reason patients can continue an aggressive treatment regime that they might otherwise be unable to tolerate.

Not to be confused with Hospice care, palliative care does NOT require that the patient have a terminal diagnosis, or that the patient forego treatment designed to "cure." As a matter of fact, palliative care is often provided to relieve the symptoms caused by aggressive  treatment, such as the nausea that so often accompanies chemotherapy. While palliative care and hospice care both share the goals of relieving symptoms and managing pain, palliative care is appropriate for those who are expected to eventually fully recover, and for those who may live with a chronic condition for many years. Hospice care, on the other hand, is reserved for those whose condition is considered to probably be terminal within six months.

While the literalist might say, "Giving my father an aspirin when he has a headache is palliative care" (true enough), formal palliative care generally involves a team approach to intractible discomfort. Working together, an interdisciplinary team of physicians, registered nurses, nursing assistants, social workers, chaplains, physiotherapists, occupational therapists, and complementary therapists, focus on optimizing the patient's comfort and quality of life while maintaining a committment to aggressively treating the underlying health issues so long as the patient wishes to fight.

Complex psychological, social, and spiritual problems often contribute greatly to physical discomfort. Much of what these dedicated members of the palliative care team do involves helping patients with these issues.

While intensive palliative care was first introduced in conjunction with cancer treatment, it is now common to see patients referred to palliative care teams for such debilitating conditions as renal disease, chronic heart failure, progressive neurological conditions such as  muscular dystrophy and muscular sclerosis, and chronic pulmonary disorders.

For those with traditional Medicare, palliative care is covered both in a hospital setting as well as on an outpatient basis. Many patients begin care while in the hospital to have their  extreme pain or discomfort treated intensively. When their pain is controlled, they continue to receive care as outpatients.

Today, more than half of all large U.S. hospitals offer palliative care programs. Many smaller community hospitals do so, as well. To find a hospital in your area that provides palliative care you can use this free locator.  

While not all palliative care is focused on end of life care, The Dallas Morning News recently featured a stunning multi-part series on the end of life palliative care program at a large Dallas hospital called "The Edge of Life." I cannot recommend this series highly enough. Read it to get a clear understanding of palliative care and the dedicated health care professionals who provide this difficult, yet rewarding, care every day.