If somebody is not feeling well, how do you fix it? That's what it means, right, to palliate, to support, to treat symptoms.  It's not taking away care. It's actually adding more care, specialized care for seriously ill people to help them and their families. And I always accentuate their families.

Being in this space with people where it's just so vulnerable and raw. It's such a humbling experience to be in that space. It’s an honor...

Here is a story about two doctors, their strong passion for patient care, and discovering there was something more they could share with their patients, and their families, when they are at their most vulnerable.  Together they reimagined what palliative care should be and uncovered the rewards they experienced along the way.

Dr. Ayesha Sooriabalan:

So how should we introduce ourselves?

Why don't we just say inpatient and you say outpatient?

Dr. Ayesha Sooriabalan, inpatient palliative care physician here at Saratoga Hospital.

Dr. John Pezzulo:

And I'm Dr. John Pezzulo, outpatient palliative care physician here at Saratoga.
 

John:

One of my favorite things is bringing out young medical students to sort of show them what real medicine is.

 
We drove from the Battlefield down to Waterford to Clifton Park, Vischers Ferry, back up to Ballston Lake. We saw these patients, but we also passed a half a dozen other houses. I'm like, "Oh yeah, I've made a home visit in that house once before.

You could go into a room and first time you're meeting somebody and they just got out of the hospital,   and you get there and you don't know what to expect because patients look different on paper. And "Oh, hey, where's dad?" "He didn't come downstairs. He's upstairs in his bedroom." "Okay. Let's go." And we go upstairs and I'm sitting on the laundry basket upside down and the wife's on the edge of the bed and the daughter's on the other edge of the bed and the daughter from out of town's on the telephone and on FaceTime. And dad's sitting in bed, he's like, "Oh, thank you for coming."

…she was like, "This is crazy. I never would've thought” … there's a population of people that need an extra layer of care, home-bound. And they just can't get out any longer.

Ayesha:

There's a misconception that palliative care is hospice, so because hospice is a form of palliative care for patients at the end of life when you're doing purely comfort care. And I think the big difference that I try to get across is palliative care, specialty in itself, it is different from hospice. … it's really very patient centered.
We focus on comfort, but we can come in concurrently with treatment. And I think that's the big piece people don't understand.

John:

It's a specialized care for seriously ill people to help them and their families. And I always accentuate their families, symptom management goals of care … of an illness ...

Ayesha:

Any age, any stage.

John:

But it's deeper. It's more nebulous than that. It's sort of like, "Hey, wait, you're just supposed to just do the right thing." If somebody is not feeling well, how do you fix it? And that's what it means, right, to palliate, to support, to treat symptoms.  It's not taking away care. It's actually adding more care.

Ayesha:

It’s really trying to meet people where they're at.

John:

And it is sort of a unique role because people are very vulnerable and you have the compassion. You can learn so much about a family in an hour and a half … and that's an honor.

Ayesha:

If we can just leave the family intact.

It's such a humbling experience to be in that space. I think that's a term that I've definitely heard within the palliative care community. It's like being in this space with people where it's just so vulnerable and raw. And when I'm meeting people in the inpatient setting, it's like I have to develop this trust and rapport fairly quickly.

John:

When we met and started training together, I was still in private practice.

Ayesha:

I was doing hospital medicine, still. I wasn't doing palliative care, yeah.

John:     
                      
And at the beginning, I was like, "You know, we need outpatient palliative care." And you were starting to forge the inpatient.

Ayesha:       
                     
When we started the inpatient palliative care, it was like we'd spend all this time with these patients making these plans.  But it also is just like there are so many complexities to them that having some specialized outpatient palliative care to help the primary out, we didn't have that until you were able to start doing this. And it just makes us feel so good that the work that we're kind of accomplishing in this crisis situation can be like then just kind of warm handoff to somebody that we know is going to be looking at all that big picture stuff.

John:

Saratoga Hospital is the only hospital in the area that offers specialty inpatient and outpatient palliative care.

Ayesha:        
                    
It's such a unique service.

There's such a gap with these home-bound patients. And especially with the palliative care patients, they're at the highest risk of being re-hospitalized and not wanting to be here. And sometimes it's a matter of just having someone to call when their symptoms are getting worse or transitioning them to a different care plan.

John:

Especially when either of us see them, they've gone through the gauntlet of all the specialists and the interventional radiologies and CAT scans and PET scans and biopsies and 30 days of radiation therapy.

Ayesha:

I'm seeing people in crisis mode.

So I feel like palliative care also has added some continuity, too, for some of these complex patients that are here for a long, prolonged hospitalization. Also, if they come back on re-hospitalizations, they're going to get the same palliative care people.

John:

In outpatient, there's a lot of patients we've seen that haven't even been to the hospital in five years. But all of a sudden they're late stage dementia, late stage Parkinson's, late stage emphysema. They've been going to dialysis for five years and now they're having a hard time.

When I was in second grade and thought, "Oh, being a doctor would be really cool." And then in sixth grade and then in college and then finally going to school, I always dreamt about coming back to my hometown. And I grew up here and I feel like it's just coming back to take care of your own. …there is a community here that needs an extra layer of care.

John: 
                          
There's a lot of other issues in Saratoga county, for whatever reason. I mean, we have high rates of pretty serious illnesses including, relative to other parts of the state there's higher rates of some cancers around here. There's higher rates of emphysema, and those people need that extra level of care as they're trying to fight those diseases.

John:  
                           
To know that Saratoga Hospital's given me a green light to do a mission in my heart, a vocation and not a job, is actually very satisfying. To wake up and say, "Hey, this isn't going to be work, this is different than a job." And when I come home at the end of the day and say, "That was a good job today," it's because we helped other people.

Ayesha:   
                         
It's actually my kind of mantra is to be at my highest service in whatever capacity that I can when I come to work.

It's a way of giving control to a patient that feels like they have no control with their disease.

John:

That's where you make a difference.