SOQUEL, CALIF.: Marilyn Cronin was too sick to live. But she wasn’t ready to die.
So she curled up on the sofa of her mobile home, next to a bucket for vomit, and cried. Suffering from liver failure and lung disease — suspended between health and death — she braced herself for the next hospitalization, then another, and perhaps still others, until the last one, when her suffering would end.
Then, unexpectedly, relief arrived: A cheerful nurse practitioner with a starched British accent pushed open the mobile home door and pulled up a chair.
For two hours, Karen Gossage just listened. Then the two women mapped out a plan: Which medicines might help. Where to get a walker. How to manage symptoms at home to prevent a midnight rush to the emergency room. Who would help her at the end.
What was extraordinary was not just the thoughtfulness of the conversation, but its rarity — and, if replicated, how profoundly it could alter modern medicine.
This seemingly simple, yet pioneering program — known as “outpatient palliative care” — is part of an experiment sponsored by the Palo Alto Medical Foundation.
Palliative care is not hospice, which also focuses on emotional support and relieving symptoms for people in the final six months of a terminal illness. Palliative patients may have several years left.
And it does not require giving up the chase for a cure, as hospice does.
In fact, palliative care can ease illnesses that aggressive treatment often triggers.
But neither is it a hospital, where aggressive care at each crisis can cost tens of thousands of dollars.
Palliative counseling enabled Joseph Weigand, 77, to enjoy oceanfront drives and trips to his office — and gave him the chance to stand his ground against dialysis at the end of his life.
Gossage’s gentle probing revealed that the quality, not quantity, of his life matters most to this deeply spiritual man with kidney, lung and heart ailments.
“It was start-to-finish information, and so very important and helpful,” he said.
Life-prolonging dialysis? Not for him.
“It was the first I’d heard him say that,” said his daughter Kathy Baazard, who is caring for him. Heavy-hearted, “I had to leave the room. He opened up, and said things that hadn’t been said.”
In Foster City, Calif., a palliative care home visit meant that retired Air Force flight surgeon Dr. John Meyers could nap and watch Wimbledon on TV, instead of undertaking a grueling trip to a clinic.
Because Meyers is weak and cannot walk, even a medical appointment is tough on the 83-year-old and his wife.
“It totally wipes him out,” Susan Meyers said. “So it’s comforting and a relief for me now to have a ‘team’ to work with me.”
Without such support, it is natural for caregivers to panic when new symptoms appear, or old ones worsen.
The medical maelstrom of a crisis may whisk away thoughtful choices on the conveyor belt from the ER to the intensive-care unit.
“If someone’s only real resource for symptom control is the hospital, can you blame them for going?” asked Dr. Neal Slatkin, chief medical officer of Hospice of the Valley, which is preparing to open Palliative Care Center Silicon Valley.
“But why wait until someone feels so bad that they have to go?
“It’s much more cost- effective and humane to better control the symptoms.”