During the years of my medical career when I treated patients (always in hospitals), I was one of those rushed doctors who focused on efficiently formulating and implementing diagnostic and treatment plans, rather than on the patient’s emotional needs. That was certainly true of “end-of-life care,” treatment and support given to people who are near the end of life and have stopped treatment to cure or control their disease. The goal then becomes controlling pain and other symptoms so the patient can be as comfortable as possible and includes physical, emotional, social, and spiritual support for patients and their families.
To a young, enthusiastic doctor, a dying patient is often seen as a failure, so somebody or something has to fill the gap, and a project at UCLA Health in Los Angeles is a stunning, munificent example.
The “3 Wishes Program” is a palliative care initiative in which clinicians inquire about and implement final wishes for patients who are expected to die imminently. As its mission statement says, “By celebrating lives and dignifying the dying process, the goal of the program is to improve the end-of-life experience for all stakeholders, including the patient, the family, and the clinicians.” It recognizes that in their final hours, most people have fears, regrets, and maybe a last, often simple request. The program has fulfilled almost 5,000 wishes for more than 1,400 patients.
I became aware of it by following on Twitter Dr. Thanh H. Neville, associate professor and intensive-care unit physician at UCLA Health. Some of the 3 Wishes stories are very affecting reminders of how meaningful small kindnesses can be.
- “One of our patients transitioned to hospice care and requested only to be married to his long-term girlfriend while in the hospital. Along with the Palliative Care and Social Work teams, the 4SW nursing staff came together to create a special ceremony for our patient, which included an officiant at bedside, decorating the room with string lights and a hearts banner, granting the number of requested visitors to be present, and providing a beautiful cake and flowers to aid the celebration. The patient, now wife, and family were grateful for the team’s efforts and eternal memories created in these lasting moments.”
- “This patient had a beloved teddy bear named ‘Candy Marshmallow’ that the ICU team became familiar with because he always kept it at his bedside. Right before intubation when the patient was hypoxic and decompensating, he placed the bear’s paws together and prayed with his mother. This was an incredibly heart-wrenching moment for everyone who witnessed it. He was intubated and on life support for a few weeks; the bear and his mother never left his side. When the patient was at the end of life, his nurses, Kristin and Noelle, wanted to support his family as much as possible. They obtained his fingerprints and Jade (volunteer artist) used a picture of the teddy bear to create this wonderful painting for his family.”
- “This patient was only in his 30s and his wife (Sandy) knew that neither of them would want his final moments to be within the four walls of the ICU room. The 3W team made it possible for him and his wife to spend his last moments outside during sunset (which was an important time for them). Right before terminal extubation [removal of the breathing tube], Dr. Neville gave Sandy a blanket and Sandy crawled into bed with him and snuggled with him as he died. She told Dr. Neville that she sleeps with that blanket every night.”
- “This was a young patient who was in our ICU for weeks. The ICU nurse, Shana, had developed a close relationship with his wife and went above and beyond in this patient’s end of life care. On her own accord, Shana bought the hand-casting kit and made them a hand mold that has become a signature keepsake from UCLA 3 Wishes. Our unit director was able to accommodate the family’s request to have Shana as the nurse on the day of transitioning to [terminal] comfort care. Shana also bought a beautiful tapestry for the comfort cart and had some refreshments for the family.”
Another recent example that really got to me was this Tweet from Dr. Neville:
We don’t often think about it, but prolonged #hospitalizations can mean that the #patient hasn’t felt #sunshine or fresh air for months, sometimes until their #death. Here, we grant the #EOL wish for some sunshine therapy. Shared with permission.
Imagine: In your last hours of life, wanting only to feel sunshine once more on your face, and having your ICU team make it happen …
The practice of end-of-life medicine isn’t for everyone, and my admiration and gratitude go out to those who do it – especially to those few who go far above and beyond for their patients and their families like the 3 Wishes team. They are genuine heroes.
Note that an earlier, abbreviated version of this article appeared on RealClearHealth.
Henry I. Miller, a physician and molecular biologist, is the Glenn Swogger Distinguished Fellow at the American Council on Science and Health. He was the founding director of the FDA’s Office of Biotechnology.