GERIATRIC EMERGENCY MEDICINE
Palliative Care Fellowship: An Option for EPs Passionate About End of Life Issues
SAEM PULSE | NOVEMBER-DECEMBER 2020
By Ashley Shreves on behalf of the SAEM Academy of Geriatric Emergency Medicine
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My emergency medicine (EM) residency director told me he was “surprised” (read “disappointed”) that I was not pursuing a fellowship. It was my third and final year of residency and I was going to stay on as an attending where I had trained, but with no clear niche. I wanted to be passionate about something in EM but none of the available fellowships were a good fit. The hospital where I worked my first couple of years out of residency was surrounded by long-term care facilities and it seemed like a large part of the job would involve “doing everything,” no matter how uncomfortable or lacking in dignity, to prolong the lives of frail, older patients with advanced dementia. I suspected that many of these patients would be horrified if their cognitivelyintact former selves could see the “care” they were receiving in their later years. The POLST (Physician Orders for Life-Sustaining Treatment) program was in its infancy in New York City so
“There has been an explosion of fellowship programs over the past decade and essentially all are available to emergency physicians.” advance directives rarely accompanied patients to the emergency department (ED). Unfortunately, when I tried to talk to family members about goals of care, I lacked any appreciable skills to navigate these discussions. In fact, I don’t think I was even familiar with the concept of a “goals of care conversation” and had only a rudimentary understanding of palliative care. In 2009, I had a particularly challenging end of life case and my failure to advocate for the patient gutted me. I started to question everything. Fortunately, that same year, a series of
articles were published in the July 2009 Annals of Emergency Medicine about a new subspecialty available to emergency physicians: hospice and palliative medicine. As I read these articles, the proverbial lightbulb went on, and soon after I started to research palliative medicine fellowships. Then in 2010 I read Atul Gawande’s “Letting Go” (the best piece of medical journalism ever written, in my opinion) and any lingering doubts were put to rest. In 2011, four years after completing residency, I started my palliative medicine fellowship at Mt. Sinai. It was a huge leap of faith
