President's Message

Monique Schaulis, MD, MPH, FAAHPM

PALLIATIVE MEDICINE

Over the years, quite a few people have said with puzzled

looks, “You do Emergency and Palliative Medicine? Aren’t those polar opposites?”

I chose to train in Emergency Medicine in the late 1990s as a way to be there for patients in the most dire situations. I became proficient at resuscitation and occasionally performed lifesaving procedures. But once I left Alameda County’s Highland Hospital, I discovered that outside of desperately underresourced communities, Emergency Medicine can be less dramatic. Unsurprisingly, when people have access to education, healthy food, good jobs, and solid preventive care, they don’t come in on death's door so often. Instead, diseases like cancer or substance use disorder are often prevented or diagnosed at an earlier stage, diabetes and hypertension are addressed, and patients don’t die nearly so young.

My current patients at Kaiser usually grow old, and with time, accumulate multiple chronic illnesses like congestive heart failure, CKD, COPD, cancer, dementia, and frailty. Their emergency visits are frequently for complications, like sepsis or trauma, that accompany chronic illness. In the decade after I trained, I admitted so many patients like this to the hospital but most seemed to cycle in and out of the ER, hospital and nursing facilities. I worried that under these circumstances I wasn’t healing anyone, and indeed it seemed that my treatments and the hospital sometimes worsened their suffering. Something just didn’t feel right and I knew I needed some different skills.

My search led me to Palliative Medicine. This new (to me) medical tribe taught me another language and culture. I learned ways to leave my agenda aside and compassionately listen, to discuss serious illness and dying, to elicit patient and family values, to help to plan realistically for the future, and provide an extra layer of support. I also grew to appreciate the power of an interdisciplinary team including chaplaincy, nursing, and social work.

Many people, even physicians, don’t truly understand what the Palliative Medicine specialty does. This doesn’t surprise me because it is so multifaceted. In a day on the inpatient team, I might work with a patient on strategies to address pain or constipation, and with the next patient discuss how to talk about cancer with children. We might weigh the pros/cons of starting or stopping dialysis, or think through options for a culturally appropriate board and care facility versus home caregiving. Palliative medicine is an incredibly broad field; the constant is providing the extra support that patients and families need.

I had hoped to help host a SFMMS palliative medicine conference this fall but organizing it during the pandemic made me want to tear my hair out repeatedly. Instead, we share this journal issue dedicated to the specialty that I hope will showcase its depth, breadth and creativity. We have such an amazing community of palliative care innovators and leaders here in the Bay Area who have graciously shared their time and expertise. Enjoy!

Monique

Dr. Monique Schaulis, MD, MPH, FAAHPM, is a graduate of the University of Chicago Pritzker School of Medicine. She practices Emergency and Palliative Medicine with The Permanente Medical Group in San Francisco. She is President of SFMMS and serves as faculty for Vital Talk, a non-profit that teaches communication skills for serious illness. Dr. Schaulis chairs the Medical Aid in Dying special interest group for the American Academy of Hospice and Palliative Medicine.

Greetings to all at the end of yet another most challenging year. In our last issue, we focused on addiction medicine as a relatively new, and entirely essential subspecialty and focus deserving of much wider attention across many medical specialties and settings. This time, with similar intent, our focus is palliative care. We are fortunate to have so many of the leaders in this field here in our local area—and in this issue of our journal, thanks largely to our 2021 SFMMS president Monique Schaulis. We hope you will find their offerings stimulating and enlightening, and we wish everyone a truly rewarding and restful holiday season. – The Editors