Stories about: Pediatric Advanced Care Team

Palliative care: Not just end of life care

Hillary and EsmeMy daughter Esmé is a four-and-one-half-year-old girl who loves listening to “The Muppets Movie” soundtrack, laughing at silly jokes and reading books. Esmé has been a patient at Boston Children’s Hospital since she was 8 months old, when she started seeing the Aerodigestive Clinic for chronic aspiration. She is followed by a number of specialists to treat her epilepsy, low tone, kidney and heart abnormalities, developmental delay, poor growth, lack of verbal communication, among other things. Esmé is presumed to have a genetic disorder, but, so far, she does not have a clear diagnosis.

Last week I had an appointment that I was both really looking forward to and dreading, simultaneously. The appointment was with Pediatric Advanced Care Team (PACT) at Boston Children’s. They are the group who does palliative care there.

Now, I know that most people hear “palliative care” and think very specific things about end of life care.

I did, certainly.

And, frankly, my associations with palliative care were enough to make me not want to have the meeting with them in the first place.

However, we have reached that place in Esmé’s care where, while she much more stable than ever, there are some roadblocks that affect her (and our family’s) quality of life. Several of my mom friends who also have children with similar needs suggested that it might be time to talk to palliative care.

I said, “No. Absolutely not.”

Palliative care and stress relief

But, after my knee-jerk reaction, I thought it might be smart to see if my understanding of palliative care was, in fact, accurate. And it wasn’t. Palliative care is “specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.

Wow, right? Obviously Ez has a serious illness. And, I’m sure this will surprise all of you, but there is stress (oh, God the stress …). While palliative care can be a method used in conjunction with end of life concerns, it is fundamentally focused on living–living happily and comfortably despite on-going serious health challenges. And, because we are in this for the longterm, it seems like improving Esmé’s quality of life–and the quality of life of our family unit–is sort of a no-brainer…

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Parents consider hastening death for terminally ill children

Joanne Woolfe, MD, MPH
Joanne Wolfe, MD, MPH

For parents already dealing with the sadness, anger and guilt of having a child with a terminal illness, watching that child experience pain in her last days is excruciating.

In a study led by Children’s Hospital Boston and Dana-Farber Cancer Institute’s Joanne Wolfe, MD, MPH, which was covered today in The Boston Globe and Time magazine, more than one out of eight parents who were surveyed considered hastening the death of a child with terminal cancer, with their child’s suffering increasing the likelihood of such thoughts. Five parents said they actually asked a caregiver to speed up their child’s death. “The fear of pain is the critical factor for parents with regard to hastening death,”said Wolfe in the Time article.

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