Leading a Cultural Revolution in End-of-Life Care

​Dawn Gross, M.D., Ph.D., FAAHPM, will present: “Dying to Talk: Making Wishes Come True,” at this year’s Hospice of the Western Reserve Hospice InstituteAnnual Conference on Sept.14. In this interview, Dr. Gross shares a few of the insights she has gained in her dual roles as a Board Certified Physician in Hospice and Palliative Medicine and an educator in end-of-life care.

Q: You have written about your desire to lead a cultural revolution in end-of-life care. Can you elaborate?

A: As a writer, radio host, educator or physician, transforming the taboo around talking about death is at the core of the work I do. By practicing Hospice and Palliative Medicine at an academic institution, I teach medical
students, residents, fellows and my colleagues- as well as patients and families - how to be curious and how to ask questions that are ultimately the deepest expression of love and respect.

Q: What can physicians learn through conversations with patients?

A: For people to die in a manner consistent with their values and preferences, it is essential that healthcare providers know what matters the most to them. When we limit conversations to what procedures patients want or don’t want
without understanding the “why” behind those choices, we fail to provide the bestsupport for someone living a life that matters to them. If I say: “I want to avoid dying on machines,” there is no context as to why I feel that way. If instead, I say: “I love the sound and feel of apurring cat on my chest and the warmth of the sun on my skin,” then medical care can focus on making these things accessible.

Q: Do you believe doctors sometimes struggle with knowing when to
transition patients from cure-directed to comfort-directed treatments?

A: Yes, medical training has positioned doctors to frame our work such that saving life is the measure of success, that anything less is failure. However, this is inherently flawed. You cannot possibly care for a whole person, for their whole life, if you leave out the detail of mortality. The patients and families I get to care for continue to reinforce this truth: that I have no idea what someone wants unless I ask.

Q: There is often a reluctance to talk about the reality of our mortality. Can you comment about this?

A: Death is sad. If you love someone, that is simply so. Yet, silence is worse, because it leaves unanswered questions. I recall my first experience with death as a young child. It was the day our beloved family cat died. He was an outdoor cat, and my father eventually found him curled on our doorstep after we had been searching for hours. He gathered my brother, mother and me into our family room. The words he spoke that day have since infused my
experience of being with people at the end of life. He said we were blessed that our cat chose to come home and to die with us. That we should experience this as an honor not to be taken for granted.

Q: What lessons have you learned from people who are dying?

A: Stay calm and be prepared to be amazed. Like young children, people approaching the end of life are often the most courageous and clear thinking, vibrant and alive people I have known. When people are intimately aware of
death, the small stuff melts away and what matters most rises to the top. They have also consistently demonstrated the difference between wanting something and needing something. When people really need something, the human spirit consistently demonstrates flexibility and astonishing resilience.