Rowan prepares hospice, palliative specialistThe Philadelphia Inquirer
September 09, 2013
WESTMONT - Jennifer Chiesa rolled her chair close to her patient, who took up a quarter of an armchair, frail and breathing heavily, with small tubes pumping oxygen into her nostrils.
"How've you been feeling?" Chiesa asked with a disarming smile.
"Good days and bad days. I like to forget about the bad," said Helen Volz, 79, a hospice patient since 2009.
Chiesa met Volz for the first time Wednesday as part of her yearlong clinical fellowship in hospice and palliative care through Samaritan Healthcare and Hospice in collaboration with Rowan University School of Osteopathic Medicine. The fellowship is the first of its kind in New Jersey and one of fewer than a dozen hospice fellowships in the country.
"It's unlike any other kind of medicine," Chiesa said. "It's really a positive thing that lets patients participate in and look toward the end of their life."
As the population ages and more hospitals add hospice and palliative care (the treatment of chronic pain for nonterminal patients), the need for the specialty is at an all-time high.
With board-certified national training requirements changing in 2015 to include a mandatory one-year fellowship, the need for programs like Rowan's is also likely to grow.
Before Rowan instituted its fellowship, the University of Pennsylvania was the only school in the Philadelphia area with a fellowship in hospice care. Penn's began in 2009.
Chiesa's training will include lectures and panel discussions as well as clinical work meeting with patients like Volz, who has end-stage lung disease. Volz's lung tissue has started to deteriorate and her muscles are starved for oxygen, making the slightest movements feel like a workout. She weighs somewhere under 80 pounds (she asked not to be weighed anymore once the scale tipped below 80). Doctors have been giving her six months to live since 2009.
"I'm still here," Volz said with a toothless smile. "It's my husband. He's giving him hell up there. Even up there, he's telling God what to do."
As Chiesa examined Volz, the two chatted easily. Chiesa asked about all of the figurines and pictures of President Obama covering the walls and bookshelves of the small bedroom in Westmont. "I love him," Volz told her, "Don't tell Michelle - I don't want her coming after me."
Volz told the doctor she voted absentee in 2012 in case she died before the election, prompting them both to break out in laughter.
"There's a stigma that hospice work is always bleak and depressing," Chiesa said. "But I love it. Often you're the one person seeing and treating this patient."
Marianne Holler, a clinical assistant professor at the Rowan School of Osteopathic Medicine and the fellowship director, echoed that sentiment.
"I have fun all day, every day. And you know, we might be the only ones who treat them that way. Friends and family treat them like sick people. We take our work seriously, but we don't take ourselves too seriously."
Holler said it was important to find those qualities in a fellow.
"They had to be compassionate and have strong clinical skills but also to be able to fool around when it's appropriate."
Still, some cases can be heartbreaking, as can the daily drain of working with terminal patients.
But hospice work is team-driven so a massage therapist, a chaplain, a psychologist, and a physician all collaborating on someone's care will support one another as well.
Once every two weeks, teams get together to remember those patients who died in the weeks preceding. It would be impossible to go to every funeral, Holler said, but she makes it to about one a month.
Chiesa, 31, who lives in Cherry Hill with her husband, did a residency program at Samaritan while in medical school at Rowan.
This year she's the only fellow, but there are hopes to expand, said Joanne Kaiser-Smith, Rowan's assistant dean of graduate medical education. She said she has received a dozen applications already for next year. The fellowship is designed for three people, but the private funding from Samaritan can support only one fellow now.
It's hard to compete for grants, Kaiser-Smith said.
"People have tended to focus on saving someone's life as opposed to quality of life. But not everyone wants that kind of care. People want to be able to have the best end of life they can, which is a relatively new focus," Kaiser-Smith said.
As Chiesa's visit wound down, Volz placed her hand on the doctor's protruding stomach. In addition to juggling classes and clinical rotations, Chiesa is expecting her first child in eight weeks. "Girl," Volz said.
"You sure? The doctor says it's a boy," Chiesa replied.
"Doctors predict wrong," Volz said. She's living proof of that.