A View of Palliative Medicine: The Third Option

Abstract

            As a fellow in Hospice and Palliative Medicine at Dartmouth-Hitchcock Medical Center, I commonly encounter patients who are facing the quandary of choosing between disease-directed and symptom-directed care pathways.  Exclusive commitment to either leads to outcomes that are often unfulfilling and at times cruel. I wrote this story as way of communicating the concept of a third pathway, one that can often bring meaning, balance and hope to the journey of terminal illness. Although the concept of the third pathway is somewhat ideal, it is the very essence of what palliative care providers strive for in the guidance of our patients.

            The story also reflects on other themes that are common to our practice: the shock that comes when serious illness becomes reality, the hard acceptance of medical technology’s limitations, the sense of isolation a patient feels from those who are still well, the regret of past mistakes, the recasting of one’s personhood and the reassigning of goals when time becomes short. Finally, the story offers an evolving depiction of medical providers as seen through the eyes of an ailing patient.