Listen or watch this episode on your preferred platform:
Mark Houston: Mark, Welcome to Doc Talk, a weekly podcast featuring monument health physicians addressing medical topics. Tune into your health with monument health. Hello again, everybody, and welcome to another edition of Doc Talk with monument health. My name is Mark Houston, and most of us don't think about end of life care until we absolutely have to, and by then it can feel overwhelming, it can be confusing, and honestly, it can be a little bit scary too. But what if the conversation didn't have to start there? What if there was a whole field of medicine dedicated to helping people feel better, not just at the end, but all along the way. So today, I'm excited to sit down with Dr Jennifer eidingon, a palliative care physician right here in Rapid City, trained at John Hopkins, worked in one of the country's top hospice centers in Maryland, and then you came here to the Black Hills. So welcome, doctor. I'm glad to have you on the podcast today. I'm glad you decided to do this, because I think this is a great conversation to have, even though it's it's kind of a hard conversation to have. So let's start with the basics. Because honestly, I think a lot of people mix these up. What exactly is palliative care? Like, if you had to explain it to somebody at like, a backyard barbecue. How would you do this?
Dr. Eitingon: Yeah, the conversation I have at a backyard barbecue is a little different than in the hospital. But yeah, thank you for having me absolutely not just here, but the Black Hills. It's been a very warm welcome.
Mark Houston: How long have you been here? Oh, that's it.
Dr. Eitingon: About three months.
Mark Houston: You're very new. Then, okay, well, where are you from originally?
Dr. Eitingon: I'm from New York. Originally, I ended up doing my residency. Well, I had a little bit of a convoluted path. I started off as a surgical resident. I was sure I wanted to do surgery, and then I started surgery, and I saw some really hard things. The way that we were taking care of patients who were approaching the end of their life, it felt like we were always offering them more interventions, more surgeries, and what we really need, needed to do was sit down and have those hard conversations. So that was my first kind of exposure to palliative care. I said, Oh, wow, this is, this is really what we need more of in American medicine, not it didn't feel like we needed another surgeon. Not that I don't have unbelievable respect for my surgical colleagues. I just wasn't, wasn't my path. So I did a 180 I moved to Montana, I did my residency in Billings Clinic, and then I kind of knowing that I was going to go into palliative care at that point. I did my fellowship at Johns Hopkins. Worked at Johns Hopkins for a few years, and now I'm here, kind of knowing I wanted to come back and yeah, to answer your question, how do I forgive me? That was right?
Mark Houston: No, no, that's exactly what I wanted to know, perfect.
Dr. Eitingon: So how do I describe? I describe palliative care as as it's a specialty like anything else, right? I had to go to fellowship like, like cardiology, like gastroenterology, it's a specialty that focuses on symptom management, so things like pain, shortness of breath, nausea, vomiting, constipation, all of the things that make us feel crummy. That's my expertise. Under that umbrella exists hospice, and hospice is it's an insurance benefit for the right patient at the right time in their life. And I can go into that a little bit more a palliative care, you know, if I were sitting with a patient a little different than, you know, talking in a barbecue, I describe what we do in three buckets. So first is the symptom management bucket. We focus on making people feel as good as possible. So a lot of our patients have these chronic illnesses. They're dealing with chronic pain, and we work to come up with a game plan to manage that chronic pain. Sometimes it's not medication, sometimes it's psychosocial, sometimes it's meditation, whatever that whatever is right for that person, the next bucket we do is get to know each other, which which helps to manage symptoms, but also to make sure that we're on the right care plan. You know, at a certain point in our lives, it doesn't make sense to go back and forth to the hospital. It makes sense to stay in our home to receive care there, and that might be appropriate to start thinking about hospice at that time. And then the last bucket I do is the paperwork. You bucket things like advanced directives, you know, Five Wishes, care planning things
Mark Houston: like that. So that's, I mean, I guess you did kind of, kind of answer the next question, which is great, because people will hear this term palliative care and automatically assume the worst, right? In how it differs from hospice, right? So these buckets you described, I think is that was a pretty good way to go about it, because it's all, it's all, it's before you get to the hospice care, correct? That's how this whole setup is kind?
Dr. Eitingon: I would describe palliative care more as the umbrella, and hospice is something that sits under the umbrella. Oh, palliative care is the kind of care that's given in hospice, but you don't have to be in hospice to get palliative care.
Mark Houston: Oh, okay, that's interesting. Can you explain that a little bit more? Though, absolutely.
Dr. Eitingon: So we offer outpatient palliative care as well. So for folks who are not in the hospital. We I'm a palliative care physician in the hospital, but we also have palliative care physicians outside of the hospital, and you can see a palliative care provider as at an outpatient appointment to work on adjusting our medications, making sure symptoms are managed. Those patients aren't yet enrolled in hospice. That might not be where they are in their disease trajectory. It just might not make sense for them at that time. So palliative care, again, symptom focused, treatment can still be offered, even if somebody is not enrolled in hospice.
Mark Houston: I see, okay, that's a that's a much better way to for me, personally, to understand that then, well, what is, what is the biggest misconception, misconception families have when they first come to you. And how does that? Can that sometimes get in the way of the care that they're about to receive? Does that happen?
Dr. Eitingon: Absolutely. So, you know, for better, for worse, I think you mentioned this at the beginning. We don't talk about about hard things, right?
Mark Houston: It's exactly, exactly.
Dr. Eitingon: And we don't. We don't like to talk about the end of our lives and what that might look like. So a lot of people do correlate palliative care with hospice. And then when you have a hospitalist or an intensivist say, Hey, I'm going to get the palliative care doctor involved, you know, everyone assumes that means that time is short. And I really try to emphasize that hospice is not a timestamp on somebody's life. Palliative Care certainly isn't a timestamp on somebody's life, but hospice isn't either. It does change the care plan, but very often for patients who have a life limiting disease, focusing on symptoms rather than, you know, recurrent interventions and traveling back and forth to the hospital can prolong life, so it's the right thing for the right person at the right time.
Mark Houston: Okay, perfect sense. Well, I'm, as you're saying this, and I'm thinking about it for someone sitting at home right now who may have parents or a spouse dealing with this, what is the one thing you wish they knew that most people don't find out until it's too late?
Dr. Eitingon: Yeah. Well, I try to think about, I try to think about reframing the conversation. Right? All of us want to live as well as possible, as well as possible, for as long as possible and as long as possible, great. That's that's an objective measure. The as well as possible is different for different people, all right? And I try to explore that when I'm getting to know people, what is the most important thing to is the most important thing to you? You know, continuing your relationships with your doctors, going back and forth to the hospital, getting those treatments, or is the most important thing for you, spending as much time as possible, quality time as possible, with your family, and spending the time that you have at home hospice does involve sending a nurse to the home or a social worker, or making sure people have the support that they need at home. So I try to reframe the way we're thinking about our healthcare in terms of focusing on our values. First, what's the most important thing for our life, and then how do we integrate medicine to help promote those values to get to get the quality of life that we want?
Mark Houston: Now, you talked about that you when you first started you you thought maybe that being a surgical doctor was the way to go, and you kind of touched on, on your thought process and getting where you are now. But was there a moment where you realize that, that, because this is a, this is an incredibly compassionate field that you have to be in, and like you said, you wanted, you know, to just go beyond the surgery a little bit to not constantly have everybody, you know, that's where they like you said that they're worried about going to the doctors and going to the appointments, but where, where was that moment for you? Because I as a surgeon, and again, we love our surgeons, of course, but they get to go to the room, do the procedure, walk out. Go to the next one, go to the procedure, walk out. I don't know how much it sticks with them. But this has to stick with you when you're talking to people like this all the time. So I'm so interested in that decision, where it clicked for you, like, well, this is what I want to do.
Dr. Eitingon: Yeah. I mean, I could name so many, so many patients I, er, there were. There was a particular patient that I was taking care of in my in my surgical residency, who had been there for months, she had these wounds on her stomach and her back, and every day, we were changing the dressings for her wound, and she had to turn over onto her side and then on her back again, and it was incredibly painful. And she was in the hospital for months, and she was becoming more and more withdrawn, and eventually she lost capacity, which unfortunately, is something that happens when somebody is in the hospital for a long amount of time for lots of reasons. And I just stopped, and I said, What? What are we doing? Like when one, when did she lose her autonomy? So, so the other kind of hat I wear that I'm very interested in is ethics. I have a master's in bioethics as well. Um, so when did she lose her autonomy, and are we doing things that are improving her life? Is, is the medicine helping? Is the medicine that we're providing helping anymore? Or should we be reevaluating our care plan? So that was, that was kind of where, where I wanted to know if there was a different way to approach things. That was, that was the patient that really stuck with me. But there were a lot of circumstances like that, yeah, you know. And for some patients, you know, I am published in the end of life care for Orthodox Jewish patients. And they're really interesting to me, because very often they they accept a kind of care that that's considered a vitalist ethic, which means do everything that you can for another breath of life. That's that's considered the appropriate care plan for them under their religious law, right? So they would do anything that they could, any procedure that was offered to potentially lengthen their life they wanted to pursue. But for most of us, that's not, that's not what we want. So kind of navigating that seeing where somebody's values lie is, I think, a really important path to explore, to get to know people and making sure we're treating them in the right way.
Mark Houston: I suppose you have to take into as well all of those different spiritual beliefs that people also, I mean, that's that has to be, that has to be a maze to walk through as well in a lot of instances. Well, you, you like said, You trained at John John Hopkins. You worked in Baltimore. You were in Israel for a while, I believe as well. You've had this whole career on the East Coast. And then you come out here, and I'm really interested to know, does the care change? Is it different on the east coast as it is in the Midwest? Because, again, we all have a lifespan, and we all have the same end. Is it different in these you mentioned, like with, especially with the the Jewish religion and how it will to the last you know, so you can get your next breath. Some religions don't follow that. Some spiritual guidance doesn't follow that. That difference has to be, first off, just fascinating, right? When you talk to people and how it's going to how it's going to wrap up. But how does it, how does it How does it differ when you come out here? What do you see different when you arrive here?
Dr. Eitingon: Yeah, so I like to approach things very modestly. I've only been here a few months. I don't pretend to have this in depth understanding of what people believe, but I'm really looking forward to learning about especially with the Lakota tribes. I want to learn more about the spiritual belief, the cultural beliefs that people have, because, again, I really want to reiterate. I want to make sure we're taking care of people the right way. Medicine can do a million things. Are those million things right for everyone? Probably not. So to speak to how things are different, yeah.
Mark Houston: Like said, you had a very short amount of time. That was kind of a big question.
Dr. Eitingon: I will say, you know, and I felt this way when I lived in Montana as well. I folks are tough as nails. Here, you know, you'll have somebody who, you know, has been a rancher their whole life. They come to a doctor for the first time. They're already missing two fingers. They just, you know, shrug it off. They said, Of course, I didn't come to the doctor. I'm fine. So folks are tough as nails here, and maybe that makes these conversations even harder, you know, maybe not. Maybe because folks are, you know, on farms, they see the death of cattle, right? That this is just more a part of life, exactly.
Mark Houston: And that's, that's, that's really interesting. That's why I asked if, and again, I should have taken that into consideration. You haven't really been here long enough, but I'm assuming that in you know, all different parts of the world, of course, it's all different. But how? How, just in our country, as big as it is, how did difference from the East Coast to the Midwest to the to the West Coast, and how people feel about this when they are nearing that stage? And you you have to navigate that with them, and you have to kind of understand that, and that is learning a lot of ways that people deal with this and that, I mean, you have to really be you have to love this, which is weird to say, but you still have to,
Dr. Eitingon: Yeah. Well, I Yeah. I love exploring people, right? They're different. They're different paths. And, you know, none of us make our decisions in a bubble, so we're all very relational. And how, you know, one person's relationship with their with their third cousin might be the most important thing to them, so everybody else's relationship with their son or their God might be the most important thing to them. And kind of everyone has their own priorities and path that they're that is taking them in their own direction. So, I mean, I really love people. I love having those conversations and learning so have me back in about a year, and maybe I'll have more to say.
Mark Houston: Oh, we're gonna, I mean, I absolutely want to do that, once you get to know the people that are here, and you've, you've kind of touched a little bit on on the conversation that we've had, but, um. Um, having that conversation with a family who isn't ready to hear it. I mean, there has to be parts of your job that you want to sit down and and talk and explain. How do you navigate that? How do you do it with the people who they know they have to hear it, but they don't want to hear it, right?
Dr. Eitingon: Yeah. Well, you know, I, I don't consider, I consider emotion, a success if we're reaching a place where we are, you know, a listening, some emotion, that's an understanding. And yes, there are going to be sad emotions. Death is sad, you know, this is disease is sad, if, if, and I think it comes with a lot of meaning and a lot of purpose and a lot of opportunity to have really hard conversations. So yes, I think a lot of what I do does elicit some really negative feelings, but sometimes that opens the door for really right?
Mark Houston: Do you get people that get, they get mad, they get they get upset because they're, you know, God, I don't know how, I don't know how you navigate that. That's just, that's amazing.
Dr. Eitingon: Well, I, you know, it's, I remind myself, and I remind my staff and the folks I work with that it's not, it's not about us, right? It's, it's the anger is not directed at us. We're angry at the situation. You know, when, when we're sick, we're angry at our bodies, but it comes off where we're projecting our anger at everyone else, you know, yeah, so I think just reminding that and staying humble in that everything is so much bigger than us, it's not anger that's directed at us. I know that right? I've had, I've had patients and their families, you know, apologize to me the next day and say, you know, I'm really sorry I yelled at you. It wasn't anything you said. And I said, I know you don't have to apologize. I get it like, this is, yeah, this is tough, and this isn't, this isn't about me, you know, right? Well, how
Mark Houston: does that like here in Rapid City, now that you're here, now that you're kind of getting, you know, into the system and getting to know the people. How does if somebody is hearing this and needs to begin this process, then where do they start?
Dr. Eitingon: Yeah, so again, it depends. Palliative care is always available. And again, I emphasize, palliative care is a specialty, like cardiology, you know, like endocrinology, if, if you feel like you're having symptoms, if you have some kind of chronic illness, and you feel like your symptoms are not adequately controlled, ask to see a palliative care provider. We haven't we have an outpatient Palliative Care Clinic, and then they can help explore with you. We can help explore with you, whether or not it makes sense to consider transitioning care to hospice. I would say again, that's up for a small part of the population that's seeing a palliative care provider. But again, palliative care, what we do is we help get to know folks and explore their values and making sure we're treating them in the right way.
Mark Houston: So I don't think a lot of people knew that this was even an option in some in some cases, that this this exists now. Now are you are you the team? Or are there other teams as well?
Dr. Eitingon: Yeah, we have, we have three doctors and two nurse practitioners as the makeup or palliative care department. We have an outpatient service inpatient the hospital as well.
Mark Houston: So did they do you recommend? Can they just make an appointment directly with you guys? Or should they go through a primary care doctor, or should there? Is it like a process?
Dr. Eitingon: Great question. Very often we get our consultations from the hospital. So when somebody is having these recurrent hospitalizations, perhaps for symptom management, then we say, Hey, do you want to see somebody outpatient? But there's no reason that you can't reach out to the palliative care department directly
Mark Houston: get an appointment. Okay, yeah. All right. Very good. Well. Dr, Jennifer, I didn't gone. Thank you very much for coming in and talking with me today. Again. This is, this is these podcasts. Are, you know, the emotion that are behind them. They're, they're kind of even hard to listen to. I think people will look at what the topic is and be like, Well, I'm not ready for that conversation. I don't want to hear this yet, but I think everybody should hear this. I'm a firm advocate of having the conversations, because you're going to have to at some point, and if you're prepared for it, then never going to get easier, but less stressful, maybe in certain situations. And just happy to know that we have it here for sure, right? So thank you very much for coming in and talking. I appreciate it. And again, we'll have you back in a year to see just how you got to know everybody around here, and if you still think we're as tough as you think we might I don't know Anyway, thank you, doctor. I appreciate it. Thanks for having me. You.