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Every weekday at 8:00 a.m., the members of the palliative-care team crowd into a conference room to discuss their patients. They begin with a poem or some other reading that helps them leave behind, at least for the moment, whatever had been on their minds as they made their way to work. "What we want to do is come together and focus on those we serve," says Donna Soltura, the team's social work coordinator (at the end of the table, in front of the bookcase). "Alone, none of us would be as good at this as I think we are together."

Simply Present

Often confused with hospice care, palliative care is, at its core, about caring. About caring for the patient, not just the patient's disease. About simply being present for patients, as Ira Byock, the nationally prominent director of the DHMC palliative-care program, puts it. Here's a look at just what that means.

Text by Amos Esty • Photographs by Jon Gilbert Fox

Palliative care is sometimes thought of as an alternative to receiving treatment—in effect, preparing to die. It's true that the doctors, nurses, and other staff members on DHMC's palliative-care team deal with death as part of their daily routine. But it's quickly apparent when observing them at work that their real gift is for helping patients and their families to live.

While some palliative-care patients are close to death, others have many years ahead of them. But all have serious illnesses that affect their health and complicate their ability to get through each day. The issues raised by the palliative-care team in their conversations with these patients and their families can be uncomfortable: physical disability, emotional well-being, family dynamics, finances, and, of course, death. But they do raise them, gently, time after time. Evidence from clinical trials shows that these efforts are effective—that palliative care can both improve patients' quality of life and, in some instances, even prolong their lives.

But the methodologies of palliative care do contrast with much of modern medicine. Unlike other specialties, what palliative care has to offer is not the promise of a cure but the ability, and willingness, to talk and to listen. As Dr. Ira Byock, the director of the program, wrote in his book Dying Well, "While I may bring clinical skills and years of experience to the task, ultimately I am simply present, offering to help."

Amos Esty is the managing editor of Dartmouth Medicine.

Life and death

Watch interviews with Dr. Ira Byock
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All the patients pictured here gave permission for their images and stories to be shared.


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