A lot of what Smith does is talk to people. She doesn't advocate for or against treatment, but she wants patients and their families to understand their decisions.
If a doctor puts in a breathing tube, for example, that may extend a patient's life, but they won't be able to eat or talk. If they die with a tube in, the family will miss hearing their last words. So now Smith sits down for hard conversations and looks patients and their family members right in the eye. Earlier this year, she was called in to consult with the wife of a patient who was dying.
"When I entered the room," Smith says, "The wife said to me, 'I know who you are.' And I said, 'Oh. OK.' And she said, 'I don't want to talk with you and I don't want to like you because you're here to talk about death and dying, aren't you?'"
Smith had a short conversation with the woman, and left her a book on difficult end of life choices. She went back to visit her the next day.
"And she said, 'You know, I so tried not to like you. And what you had to say. And I really realize that we need to have this discussion now, don't we?'
"And I said, 'When you're ready, we're ready to have that discussion.' And she said, 'I'm ready now,'" Smith recalls.
There's a shortage of doctors who provide palliative care, and the need is growing as baby boomers slide towards old age.
Smith was planning to go back to the emergency room. But interactions like that one persuaded her to stay in palliative care. Now she works more and makes less money. Some days, she wonders if she's crazy.
But then she gets to visit a patient like Dawn Dillard.
Back in her hospital room, Dillard and Smith talk about having a second procedure. Smith leaves and calls Dillard's other doctors. They end up agreeing that the second procedure isn't really necessary after all. So instead of staying another night in the hospital, Dillard is back home by the end of the day.
This story is part of a reporting partnership that includes APRN, NPR and Kaiser Health News.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.
Wed, Jul 03 2013