Skip to main content

Dr. Desiree Pardi: Reconciling Her Life and Her Death

The New York Times recently ran an article titled "Helping Patients Face Death, She Fought to Live". The article told the story of Dr. Desiree Pardi's experience dealing with breast cancer, and how she "angrily refused" palliative care consultation when confronted with the advanced nature of her underlying cancer. What makes this story so provocative is that Dr. Pardi was the palliative care medical director at Weill Cornell Medical Center.  Many questions are raised but there is little to help with the reconciling "Desiree Pardi palliative care doctor who believed in a peaceful death, with Desiree Pardi the patient who wanted to keep fighting."

Well today, thanks to our colleagues at Pallimed, we hear from Dr. Pardi's husband, Robert. He very eloquently clears up some of the misconceptions about Dr. Pardi's decisions. He also does something that we as a community have difficulty with - describing to the general public the role of palliative care:
Please understand Palliative Care is about providing people the information they need (and avoiding false hope) so each and every one of us can make a decision about how we want to deal with a chronic disease. It is about quality in life and quality in death and tailoring a medical plan to achieve those goals.
The Times piece and the Pallimed posts are well worth the read. As Rob Pardi states in his comment on Pallimed: "One thing my wife wanted was for people to learn, to discuss, to explore the concept of palliative care based on her illness and I am thankful so many of you are discussing." So, please join the discussion...

-

Comments

Chrissy Kistler said…
I do wonder about how I might handle a terminal diagnosis at an early age... or at any age... I think that she died as she wanted and we should respect that. But we also shouldn't make everybody feel they have "to fight on" or "never give up". Maybe I don't want to have to endure what Dr. Pardi did. Does that make me weak? I guess the article made me a little angry to begin with, in that I thought, perhaps, her behavior was a rebuttal of my palliative care beliefs. However, on reflection, I think they aren't incompatible with palliative care.

I think we should be careful to say that one-size-fits-all doesn't work for older adults and neither does it work well for dying. I remember hearing a quote somewhere that goes something like, "One door leads into life, but many lead out." We all have to find our own way. With this in mind, I can be sad that Dr. Pardi had so little time but glad that she was in control of her life and her death. And that, that is okay.
Dan Matlock said…
I have had 2 cardiology and 1 oncology colleague refer me to this article "you should read this" as if it was going to be some surprise. I sent each of them her husband's response which I think is extremely powerful. The author of the NY Times article perpetuated many of the wrong assumptions that many of our colleagues have about palliative care.

Good patient-centered end-of-life care may entail a very aggressive course of treatment (often it doesn't, but that doesn't mean it shouldn't)

Thanks pallimed.
Eileen Kennedy said…
What an interesting story. It just reinforces what I've learned in my 40 yrs of nursing, that you cannot assume anything with our patients. We often come into their lives after they have almost lived them in their entirety. We cannot assume what they know or who they are, but be grateful to be in their lives to assist them near the end. There is always something to learn from each and every patient we meet, and that is what is so fascinating about this profession.
This story is also an amazing love story on the part of her husband. It left me amazed at the journey she chose to take, and his support of it.

Popular posts from this blog

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Length of Stay in Nursing Homes at the End of Life

One out of every four of us will die while residing in a nursing home. For most of us, that stay in a nursing home will be brief, although this may depend upon social and demographic variables like our gender, net worth, and marital status. These are the conclusions of an important new study published in JAGS by Kelly and colleagues (many of whom are geripal contributors, including Alex Smith and Ken Covinsky).

The study authors used data from the Health and Retirement Study (HRS) to describe the lengths of stay of older adults who resided in nursing homes at the end of life. What they found was that out of the 8,433 study participants who died between 1992 and 2006, 27.3% of resided in a nursing home prior to their death. Most of these patients (70%) actually died in the nursing home without being transferred to another setting like a hospital.

 The length of stay data were striking:

the median length of stay in a nursing home before death was 5 months the average length of stay was l…

Palliative Care in Nursing Homes: Discussion of a Multinational Trial with Lieve Van den Block

Nursing homes are a tough place to do palliative care.  There is extremely high staff turnover, physicians are often not present except for the occasional monthly visit, many residents die with untreated symptoms usually after multiple hospitalizations and burdensome life-prolonging treatments, and specialty palliative care - well that is nowhere to be found in most nursing homes outside of hospice.  So what can we do to improve the palliative care outlook in nursing homes?

On todays podcast we talk with Lieve Van den Block about her recent palliative care intervention that was published in JAMA IM this week.  Lieve led a multicomponent intervention to integrate basic nonspecialist palliative care in in 78 nursing homes located in 7 different European countries.  Just take a moment to grasp the size of this study - 7 counties, 78 nursing homes.  I struggle with just trying to improve palliative care in one site!

We discuss with Lieve the results of the study, her take on why they got…