I get to watch Oprah usually once or twice a week and yesterday was one of those days that I'm glad I didn't miss. The two guests were both "terminal" cancer patients with hopefully realistic outlooks on their respective prognoses. As a longtime student of palliative care and end-of-life care improvement, I was intrigued enough with Randy Pausch's abbreviated version of his famous "Last Lecture" that I went to the Carnegie Mellon website and viewed the entire lecture. It's an hour and a half long, so save the link until you have the uninterrupted time to pay attention. It's both inspirational and bittersweet...and time well spent for anyone who, like me, is tempted to give up when the going gets tough.

The cornerstone of the lecture is childhood dreams and how to achieve them. I've always been a big dreamer beginning with the desire to be an astronaut as a kid. Never mind that I'm scared to fly...I was just fascinated with the whole idea of being able to go out in space and explore things outside of our little planet. I remember like it was yesterday sitting in awe in front of a black and white TV screen watching the first walk on the moon. While I never dreamed about working in healthcare, my natural gravitation toward science courses foreshadowed my future career. The clinical laboratory tends to be a very structured type of work environment with life and death decisions being made on the results of tests where there is very little room for error. Once again, the dreamer in me tired quickly of being in the box, so to speak. Years of watching patients and their families deal with healthcare decisions sent me on a side trip where I found a passion for alternatives to aggressive and often futile treatments in which the focus is on quantity rather than quality of life. The buzzword around the healthcare industry these days is "outcomes" with payor reimbursement soon to be based on easily available information compiled and distributed about the "outcomes" at all facilities.

I am not against this...by any means. Healthcare providers should be held accountable and the consumer should have that information to aid in the decision making process. But how do you "measure" the outcome of a life lived fully with no regrets and a a peaceful death? Each of us will die...mortality and taxes are givens ;) The difference is that some will die never knowing how to truly be happy in the moment while others will die knowing that they've done something meaninful with the gift from Big Ernie. Some will whimper on the way out, and others will sing. It's a glass half full type of deal.

That is where the improvments can be made. Palliative care seeks to keep a patient comfortable and maximize the quality of the time that is left rather than focusing on a "cure", per se. That is not to say that all treatment is abandoned. Many treatments, including chemotherapy and radiation, can be used palliatively to keep a patient out of pain or buy him or her a little more time to deal with end of life issues like finances and resolution of family matters. Yet the focus is always on QUALITY of life.

That's not a childhood dream, but an adult one. And I intend to find a way to make it happen for more people. I don't know how or when, but the karma is out there somewhere to pull that discipline into the prominent spot that it should be within the medical community. And I intend to be a part of it. As Randy says, the brick walls are there for a reason...to see how bad you really want something. I've hit a lot of them and given up before.

Thanks dude. The fire has been re-kindled.

^j^