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Palliative care, hospice devoted to end-of-life needs by Chris West  Public Relations   “It's not that I'm afraid of dying, I just don't want to be there when it happens,” said Woody Allen.  Culture, belief and faith aside, it confuses us, eludes us and petrifies us. And to make matters worse, we're expected to do it the right way. What is it about the end of life?  Fear of the unknown, cessation of life, coming to the end—however it is termed, the majority of us would side with Woody.  Yet, there exists a group of facilitators who devote their care to the dying process. Not their own death and dying process, but yours. And where we all must walk the path towards the end of life, hospice and palliative care tell us the condition of the path is fully within our grasp.  The nature of palliative care is rooted in its very definition. Palliate has come to mean ‘to reduce the severity or intensity of...’ Palliative and hospice, in terms of health care have come to mean making the end time of a patient comfortable, managed and ever maintaining the maximum quality of life.  At least that's how Frank Brescia sees it.  “The words hospice and palliative are really interchangeable,” said Brescia, M.D., professor and clinical director of palliative and supportive care. “Within the big world of medicine they have been interpreted differently, but the level of care is the same. “It is a very different form of care,” Brescia said. “In this type of care, you are already aware of what the outcome will inevitably be and you aren't trying to change that. You simply attempt to make the path towards that outcome better. Treatment will be comprehensive and either short-term or extended.” Brescia admits this isn't always easy in that it brings into conflict two different missions.  “As physicians we do what we do to preserve life. But how does that factor in when you know a patient's condition just isn't going to improve? Then your focus must shift from curing the incurable, to making the conditions acceptable. But physicians don't like to give up. That's a form of admitting defeat. It may be unethical to only prolong the dying experience. This is where the two mission statements come into contrast.”  The condition Brescia is talking about is the very root of successful palliative care in comprehensive management of pain and  other symptoms. Once what looms on the horizon in the condition of a sick patient has been established and final assessments have been made, palliative and/or supportive care goes into motion by managing or alleviating pain and symptoms and insuring that the maximum quality of life is sustained.  What is required to ensure that quality end-of-life care is maintained? Anything and everything according to the patient.  “In this manner of care, the goals of each patient are different and unique to that patient. Generally, our goal as physicians under the umbrella of palliative care is to make the patients' conditions comfortable, pain-free, with their family and as in control of their situation as can be expected,” Brescia said. “Palliative care and hospice encompass social, family and spiritual components and attempts to meet the needs of each component.” With so many facets within this form of care, it leaves no type of facilitator untouched. Pharmacists are required to disperse medications to manage symptoms, psychologists, psychiatrists and social workers may be needed to address end-of-life issues, pastoral care may be necessary to cover spiritual needs of patients and their families. And perhaps the most necessary, nurses who accommodate any hands-on needs of the patient.  “It has to be multidisciplinary due to the myriad of needs that may have to be addressed,” Brescia said. “But nurses are the glue of the system. They hold it all together and bare the brunt of the care.”  With more than 2,000 hospice facilities nationwide, more than 390,000 people used its services in 1995. Brescia speculated that current numbers would probably be around 500,000 people opting to receive this type of end-of-life care.  And while those impending days will catch up to us all, no one seems to want to talk about it. As if our very society has chosen to deny those end days only to address them when they may come. Brescia echoes this mentality.  “We don't want to think about it. Most of us would endorse the 'death with dignity’ credo, but when it comes down to it we really don't want to do it at all,” Brescia said. “We are a society geared toward youth and being young, yet we are becoming an older society where most deaths will happen.”  While we know what looms on the horizon for us, what's to come for hospice and palliative care? Brescia and the palliative team have continued to make strides since their beginnings in January 1998. The palliative level of care is shared with physicians through monthly conferences. It is reinforced on rounds and hopefully become part of fellow training.  “We are examing what needs to be done to fit into the academic culture here,” Brescia said. “We are trying to establish a palliative fellowship with funding, attempting to establish research goals and concentrating on  teaching students and physicians. Our plate is pretty full.”  For more information on hospice, contact Chris Darnell, Hospice of Charleston, at 529-3100.