韩国裸舞

Ahead of his January 21 lecture 鈥淧alliative care as a place of healing,鈥� the inaugural event in the 韩国裸舞 Palliative Care National Grand Rounds Programme, Michael Kearney, MD, sat down with us to share his wisdom gleaned from聽nearly 50 years in the field, including here at 韩国裸舞 working with the legendary Balfour Mount, MD.聽

Can you tell us how you first became interested in the field of palliative care?

It was in the 70s 鈥� back then, it wasn鈥檛 palliative care, it was just hospice 鈥� and I was a medical student and sort of disillusioned midway through my medical studies.聽A mentor of mine said, 鈥楤efore you leave medicine, please visit this place in London called St. Christopher鈥檚 Hospice [founded and run by Cicely Saunders] 鈥� it鈥檚 a place of healing.鈥� There was something in that phrase 鈥� 鈥渁 place of healing鈥� 鈥� that really resonated with me. And so I ended up there on a one-week training and I just felt, 鈥楾his is where I want to be.鈥�

Each of us got to meet with Cicely Saunders at the end of the week and she said to me 鈥業鈥檝e someone here I鈥檇 like to introduce you to, a Canadian surgeon who鈥檚 come over to see what we鈥檙e doing here聽because he wants to bring our approach into the acute hospital setting. His name is Balfour Mount.鈥櫬燬o that鈥檚 where I met Bal for the first time.

Incredible that you are connected to two of the legends in the field of palliative care. Can you share a little bit about their influence on your career path?

What I got from Cicely Saunders was an approach to medicine that combined the best of evidence-based biological medicine with heartwork 鈥� care and kindness. What I learned from working with Bal was his passion for what he called 鈥榳hole person care鈥� and how the more we clinicians are whole persons in our caring, the more we can foster that in our patients and families.

Your lecture is titled 鈥淧alliative care as a place of healing鈥� 鈥� can you explain what healing means in the palliative care context, when people are approaching death?

Cicely Saunders talked about the concept of 鈥榯otal pain鈥� and how physical pain is really just the tip of an iceberg 鈥� nine-tenths of it is out of sight, namely the psychological, emotional, social and existential dimensions of pain. Encouraging healing in this setting is recognizing that suffering is a multidimensional experience. That鈥檚 why palliative care is very much a team approach, with different disciplines bringing a different perspective and skill. But at the core of it is a movement towards an experience of integration and wholeness.

Bal and his colleagues Pat Boston and Robin Cohen published an extraordinary study in 2008 where they looked at 20 individuals who were close to the end of their lives. Ten identified as experiencing existential anguish, poor quality of life, a lot of fear, a lot of distress, while the other 10 identified as experiencing what they rated as really good quality of life, feeling well in themselves, feeling peaceful.

The team tried to identify what determined which group we end up in and they found it came down to the presence or absence of healing connections, which is a feeling of being part of something greater than just their small, isolated individual experience, of belonging, which opens into a bigger sense of self. Somehow, it made all the difference.

Can healing connections occur during the palliative process?

I think they can and that is what palliative care can really encourage. If we have that sense of healing connection from earlier in our lives and we bring it with us into our experience of illness, that鈥檚 an incredible resource to be able to tap into. But even so, the experience of illness and living with uncertainty and pain engenders so much distress and fear that it can cause an inner contraction and isolating effect.

That鈥檚 where palliative care comes into its own 鈥� by skillful relief of pain and other symptoms, and deep listening and support. For example, sitting with somebody and asking them about those parts of their lives where they experienced healing connection can open things up for those who were feeling very isolated and cut off who didn鈥檛 have a lot of experience of healing connection earlier in their lives. It鈥檚 not easy to rekindle that sense of connectedness and that鈥檚 still the challenge of palliative care. Bal and I have both been really interested in helping that group of individuals in particular.

Your lecture will also touch on resilience and self-care for palliative care professionals. Can you define deep resilience and share what you鈥檝e learned about self-care as a palliative care doctor?

I was the lead author on an article we were writing for JAMA on self-care of clinicians working at the end of life, with Bal and others. I was reviewing one last time the symptoms of burnout and the light went on. I realized 鈥� that鈥檚 me. I鈥檓 actually burnt out. I was practising everything we were advocating 鈥� what I call self-care 1.0: taking breaks and vacations, engaging in restorative activities, stepping back and asking for help 鈥� and yet I was burnt out. And so I realized I needed something more, and that is what I think of now as self-care 2.0 or deep resilience. In addition to regenerative practices, we also need practices that help us tap into something deeper. It comes back to healing connections, that bring us into a felt sense of deep connectedness with something more than our small individual self. That鈥檚 deep resilience for me.

Where would you like to see the field of palliative care in the coming decades?

My hope would be that we in the specialty recognize that as well as doing a really valuable job in helping to make decisions about direction of care and in supporting patients and families, that we are also healers. That healing is part of our mandate in the sense of helping people to remember that they already have this deep inner wellness. The best way we can help our patients experience that, I believe, is to recognize the importance of healing connections in our own lives.

Register for Dr. Kearney鈥檚 lecture (virtual or in person). To learn about the rest of the Palliative Care National Grand Rounds Programme, please visit their website.