Meredith Wold, PA-C, MAPA President
“It’ll be by 4.”
My father passed away peacefully just days after penning my initial Prez Says article. He was in his Florida home surrounded by his wife of 40 years and his three children, just how he had wished.
During my career as a PA I have looked at the initials behind my name at times as both a curse and a blessing. Yes, sometimes being the ‘go to’ person in the family for any and all medical questions (the rashes are the worst), can be tedious and tiresome. Seeing the worst of the worst, catastrophic injuries, and tragic illnesses can be exhausting. Knowing too much keeps us up at night thinking of all the possible bad outcomes because we’ve seen it happen to people not too unlike us. However, most often, what we do is a privilege and the information we bring a blessing. At the end of my dad’s life, I was able to give him complete confidence that I, along with my siblings and mother, would know his unsaid needs and assure him a peaceful, dignified death.
Thankfully, in the months preceding his death, my dad talked openly about his end of life wishes. His preparedness took the pressure off us and we drew comfort knowing we were doing exactly what he wished us to do. Unfortunately, many families are not this lucky. In fact, less than 30% of Americans have an advance care plan in place. This lack of planning can result in questioning, confusion, or disagreement among family members who are trying to envision what their loved one would want in their eleventh hour. Instead of celebrating their loved one’s life, they are left wondering if they did ‘the right thing.’
I encourage all of you, no matter your area of practice, to discuss advance care planning with your patients. It’s not just about old age or chronic illness. At any age, a medical crisis could leave someone too ill to make his or her own healthcare decisions. Furthermore, sit down with your family and talk about your own wishes. Even if you are not sick now, making healthcare plans for the future is an important step toward making sure you get the medical care you would want. As a hospitalist, I have this discussion often and it’s always easier for the patient to articulate their wishes if the foundation was set prior to their acute illness. As a daughter, I am so thankful that in the sunset of my dad’s life we took comfort in knowing we were doing exactly what he wanted when he told us that morning, “It’ll be by four”.
June July Prez Sez
Meredith Wold, PA- C
The patient was never supposed to be my dad.
My dad was hospitalized in November for what was initially thought to be pneumonia. Ultimately, the shortness of breath and cough turned out to be extensive stage small cell lung cancer, median survival 6 months. This was devastating for our family. He was young, too young. He celebrated his 65th birthday in New York City with my mother, his wife of 40 years, just weeks before. I remember arriving at the keenly architectured hospital in the southern coastal state that they call home. A beautiful tranquility fountain and lively flowers welcomed patients and visitors alike. As a hospitalist, the hospital is my comfort zone; however, walking in this time, I had an uneasiness that was unfamiliar. When I arrived at his room, I looked in to see a thin man with his back to me, gown tied loosely about his shoulders. Features in some ways different this time, but all together forever familiar. He was unmistakably my dad. And so begun our cancer journey.
My dad will be the first to tell you that he never expected the last 8 months would be as good as they’ve been. He’s played golf, shot skeet, floated in the pool, entertained guests, celebrated his three grandchildren’s birthdays and, most notably, beamed with pride as he watched his youngest child graduate from Penn State University all while enduring round after round of chemotherapy. Despite our best effort to delay its return, inevitably the cancer started outsmarting the drugs designed to kill it and we enrolled in hospice the week of Father’s Day.
People say that positives will come from going through a loss such as this. That through the pain and profound sadness will emerge a stronger, more resilient me. I’ll keep you posted on that one because right this very minute I feel many things but wouldn’t define any of them as strong or resilient. I do know for certain going through this process has made me a more compassionate provider. Delivering unexpected news takes on a much heavier responsibility having been on the gown side. It truly is a gift to understand the emotions, questions, hopes and fears running through the minds of these patients and their families. I now have lived empathy and I know my patients will benefit from it.
This journey has also strengthened my appreciation for how we practice medicine in Minnesota. I naively assumed that by now patient-centered care was embedded in the mission statements of all hospitals around the country. Unfortunately, this was not the case at this highly regarded regional hospital in the sun. My dad was lost in the shuffle of a provider-centered paradigm. Because of this, after 3 days we flew to a bitterly cold St. Paul and stayed for nearly 2 weeks in a warm hospital that doesn’t accept anything less than a patient-centered approach to medicine. Initially, my dad wasn’t too sure about the transfer, worried that it would all be for naught: “But the outcome may not be any different.” Yes, but the process sure is. I am thankful that I, and all of you, are part of this process.
Tracy Keizer, PA-C : St Paul
Happy New Year, I hope you all had a safe and delightful holiday season. While I am not one to make a New Year’s resolution, many people make them every year. New Year's resolutions are fun to make, but they are extremely difficult to maintain. Each January, roughly one in three Americans resolve to better themselves in some way. A much smaller percentage of people actually make good on those resolutions. While about 75% of people stick to their goals for at least a week, less than half are still on target six months later. It's hard to keep up the enthusiasm months after you've swept up the confetti, but it's not impossible.
This year, the MN Academy of Physician Assistants is making New Year’s resolutions as well. We are committed to improving our recognition with insurance payors, the public and other organizations. We are committed to increasing participation among MAPA members, MAPA committee and board members. And, last but not least, MAPA is focused on to connecting with our growing number of Physician Assistant students.
The MAPA Board annual winter strategic planning meeting is scheduled for January 11 and 12 and we plan to reassess our goals and address the challenges we have ahead. We plan to discuss how we can better serve and motivate our members. We are interested in seeking advice from, and reaching out to, our MN PA colleagues who serve in specific specialties. And an important conversation the MAPA board needs to begin is our response to questions regarding the future of PAs in MN and questions regarding independent practice. We have our work cut out for us. Stay tuned to see how this winter’s strategic planning will change MAPA’s goals for 2013.
If you haven't made a New Year’s resolution yet and would like a new challenge for the New Year, I encourage you to seek out a new adventure and get involved in MAPA. Here are 3 great options to get started.
- Join us February 6 for PA day on the Hill in St Paul.
- Help with the student Challenge Bowl in Spring CME in March
- Get involved with a MAPA committee. Check out the PA Interest form on the MAPA website http://www.mnacadpa.org/pa-interestparticipation-form
I’m excited to work with you as we meet our New Year’s resolutions together. Thank you for all of your support. Have a great 2013!