Getting More Comfortable With Death and Dying

Last winter, Victoria Kissell, MPAS ’18, was able to added a facet to her education that not many physician assistants are able to claim.

“We don’t learn how to deal with death in school,” she says. “Because we’re focused on making people better, we tend to push it aside, even though it’s inevitable. Through the Jewish Healthcare Foundation’s Fellowship in Death and Dying, I was able to talk to people who handle it every day, so that if I do have a patient who is terminally ill, I’m more comfortable talking about it.”

Participants meet as a group weekly to discuss readings and perform role plays, and then visit hospitals and other sites where death and dying are not infrequent occurrences, including a hospice and the Neonatal Intensive Care Unit of Children’s Hospital of Pittsburgh of UPMC. They meet with members of teams who work with patients and families in terminal situations, including hospice and palliative care; social work; and religious support.

“It was interesting to see aspects of death that come into play when it’s a child as opposed to an adult,” says Victoria, “such as who has the right to make decisions about prolonging care. A lot of times, patients—including kids—better understand what’s going on, or have an easier time accepting it than the families, who are the ones pushing for more treatment, and feeling resistance to palliative care and hospice teams stepping in.”

“When people hear hospice and palliative care, they think death,” she continues. “But we learned to push hospice and palliative care as more about improving quality of life than sentencing to death.

“We’re not telling families their loved ones are going to die; we’re telling them that we’re going to do everything we can to make them comfortable and live the rest of their days happy, and the way that they want to.”

Victoria feels that the Fellowship has helped her communicate in non-terminal scenarios, too. “Some diseases such as diabetes, depression, or hypertension are difficult for patients to handle,” she says. “They may feel like a death sentence. Patients don’t want to be labeled, or burden their families. I think this training has helped me communicate with patients about these conditions. There’s no reason these patients can’t live long and prosperous lives, as long as their condition is well managed.”

The Fellowship paid off sooner than Victoria might have expected. “On my very first rotation, I had my first patient pass away,” she says. “It was like I was watching the program come to life. Once his cancer was discovered, his family couldn’t understand why we weren’t treating him with chemotherapy and radiation, but he understood that his body wouldn’t be able to handle the treatment. The palliative care team was on board, after a lot of work convincing the family, but not the hospice team because the time went too quickly. The family didn’t want to ‘give up’, but to see the transition care go from aggressive to supportive was amazing.”

“One of the most moving things I learned from the program was something a hospice nurse coordinator said at Children’s,” says Victoria. “She said ‘If you’re going to work with death every day, you better remember to live’. I think that’s important in medicine in general.”

Jewish Healthcare Fellowships are open to all graduate students in Chatham’s School of Health Sciences. Learn more.

The Master of Physician Assistant Studies (MPAS) program at Chatham University provides academic and clinical training that will prepare its graduates to be certified and licensed to practice as extenders to the practicing physician, especially the primary care physician, in a competent and reliable manner.