Heart and Soul
Photos courtesy of Donna Schulter and by Gary Matoso
At Providence, specialists blend a highly personal approach with innovative medical care
By late last year, Donna Schluter’s husband, Gene, had exhausted most of the treatment options for his congestive heart failure. The couple were then introduced to Providence Health Care’s new palliative care program for cardiac patients.
“When we walked in that oﬃce, it was such a change,” Schluter says. “Before, it was the bells and the whistles, we’re going to try this and do that. This was like a new door opened and we were gathered in to just be comfortable and at rest.”
Providence is known for its innovative, high-tech cardiac care. But for some people with heart failure, leading-edge procedures are no longer preferable. “We take what we learn in life-extending, technological interventions and learn to apply that same, focused approach to symptom management and quality of life,” says Andrew Coletti, M.D., FACC, Providence Spokane Heart Institute medical director of advanced heart failure and cardiac transplantation.
At that point, the focus can shift from high-tech care to “high-touch” care, provided by an expert palliative medicine team embedded in an outpatient cardiology clinic.
Knowing When to Slow Down
Palliative care is focused on the whole person—body, mind and spirit—says Wendy Knowlton, D.O., who leads the Providence palliative medicine program.
“Sometimes our team will be asked to continue a conversation about health care goals, hopes and concerns. Sometimes we are asked to make recommendations about symptom management. And sometimes we do both,” Dr. Knowlton says.
“When the stakes are high,” she adds, “that’s the time to slow down.”
People who are not pursuing high-tech care still want good care, “but there’s an uncertainty about what that looks like, what that can be,” Dr. Knowlton says. For congestive heart failure patients, palliative care might involve diuretics, cardiac medications and daily weight checks, with the goal of keeping symptoms under control as long as the treatments are not burdensome for the patient.
Right Time for the Right Discussions
The palliative model is built on developing relationships with patients and their families. Dr. Knowlton strives to engage with patients and families and quickly put them at ease. She is sensitive to the fact that congestive heart failure patients might have energy limitations, so she carefully weighs whether the time is right for a discussion. Schluter says the limited time she and her family spent with Dr. Knowlton “was just what we needed, just when we needed it.”
The palliative care team also includes a chaplain, to address spiritual needs and concerns. People living with serious illnesses often are forced to focus on the medical aspects of their lives, but “we are emotional and spiritual beings, too,” Dr. Knowlton says. Meeting with a chaplain is “a good reminder for patients that there are parts of who they are that their illness can never touch,” she says.
Focus on What’s Most Meaningful
Schluter says there was a time in her husband’s illness when they could see the current care path wasn’t right anymore, and more interventions wouldn’t extend Gene’s life. He passed away in early December.
“The medical ﬁeld is wonderful, but their part ends and you need help getting into that next step—when to choose, and what to choose,” Schluter says. The palliative care team helped the Schluter family “make the next steps forward, calmly,” she says.
The palliative care team’s involvement allowed Schluter to be a wife again rather than a caregiver, which she says was “very precious at the end.”
What is Palliative Care?
Palliative care is a medical specialty focused on improving quality of life, and Providence Health Care now offers a program speciﬁcally for cardiac patients.
What It Is:
- For mind, body and spirit for people of all ages.
- For those who suffer from serious, chronic and life-threatening illnesses.
- Provided alongside curative therapies.
- A team approach by medical professionals with different types of expertise.
What It Does:
- Helps with management of complex symptoms such as pain, nausea, fatigue and shortness of breath. Offers coping strategies for anxiety, depression and loss.
- Offers guidance regarding ethical and legal aspects of care.
How It Works at Providence:
- The team is embedded in a cardiology practice.
- Your regular physician can refer you to the team, just as he or she would to any other specialist.