Greg Gramelspacher, MD, associate professor of medicine, gently takes Therese Davis by the hand, looks into her eyes and says softly, "You are doing so well - so well - and I want you to know what an inspiration you are to your family and to all of us in this room."
She can't respond with words. But Therese can communicate with her eyes; one blink "yes," two "no." She's dying of amyotrophic lateral sclerosis (Lou Gehrig Disease). While the progressive neurological disease has robbed her of most of her faculties, her final days will be marked by dignity, thanks in large part to the Palliative Care Program at Wishard Memorial Hospital.
A clinical definition holds that palliative care is the active, total care of patients whose disease or condition is not responsive to curative treatment. More simply, it is the act of providing comfort to the dying and their families.
"We're great at science and providing the best medicine has to offer," Dr. Gramelspacher says, "but often we're not so great in teaching the human dimension of the care and compassion needed by the terminally ill and dying. That's what our program is all about."
Services offered by the Wishard Palliative Care Program are far-reaching. A 24-hour on-call phone service puts patients and families with urgent needs in touch with a nurse who can help troubleshoot the problems and contact other team members. The program also offers home care services, follow-up and continuing care at outpatient clinics, bereavement assistance to families before and after a patient's death, pain management options, and inpatient consultations with specialists and a patient's primary care physician.
As director, Dr. Gramelspacher heads a staff that includes clinical nurse Jo Groves, RN, MS, social worker Linda Pride, MSW, community liaison Pat Darden, medical sociologist David Moller, PhD, and chaplain/patient advocate David Clinton.
The in-house team works with several outside groups, including the Visiting Nurse Service, Inc., which offers home-based hospice services to the terminally ill. It also teams with Mt. Nebo Baptist Church of Indianapolis, where Therese is a member, whose congregation offers emotional, physical and spiritual support.
Dr. Gramelspacher, a medical ethicist and internist, says surveys show that eighty percent of people want to die at home if given the opportunity. The reality is that sixty-seven percent die in hospitals and seventeen percent die in nursing homes.
"Being at home surrounded by loved ones and a familiar environment is the greatest desire of most terminally ill," Dr. Gramelspacher says. "I say why not make every effort to ensure they get what they want and, when possible, bring the clinical care to them."
Since it was established in July 1999, the palliative care program has helped more than 250 Indianapolis and Marion County residents.
Dr. Gramelspacher and some of his patients were the focus of one episode of Bill Moyers' PBS series, On Our Own Terms. (The segment was filmed before the Palliative Care Program was established.) The four-part series, which aired last September, examined how terminally ill Americans, their families and medical professionals deal with death.
In a Wishard hospital room on a late summer morning, the palliative care team is about to end its visit with Therese Davis, her daughter Shonetelle Davis, and granddaughter, Shamaine. There's still one more service to be carried out. The team and family surround Therese's bed, hold hands and join in prayer.
"God bless you," a team member says, as she prepares to leave the room. Therese Davis returns her gaze.
She blinks once.
Therese Davis died Sept. 28 at her home, surrounded by family and friends. For more information about the Wishard Palliative Care Program, call 317-630-6721.