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PostPosted: Mon Apr 05, 2010 9:54 am 
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After helping patients face death, doctor fought to live

By the time she was 38, Dr. Desiree Pardi had become a leading practitioner in palliative care, one of the fastest-growing fields in medicine, counseling terminally ill patients on their choices.

She preached the gentle gospel of her profession, persuading patients to confront their illnesses and get their affairs in order and, above all, ensuring that their last weeks were not spent in unbearable pain.

She was convinced her own experience as a cancer survivor — the disease was first diagnosed when she was 31 — made her perfect for the job.

In 2008, while on vacation in Boston, she went to an emergency room with a fever. The next day, as the doctors began to understand the extent of her underlying cancer, "They asked me if I wanted palliative care to come and see me."

She angrily refused. She had been telling other people to let go. But faced with that thought herself, at age 40, she wanted to fight on.

While she and her colleagues had been trained to talk about accepting death, and making it as comfortable as possible, she wanted to try treatments even if they were painful and offered only a 2 percent chance of survival. When the usual cycles of chemotherapy failed to slow the cancer, she found a doctor who would bombard her with more. She force-fed herself through a catheter and drank heavy milkshakes to keep up her weight.

During the past decade, palliative care has become standard practice in hospitals across the country.

Born out of a backlash against the highly medicalized death that had become prevalent in American hospitals, it stresses the relief of pain; thinking realistically about goals; and recognizing that, after a certain point, aggressive treatment may prevent patients from enjoying what life they had left.

Pardi had gone into the field because she thought her experience as a patient would make her a better doctor. Now she came face to face with all the ambiguities of death, and of her profession.

She remembered patients who complained to her that she did not know them well enough to recognize that they were stronger than she had thought. Now she discovered that she felt the same way about her own doctors. "I think they underestimated me," she said last summer.

She came to question the advice she had been giving. She thought about quitting. "I just decided I have to believe in what I'm saying," she said.

She was overachiever

Desiree Dougherty was the overachiever of a modest family, the daughter of a sheet-metal worker and a nurse in Rockland County, about 30 miles north of New York City. She was 5-foot-1 with a wide, warm smile, a cascade of blond hair, blue eyes and a figure that turned heads.

She met her future husband, Robert Pardi Jr., on her first day of college at Stony Brook University. "She was a hippie chick with blue eyeliner," her husband recalled, "a far cry from the Ann Taylor woman she would later become."

She began an M.D.-Ph.D. program at Mount Sinai School of Medicine in Manhattan at 24. In 1998, she decided to take a few months off to join her husband in the United Arab Emirates, where he was working as a portfolio manager.

"Queen of Denial"

She needed a routine health screening to obtain a visa to remain in the country, and opted for a more thorough exam. At the hospital in Dubai, she later explained, the custom was for doctors to talk to the husband, even when the wife was the patient.

So her husband came home early one afternoon, and sat her down and said, "I'm afraid it was bad news." Further tests showed she had breast cancer. She had just turned 31.

She discovered that she liked having her husband act as a buffer between her and her doctors. From then on, even when she was in the United States, her doctors were told they should communicate only with him.

She lightheartedly called herself "the Queen of Denial," because she did not want to know anything about her disease. Her husband gave her just enough information to enable her to make decisions, and she always chose the most aggressive treatment.

After a mastectomy and months of chemotherapy, she was told the cancer was gone. She had her other breast removed protectively, though her double-D figure had been a source of pride.

She graduated from medical school in 2002, and was invited to appear on a segment of "The Oprah Winfrey Show" about people who had overcome obstacles and graduated.

She did her residency at NewYork-Presbyterian/Weill Cornell Medical Center, where her mentor, Dr. Mark Pecker, said she had among the highest medical-board scores he had seen.

During her residency, her cancer returned, invading her liver. She was never fully in remission.

When it came time to choose a specialty, she was drawn to oncology and psychiatry, but thought palliative care was a good compromise.

In 2006, Weill Cornell needed a medical director for its new palliative-care service, and recruited her. Her inexperience and illness gave the hiring committee pause, said Dr. Ronald Adelman, co-chief of geriatrics, who became her supervisor. But she won them over with her enthusiasm.

She was sparing about sharing her own survival story with her patients; she needed to maintain some boundaries to be able to do her job. Before she walked into a patient's room, she said, she took a deep breath and reminded herself that, "It has nothing to do with me."

From doctor to patient

Chemotherapy had become a regular part of Pardi's life, scheduled every Friday. In between, she tried to cram in her work; playing with her Yorkie; and being "Auntie Mame," as she put it, to her niece Jessica.

In summer 2008, she and her husband took Jessica to Boston for a weekend.

She was admitted to Massachusetts General Hospital after waking up with a high fever, and it soon became clear how far her cancer had spread.

A doctor asked if she would like a palliative-care consultation. She was shocked; she interpreted the question to mean that she had been identified as someone who was dying, and she did not think of herself that way.

She had crossed to the other side of the mirror, from doctor to patient.

Months of constant chemotherapy kept her alive but destroyed her appetite. Once an athletic 125 pounds, she had dropped to 85. She lost her hair and wore a pixie-cut wig.

Based on her symptoms, the standard medical advice, she said, would have been that she could no longer tolerate chemotherapy, and that she should start to think about how she wanted to live out her remaining time.

She did not want to stop, even when she had exhausted standard chemotherapy regimens.

She said she thought of all the times that her own patients had argued that she was underestimating their capacity to get better. "Then am I writing them off too soon?" she mused. "When they do say, 'Well, you don't know me. I can, blah-blah-blah,' that's what I said, too, in my mind. 'You don't know me.' You don't know my husband, for sure."

When she went to the hospital, she chose Mount Sinai, avoiding NewYork-Presbyterian because she did not want the humiliation of being treated by her colleagues and students.

Her husband and her best friend, also a doctor, persuaded her to allow a palliative-care doctor to oversee her care, with a team of gastroenterologists. She settled on a young doctor she had never met, Betty Lim.

Lim believed it was her role to listen to her patient's wishes.

"She said, you know, 'I can suck it up,' " Lim recalled. "Anything that gave her another chance to get back to what she was doing before."

She needed an extraordinary amount of pain medication. "It wasn't working, because her disease burden was so great," Lim said.

She was also being given sedatives to help her rest, but one day, she flung herself out of bed, ripping out tubes, because of a jolt of pain in her bowel.

Doctors gave Pardi stronger sedatives. As her body shut down, she began to grow confused and lose consciousness.

Robert Pardi, who stayed at his wife's bedside with her mother, said he and his wife had talked in detail about her wishes. He had no qualms about sedating her, about taking away artificial nutrition and hydration, or about letting her kidneys shut down. Even though she desperately wanted to live, she had said that when it was her time, she did not want to be in pain.

"We had talked about how in some situations, family members want to bring you to consciousness to say goodbye, but that is not for your benefit," he said. "God, I would have loved to say goodbye. But that was her wish. She never wanted to open her eyes and see people sad around the bed."

She was 41 when she died in her husband's arms on Sept. 6, after two weeks in the hospital, seven years as a doctor and nearly 11 years with breast cancer. Her eyes opened in the moment before she died, her husband said, but she seemed unable to see anything.

She died without ever learning the extent of her disease. Her husband said that she had tumors in both lungs, her liver, the lining of her small intestines, her colon and her bones.

Lim attempted, in her own mind, to reconcile Desiree Pardi, the palliative-care doctor who believed in a peaceful death, with Desiree Pardi, the patient who wanted to keep fighting.

Lim said she believed that "somewhere deep inside, she knew this was not fixable." But Pardi "knew exactly how much she was willing to endure," Lim added. "And she was able to endure a lot."

http://seattletimes.nwsource.com/html/n ... are04.html


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PostPosted: Thu Oct 09, 2014 10:19 pm 
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Joined: Thu Oct 09, 2014 9:44 pm
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he's pretty much the same age as me. This makes me feel pretty old


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