Cancer Doc is Helping Patients Live Better

 

 

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Andrew Putnam, MD, known to all as “Put,” is the go-to expert when it comes to managing pain and other symptoms of disease or side effects from treatment. So when he comes around it often means that things aren’t going as smoothly as patients might have hoped.

But Putnam, who is director of the Palliative Care Program at Georgetown University’s Lombardi Comprehensive Cancer Center, is prepared for that recognition, and is quick to use his melodious voice to both soothe and to inform patients that there are ways to help. He can easily spend two hours with each person he sees, offering them the number to his beeper, a device he never turns off. The stories told about him are fond ones: the time Putnam − the pain buster − was called in to relieve a man of the hiccups that had debilitated him with for two weeks; the many times Putnam has personally walked outpatients to the pharmacy to make sure they don’t get lost, and to expedite quick delivery of a pain prescription.

If there is nothing more that can be done to prolong life for a patient whose life-threatening disease cannot be cured, Putnam is comforting and supportive in his discussions with patients and their families about managing end-of-life issues.

“Then I am there to take care of both the physical and psychological suffering,” he says.

Palliative care is different from the care provided by hematologists and oncologists. “These Specialists are dedicated to curing disease or prolonging life; palliative care physicians concentrate on improving a patient’s quality of life before, during and after that treatment, he says. “I don’t keep a cancer patient from dying; that is what an oncologist does. What I do is make that person feel better and − if it must be − to die well.”

The field of palliative care, which includes hospice care, has gained increasing credibility and is becoming much more widely available, Putnam says. Board certification has been offered by the American Academy of Hospice and Palliative Medicine since 1995, and increasing numbers of academic medical centers have developed fellowships in palliative care. Lombardi started a Palliative Care program in 1997 under former director Jane Ingham, MD, and to date has trained nine fellows. One of Putnam’s goals is to expand the palliative care fellowship program and extend the services to other areas of the hospital beyond oncology.

“Palliative care ought to be a regular part of health care treatment for people with serious diseases,” Putnam says. “It is what patients expect.”

The need certainly is there, Putnam says. Along with the fellow that he supervises, Sunitha John, MD, Putnam may care for 20 patients per day in the hospital and the outpatient clinic who are referred to him from Lombardi hematologists and oncologists. He will often telephone just as many, fitting those calls in between teaching, either in the School of Nursing & Health Studies and the School of Medicine or clinical teaching of medical students and residents in the hospital.

Both Putnam and John took unconventional routes to palliative care. After graduating from Yale University, Putnam worked as a middle-school science teacher in Connecticut, traveled to Australia to teach Biology and British history, and then went to Thailand to teach English at Dhurakijpundit University. At age 30, he decided to go into medicine, and worked in virology labs, first at a US armed forces lab in Bangkok and then at Yale University for one and a half years. At 34, he started medical school at the University of Connecticut with the idea that he would become a family physician. “I wanted to birth babies and take care of the grandparents,” he says. But halfway through his residency, he found that with sometimes only ten minutes to spend with patients, he had no chance to intervene in a meaningful way in their lives. “I wanted to be the doctor who makes a difference, and primary care was not the best way for me to do that,” he says.

Putnam discovered palliative care through one of his attending family physicians who is married to a palliative care physician, and completed a two-year palliative medicine fellowship in 2001 at the Massachusetts General Hospital in Boston. At that time, there were only five such fellowships in the nation – now there are close to 40. “I found that I felt really good about treating pain and that I now had the time to talk with the patients and their families,” he said. “This field was all about taking care of very sick people.”

John is a self-avowed “people person” who was born in India, grew up in Kuwait, came to the United States during the first Gulf War, and studied medicine at Cambridge University Medical School in England. She gravitated to palliative care because of the feelings of desperation she felt in Kuwait, seeing that her uncle was dying the day after the Iraqis invaded, and having no one to turn to for help. “My goal is to help patients and their families as much as I can, providing comfort, dignity and support,” she says.

Palliative care should be part of every medical student’s curriculum, John says − a notion that Putnam agrees with. “We graduate from medical school but we still don’t know how to keep our patients comfortable, and allow them to live as close as we can to what they felt like before they were diagnosed,” she said. “This fellowship has really changed my perspective.”

Putnam says that while the need for palliative care specialists grows, much of the care they provide, especially that given to families of dying patients, is often not paid for by medical insurance. “If it were, it would be much easier to provide the services,” he says. “Dying is natural, and inevitable, but many of us do not handle it well. Giving permission to allow someone to go down that road is very important,” he said. “Helping the patient’s family to understand and accept that is also part of what we do.”

By Renee Twombly
Photos by Phil Humnicky
Production by KeyBridge

February 2007