Fall 2009 - Mount Sinai Hospital

Fall 2009
Palliative Care
Lilian and Benjamin Hertzberg
Palliative Care Institute
2008-2009 Fellows Lori Smith, MD;
Earl Smith, MD; Jessica Cook-Mack, MD
Administrative Staff Yvette Brown,
Cortney Casale, Mariellen Giordano
Brookdale Department of Geriatrics and Adult Development
The Mount Sinai School of Medicine
An Aerial View of Mount Sinai Medical Center
“ This Award Belongs to All My Colleagues
in Palliative Care.”
Diane E. Meier, MD, MacArthur “Genius” Grant Winner
Recognizing exceptional creativity, significant achievement, and continued promise,
the MacArthur Foundation honored Diane E. Meier, MD, Director of the Hertzberg
Palliative Care Institute and the Center to Advance Palliative Care, with one of its 2008
Fellowships. “I was on an airplane getting ready to take off for Seattle when my cell
phone rang,’’ recalls Dr. Meier, still incredulous. “A soft-spoken person said something
about MacArthur. I asked him to wait until the overhead announcement stopped. I heard
him tell me I had been named a MacArthur Fellow. I was speechless – something
that never happens to me!”
The highly coveted MacArthur awards provide $500,000, paid over 5 years, to each
recipient. A “no strings attached” policy allows the self-directed, talented Fellows
to follow their creative vision as they strive to make or find something new, or connect
the seemingly unconnected in significant ways.
Diane E. Meier, MD
Director, Hertzberg Palliative Care Institute
Continued on page 5

2
Lilian and Benjamin Hertzberg
Palliative Care Institute
Brookdale Department of Geriatrics
and Adult Development
Mount Sinai School of Medicine
One Gustave L. Levy Place, Box 1070, NY, NY 10029
Tel. 212-241-1446
www.mssm.edu/palliative
Diane E. Meier, MD
Director, Hertzberg Palliative Care Institute
Director, Center to Advance Palliative Care
Catherine Gaisman Professor of Medical Ethics
Professor, Departments of Geriatrics and Medicine
Albert L. Siu, MD, MSPH
Ellen and Howard C. Katz Chairman’s Chair
Brookdale Department of Geriatrics
and Adult Development
Mount Sinai School of Medicine
Director of the GRECC at the James J. Peters
VA Medical Center
R. Sean Morrison, MD
Vice-Chair for Research
Director, National Palliative Care Research Center
Director of Research, Hertzberg Palliative Care Institute
Hermann Merkin Professor of Palliative Care
Emily J. Chai, MD
Medical Director
Hertzberg Palliative Care Institute
Assistant Professor, Brookdale Department
of Geriatrics and Adult Development
Gabrielle Goldberg, MD
Education Director
Hertzberg Palliative Care Institute
Assistant Professor, Brookdale Department
of Geriatrics and Adult Development
Bette Kerr
Writer and Editor
Co-Editor: Susie West
Photographer: Bruce Kushnick
Art Director: E. Fitz Art, Inc.
The Hertzberg Philanthropic
Leadership Council
Peggy Danziger
Joseph Hertzberg
Walter W. Hess, Jr.
Diane E. Meier, MD
Susan L. West
Zena Wiener
Doulas Volunteer as Patient Companions
For Nurse Practitioner Marianne Gelber,
the loneliness of hospitalized, critically
ill patients was a major concern. Haunted
by observations that Mr. A doesn’t have
many visitors, or Ms. B’s family lives far
away, she thought: “Wouldn’t it be great
to have special volunteers, non-clinical
companions, to visit, support, and sit with
our patients I’d learned about Doulas to
Accompany and Comfort, a non-sectarian
program of the Shira Ruskay Center of
the Jewish Board of Family and Children’s
Services (JBFCS).”
Nurse Practitioner Marianne Gelber
with Doula Volunteer Marie Ginther.
In a partnership embraced by Judith Kahn and Amy Levine, Director and Assistant
Director of the Doula program at JBFCS, the first volunteers came to Hertzberg in April
2008. In ancient Greece, “doulas” were companions for women in childbirth. Noting
similarities between the sensitive care required at both the beginning and end of life,
JBFCS chose this name for their program.
Trained and supervised by Ms. Kahn and Ms. Levine, 5 Doulas now work in Palliative
Care, under Ms. Gelber’s aegis. “I orient them, teach them about washing, gowning, and
gloving, and assign them to patients weekly,” says Ms. Gelber. “I escort them to their first
patient.” Depending upon the length of a hospital stay, Doulas may see a patient for 1 month,
4 months, or longer. “They are beautiful people,” adds Ms. Gelber, “and have become an
integral part of our Palliative Care team. We are grateful to them and to the JBFCS.”
After 8 weeks of training at JBFCS, Doulas come to Sinai well-prepared. Ms. Levine
describes their training as “a mixture of the didactic and experiential, stressing
communication skills and introspection. We look at spirituality, at what we are like
when we’re sick. How do our families handle critical illness” After the Doulas have
been assigned, adds Ms. Levine, “We continue to support them via group meetings,
monthly reports, and individual conferences. The in-hospital Palliative Care program
is a new model for us and we are learning all the time how we can best support it.”
Three Doulas comment on the impact of their work.
“ I try to keep in mind that I am not there to do, but to make people feel
less alone. It’s rewarding to realize I’ve added something to someone’s life,
just by being there.” – Elaine Orr
“ A recent experience with a patient and her family really struck me.
She was nearing the end of life, and her son came in to play the violin for her.
Everyone had tears. They were so loving, so strong.” – Marie Ginther
“ I try to find common ground and start a conversation around it. I sense
there’s a comfort for patients to have me with them at difficult times. At times
I’ve experienced a depth of emotion that is hard to describe.” – Steve Polvent
Strong testimony to the power of a Doula-patient relationship comes from patient
Beth Stechman: “Steve and I often talk about music. When I’m upset, he is so patient.
It can be easier to confide in a Doula than a staff or family member. Doctors and
nurses can have a way of saying things that’s not always gentle. One day I got bad news
and was crying. The Doula came in and I could unload. It was freeing.”

3
The Inpatient Unit: A Vision Is Shaped
Dreams for the future can materialize with the right combination
of vision, leadership, planning, and support. With all these
in place, the Hertzberg Palliative Care Institute, at press time,
is two-thirds of the way toward a fundraising goal of $5 million
for its new venture: a state of the art Inpatient Unit.
“The new unit has the potential to transform completely the
quality of care,” marvels Hertzberg Director Diane E. Meier, MD.
She adds: “The Hospital has committed space on the 6th floor of
Klingenstein Pavilion, overlooking Central Park. An aesthetically
beautiful patient and family-centered unit will deliver efficient and
effective care to the sickest, most complicated patients in a manner
that is respectful, comforting and restorative. Attention to light,
space, and design will be coupled with well-trained, expert, and
adequate staffing.”
“Mount Sinai’s commitment of space and support
acknowledges the efficacy of palliative care.”
– GABRIELLE GOLDBERG, MD
While continuing to head Hertzberg’s educational programs,
Gabrielle Goldberg, MD, will become Medical Director of the
new unit. “Sinai’s commitment of space and support acknowledges
the efficacy of palliative care,” says Dr. Goldberg. “Everyone
who works on the unit – from physician to business associate –
will be able to help us implement optimal symptom and pain
management and increased patient and family satisfaction.”
She sees “a wonderful opportunity for education for our medical
students and all our house staff.”
Nurse Practitioner Sue McHugh-Salera looks forward to seeing
patients in “a place with a peaceful aura that will resemble a
home-like situation for patient and family alike.” In her leadership
role, Ms. McHugh-Salera is eager to educate and mentor nurses
new to the unit. As the project moves toward fruition, she and
Dr. Goldberg are working closely with: hospital, nursing, and
Inpatient Unit Leadership: Sue McHugh-Salera, NP and Gabrielle Goldberg, MD
facilities administrators; architects and design team; and everyone
in Geriatrics and Palliative Care.
Mount Sinai will provide the space, staffing, and overhead for
the unit, but Hertzberg must raise funds to renovate and furnish
the area. “As with all our projects,” says Development Director
Jane MacDonald, “it’s a partnership between the hospital and
philanthropic support from our community.”
Dr. Meier emphasizes, “We could not do this without
generous, consistent support from members of our community
who believe in this kind of care.” Zena and Michael Wiener
were among the unit’s first and major supporters. Mrs. Wiener
comments: “We could have contributed to new drugs, new wings
or medical centers. But to help provide a Palliative Care unit
is the kindest contribution of all. This kind of care is as vital
a part of medicine as the medicine itself.”
Opportunities to name private rooms or public spaces in
the Inpatient Unit are still available. For information, contact
Jane MacDonald, Director of Development, at (212) 659-8517.
What Is Palliative Care Anyway
“Palliative care (pronounced pal-lee-uh-tiv) specializes in the relief of the pain,
symptoms, and stress of serious illness. Palliative care is appropriate
at any point in an illness, and it can be provided at the same time as treatment
that is meant to cure you.”
Information on free resources for
help in situations that may require
palliative care can be found at:
www.getpalliativecare.org

Lilian and Benjamin Hertzberg Palliative Care Institute
4
Navigating the Labyrinth of Caregiving with Gail Sheehy
After 14 tortuous years wending their way through the health
care maze, prominent author Gail Sheehy and her husband,
publisher Clay Felker, discovered palliative care. “Honest to God,
a doctor insisted on making a house call,” recalls Ms. Sheehy.
Sean Morrison, MD, took charge of Mr. Felker’s care and brought
the resources of the Hertzberg Palliative Care Institute to the
Felker-Sheehy home.
Shortly before Dr. Morrison’s visit, Mr. Felker had developed
pneumonia. His regular physician sent him to the emergency
room, ordering yet another CAT scan. After a wait of 8 hours, the
test was done only after Ms. Sheehy threw a small fit. By that time,
“all the radiologists had left so no one could read it,” recounts Ms.
Sheehy. “A sympathetic resident produced some results that
sounded foreign. It was a scan taken 9 months before! I wheeled
Clay out of the emergency room, and we congratulated ourselves
on a jailbreak. We had spent several years frantically circling
through the revolving doors of acute care.
“After beating cancer 4 times, Clay wanted to spend the long
afternoon of his life at home,” says Ms. Sheehy. “Treatment
had left him with chronic conditions that made it difficult to
talk or walk.” Yet, like many patients with long and serious illness,
his vibrancy and zest for life prevailed. His mind and intellect
remained sharp.
“This is palliative care – a return of
some control to people during a passage
of life that is otherwise uncontrollable.”
– GAIL SHEEHY
Ms. Sheehy praises our health care system for excellent hospitals
and professionals working toward one goal: cure. “But,” she warns,
“chronic illnesses are impervious to cure; people often live with
them for years, even decades, looked after at home by family
members with no professional training, no financial support,
and little respite. Properly funded home care could deliver huge
savings to Medicare. But now it shifts the costs onto people’s
personal bank accounts.”
On the first of many home visits, Dr. Morrison sat at Mr. Felker’s
bedside. According to Ms. Sheehy, “we had the first full and
frank conversation about Clay’s wishes for this phase of his life.
This is palliative care – a return of some control to people during
a passage of life that is otherwise uncontrollable.”
With assistance from Palliative Care and subsequent
help from hospice, Ms. Sheehy cared for her husband at home
for 7 months. Emboldened by Dr. Morrison’s ability to
Susie West, Gail Sheehy, Diane Meier, MD and R. Sean Morrison, MD
at the Douglas West Memorial Lecture in Geriatrics and Palliative Care
keep Mr. Felker comfortable, she determined to take her eager
husband on what would be his final excursion: hearing jazz
at Dizzy’s Club Coca Cola, with its dazzling vistas across
Central Park. Ms. Sheehy describes the evening: “Clay sat tall
and straight in his wheelchair and drank in the music, tapping
his fingers to the beat.” After returning home, “he gripped my
hands,” remembers Ms. Sheehy, “and said clearly, with gusto,
‘it was a magical evening.’”
Gail Sheehy, author of 15 books, including the revolutionary
“Passages,” shared her experiences as a caregiver at the
June 3, 2009 Douglas West Endowed Memorial Visiting
Lecture in Geriatrics and Palliative Care. She is the AARP
Ambassador of Caregiving and offers weekly postings at
AARP.org/Gail Sheehy. Her next book, “Labyrinth of Caregiving,”
will be published in 2010.
2009-2010 Palliative Care Fellows
In July, the Hertzberg Palliative Care Institute welcomed 4 new fellows: Marcelo
Bonomi, MD; Katharine Batt, MD, MSc; Aluko Hope, MD, MSCE; Mara Lugassy, MD

5
Advancing the Science of Palliative Care Through Research
While fully engaged in clinical work and teaching, Palliative
Care faculty are also making major contributions to medical
research. The following are a few of the many projects underway
at Hertzberg.
Diane E. Meier, MD, and R. Sean Morrison, MD, are Principal
Investigators in a national study designed to improve the quality
of palliative care for in-hospital cancer patients. With funding
from the National Cancer Institute and National Institute for
Nursing Research of the National Institutes of Health (NIH), this
project has enrolled several thousand patients and their families.
With awards from the Hartford Foundation and the National
Institute of Aging of the NIH, Nathan Goldstein, MD, is
pursuing questions about optimal care for patients with implanted
defibrillators who are nearing the end of life. Defibrillators monitor
the heart and, when necessary, deliver small electrical shocks to
restore a normal pattern of beating. These shocks can impede the
comfort of a patient who is seriously ill. Dr. Goldstein is working
on a protocol that would help physicians communicate with
patients in declining health about the possibility of deactivating
their defibrillators.
Investigating access to hospice care, Melissa Carlson, PhD,
is conducting a 5-year study funded by the National Institute
for Nursing Research of the NIH. Ultimately, she hopes to identify
areas across the nation where there is no access to hospice and
stimulate a quest to bring hospice to such regions.
With support from the National Institute of Aging of the NIH,
Dr. Morrison heads a project designed to improve pain
management in older adults who experience hip fractures.
Nathan Goldstein, MD and Melissa Carlson, PhD
Immediately after a fracture, emergency room physicians are
introducing regional nerve blocks, or injections of local anesthetic,
in an attempt to minimize pain, avoid side effects of medications,
and improve later functioning.
Discussing the need for scientific evidence, Dr. Morrison,
Director of the National Palliative Care Research Center (NPCRC;
www.npcrc.org) cites the fact that more people are living longer
with multiple chronic illnesses. Up to now, little research has
focused on complicated patients. To provide the best quality of
life to this growing patient population, palliative care professionals
need to rely on a body of solid scientific evidence. “We aim to
take our research findings and rapidly translate them into effective
clinical practice,” says Dr. Morrison.
“This Award Belongs to All My Colleagues in Palliative Care.” Continued from page 1
Until all 25 awards were made public a week later, Dr. Meier
was allowed to tell no one but her husband. Unable to call him or
speak further with anyone at MacArthur until her flight landed
hours later, she feared she was dreaming or hallucinating. She kept
checking her cell phone to confirm that the incoming call had really
taken place. By week’s end, when reporters were phoning, she broke
the joyous news to her parents and to her chiefs at Sinai.
MacArthur grants have often gone to people in the arts, but the
2008 awardees included 4 groundbreaking physicians. “My award,”
says Dr. Meier, “truly recognizes the importance of the whole field
of palliative care, all that my colleagues from so many disciplines
have contributed. Collectively, we have changed American medicine.
It is gratifying, validating, and re-energizing.”
A mere 15 years ago, palliative care’s original major funders, the
Robert Wood Johnson Foundation and the George Soros Open
Society Institute, demonstrated faith in a completely undeveloped
field. Dr. Meier marvels: “Here we are, just 15 years later, with
a new specialty. More than half the nation’s hospitals report
a palliative care program. And we have a MacArthur award!”
She credits Mount Sinai with being “100% supportive of our
clinical and research endeavors and our efforts to train the next
generation of physicians.” Grateful for support from the larger
community as well, Dr. Meier adds: “Our donors’ farsighted and
early investments have been validated by the judgment of the
MacArthur Foundation.”
Always planning for the future, Dr. Meier is grateful that the
MacArthur award has raised the profile of palliative medicine
with a number of audiences, including policy makers. “This will
help me advocate for the pivotal role of palliative care as part
of the solution to many aspects of our current health care crisis.”

6
From Finance to Philanthropy
Walter (Tommy) Hess, Jr. recalls his first meeting with Diane E.
Meier, MD. “It was the weekend of the New York City Marathon.
Central Park and all crossroads were closed to vehicles. My late wife
Barbara, suffering from multiple myeloma, was in distress. We were
fortunate to have made contact with Dr. Meier, who agreed to accept
Barbara as a patient. Remarkably, this renowned physician would
make a house call – and on a weekend. Answering my doorbell, I
was astonished to see the doctor balancing her bicycle and carrying
her helmet. ‘The only way to get across town,’ she casually said.”
“I’m so impressed by the young doctors and health
professionals being trained in palliative medicine.”
– WALTER (TOMMY) HESS, JR.
“When someone in your family is very sick, you’re nervous,” says
Mr. Hess. “I’d call our prior physician, a very fine doctor at another
hospital, to ask questions. When he didn’t return my call for two
or three days, that drove me up the wall.” Contrasting this with the
palliative care approach, Mr. Hess was incredulous that a member
of the Hertzberg team would call Barbara several times a day when
her symptoms were getting worse. “She was made as comfortable
as possible at home, surrounded by family.”
Soon to celebrate his 90th birthday, Mr. Hess
decided it was time to retire from a long
and distinguished career on Wall Street,
including senior executive positions at two
major firms. As a Board member of the
Blythedale Children’s Hospital in Scarsdale, Walter (Tommy) Hess, Jr.
a life Trustee of the Jewish Home and
Hospital for the Aged, and head of the Wall Street Division of
UJA/Federation of Jewish Philanthropies, he brought financial
resources and expertise to many aspects of health care. Ever ready
for new ways to contribute, Mr. Hess, who remarried several years
after Barbara died, was delighted that his wife Peggy embraced
and shared his commitment to furthering palliative medicine.
“When Diane asked me to join the Hertzberg Philanthropic
Leadership Council,” exclaims Tommy Hess, “I was thrilled!
I’m so impressed by the young doctors and health professionals
being trained in palliative medicine. They’re learning the
clinical and communication skills needed to take care of seriously
ill people. I get such pleasure from contributing and bringing
others in to support Hertzberg.”
Explaining how Walter Jr. became known as Tommy, Mr. Hess
chuckles: “When I was a tot and my mother called ‘Walter,’ I would
come running when it was my Dad she wanted. Mom decided:
‘You look like a Tommy.’ The name stuck.” Mr. Hess laughs as
he muses how young Tommy, always struggling to earn passing
grades in mathematics classes, became a respected Wall Street
executive, philanthropist, and forceful advocate for palliative care.
Hertzberg Highlights
In addition to the MacArthur Fellowship, Diane E. Meier, MD,
has recently received awards from several other national
organizations. At the Castle Connolly National Physician of
the Year Awards Ceremony on March 23, 2009 in New York
City, Dr. Meier was one of three physicians nationally honored
by the Clinical Excellence Awards. Physicians listed in the
Castle Connolly “Top Doctor” guides nominated Dr. Meier
for this honor.
The American Association of Retired Persons (AARP)
selected Dr. Meier as a recipient of its 50th Anniversary Social
Impact Award, bestowed upon “champions of social change”
who “are enhancing the lives” of others.
In February 2009, the American Academy of Hospice and
Palliative Medicine announced the election of R. Sean Morrison, MD,
as its next President. On March 25, 2009, at its annual conference
in Austin, Texas, the Academy presented a Life Time Achievement
Award to Dr. Diane E. Meier.
Diane E. Meier, MD with Susie West and
Bette Kerr at the Castle Connolly Awards
John K. Castle, Diane E. Meier, MD,
John J. Connolly, EdD
On behalf of Hertzberg’s Nurse Practitioners, Marianne Gelber,
Jay Horton, and Sue McHugh-Salera received this year’s Preceptor
Award from The College of Nursing of New York University.
The Award singled out the Palliative Care nursing practice for
its outstanding contributions to the clinical education of NYU
graduate nursing students.
Gabrielle Goldberg, MD, received the 2009 Mount Sinai Teaching
Excellence Incentive Plan Award, in recognition of her
“valued contribution to educational efforts to create future
leaders of academic medicine and clinical care.”