Cloak Vol3 Issue2 April by dffhrtcv3


									                    The Cloak
                                                                                              Department of Veterans

                                                                                                   Volume 3, Issue 2
                    The VISN 3 Palliative Care E-Newsletter                                           April 2006

                                                                                             Inside this issue:
Paul Stolz, LMSW receives 2005 VISN Palliative
Care Outstanding Individual Award                                                            James J Peters VA         2
                                                                                             Medical Center
   During the VISN Pallia-     in ongoing dialogue with
tive Care Quarterly Meet-      the hospice partners, to                                      New York Campus           2
ing on September 20,           ensure an ongoing seam-                                       Brooklyn Campus           2
2005, Paul Stolz, LMSW,        less transition of care for
                                                                                             Northport VAMC            2
Hudson Valley VA PCCT          our veterans needing end
Social Worker, was pre-        of life care in the commu-                                    Words of Healing          3
sented with the 2005 Out-      nity. He was able to dem-                                     HPCANYS Award             3
standing Individual Award.     onstrate, that as a mem-
                                                                                             A Social Work Intern      4
He was recognized by the       ber of the VISN Palliative
VISN for his outstanding       Care Initiative, he can
leadership with the local      make a difference by
                                                                                             Awards                    5
Hospice Veteran Partner-       building the Hospice Vet-
ship in the Hudson Valley      eran Partnership on a                                         Editor’s Note             5
region. His work has in-       local level.
creased the awareness by                                     contribution and commit-
                                VISN 3 recognizes Paul       ment to the VISN Pallia-
all the Palliative Care        Stolz for “your exemplary     tive Care Program.”             HOT OFF THE
Team members to engage
                                                                                             PRESS — VISN3 just
                                                                                             learned that is has re-
                                                                                             ceived the Circle of
VISN 3 Update                 Submitted by Therese Cortez, NP and Carol Luhrs, MD
                                                                                             Life Citation of Honor
From our last Cloak up-        Death Survey results from     HVP hosted a one-day            Award! Full coverage
date in January 2006, our      FY 2005 and 1st Quarter       modified EPEC program to        in the June Issue.
VISN Palliative Care Pro-      2006, PCCT activities,        enhance the knowledge of
gram continues to grow in      compliance with the docu-     hospice and VA staff on
key aspects of program         mentation of the Palliative   end of life care for veterans   Calendar of
development: ongoing           Care Consult symptom          on March 23, 2006. Over         Upcoming Events           :
quality improvement, staff     assessment, Psychosocial,     60 participants from both
education/ mentorship,         and Spiritual Assess-         VA and the community at-        • April 25, East Orange and
                                                                                               Lyons Campuses Team
and partnership with the       ments, review of the site     tended the program.
hospice community on           Performance Improvement       Speakers from both the VA
both a state and local         plan, and other identified    and the community spoke         • May 18, 12:00 -1:00 pm,
level.                         projects at each site. We     about the Philosophy of           VISN Noon Case Confer-
                               continue to look forward to   Hospice and Palliative            ence
  The ongoing VISN 3 Af-
                               these feedback meetings       Care, Bereavement and
ter Death Bereaved Family                                                                    • June 19, 8:00 am - 4:00pm,
Member Interview contin-       with the teams and ensure     Complicated Mourning in           NY Harbor HVP EPEC
ues to provide us valuable     the program development       Adults, Spirituality at the       Program
information about the end      and growth at each of the     End of Life, Nutrition and
                               sites.                        Hydration, Support for the      • June 20, 8:30 am - 2:00 pm,
of life care we are provid-                                                                    VISN Palliative Care Quar-
ing to the veterans and           This year, the local       Caregiver, and Pharma-
                                                             cologic Issues at the End         terly Meeting
their families. During         HVPs take the partnership
March to April, we are con-    to a new level with the       of Life.                        • July 20, 12:00 -1:00pm, VISN
ducting our ongoing VISN       planning of collaborative        Modeling this best prac-       Noon Case Conference
feedback meetings with         events to promote educa-      tice to collaborate with our    • September 19, 8:30 am —
the individual teams to re-    tion to staff about end of    community partners on an          2:00 pm, VISN Palliative
view site-specific After       life care. The Long Island        (continued on page 3)         Care Quarterly Meeting
                      Page 2                                               The Cloak

James J. Peters                      VA New York Harbor Healthcare System:
VA Medical Center                    New York Campus
An extension of the inpa-            The New York VA Pallia-         panionship and comfort to      followed the patients as
tient Bronx VA Palliative            tive Care Team provides         the dying. Patients who        they have gone home or
Care Consultation team is            interdisciplinary consulta-     have been identified by        to other venues of care.
the Bronx outpatient Pallia-         tive services to the acute      the Palliative Care Team       The Doula Program been
tive Care Clinic. Formally           care patients in the New        as isolated and without        a great extension of the
developed in 2004, the               York Campus. Incorpo-           family support greatly         NY VA Palliative Care
Bronx Palliative Care Clinic         rated into the New York         benefit from the suppor-       Program, as the suppor-
enhances the continuity of           VA Palliative Care pro-         tive presence of the           tive needs of the immi-
care across care settings            gram is the Doula Volun-        Doula volunteer. The           nently dying are ad-
for patients with life-limiting,     teer Program. The Doula         emotional, spiritual and       dressed.
advanced illness. The                Volunteer, from Jewish          social support and advo-
goals of the Outpatient Pal-         Board of Family and Chil-       cacy have meant a great
liative Care clinic are to pro-      dren’s Services and the         deal to those veterans
vide effective symptom               Department of Social Ser-       receiving it. They often
management, assist with              vices of NYU Medical            come in during the eve-
care planning, goals of              Center, is someone              nings and weekends. At
care, emotional support for          trained to provide com-         times the volunteers have
patients and caregivers,
and strengthen ties with
community hospice pro-               VA New York Harbor Healthcare System:
grams for patients co-               Brooklyn Campus
managed by the VA and
hospice.                             Brooklyn VA Medical            re-adapted for VA utiliza-     PCAD Clinical Pathway
                                     Center implemented the         tion. Since the implemen-      are discussed in the
                                     PCAD (Palliative Care for      tation of PCAD, the staff      2005 Journal of Pain and
                                     Advanced Disease Path-         have improved in their         Symptom Management
                                     way) in June 2002 for the      ability to identify dying      “Pilot of a Pathway to
                                     acute care Oncology/           patients and to provide        Improve the Care of Im-
                                     Palliative Care Unit. Ini-     comprehensive interdisci-      minently Dying Oncology
                                     tially developed in Beth       plinary management of          Inpatients in a Veterans
                                     Israel Medical Center,         these patients and their       Affairs Medical Center”
                                     NY, PCAD was                   families. (Details of the      JPSM 2005:29:544-551.)

Northport VAMC- Celebration of Life with Butterflies, Light and Music
The oldest Palliative Care         tern at the nurse’s station     their respect to the de-        allows remembrance of
Unit in VISN 3, Northport          symbolizes that a resident      parted veteran. As the pa-      the veteran by the family,
VA Medical Center opened           has passed away. A lan-         tient’s body is wheeled         staff and fellow residents.
the Palliative Care Unit           tern placed outside of the      from the unit (accompanied      Through the symbolic
in1985. One of the innova-         patient’s door identifies       by two staff members) the       nature of butterfly, music,
tive programs taking place         the resident’s room. (1)        stretcher is draped with the    and lights, the veteran’s
in Northport is the Butterfly      Place the red lantern at        red, white, and blue bun-       life is commemorated and
Program. Implemented in            the nurses’ station and         ting, which is removed from     his/ her legacy continues
May 2005, a ritual com-            turn it on. (2) Place the       the stretcher as it enters      to live.
memorating the life of the         second lantern outside the      the elevator. After the resi-
veteran takes place imme-          door of the resident’s          dent’s body is removed
diately after his/ her death.      room. (3) Place magnetic        from the unit the lantern
   When a resident passes          butterflies around the door     may be turned off. The lan-
away, the Northport Pallia-        frame. (4) Load the favor-      terns are left in place as a
tive Care Unit staff will          ite music into the CD           reminder that someone
commemorate his/her life           player and turn it on.          recently passed away.
with a vigil of butterflies,         Families, staff, and other      The Butterfly Program
light, and music. A red lan-       residents can now pay
                                  Volume 3, Issue 2                                                            Page 3

                                                                                                WORDS OF HEALING
What Do We Remember on Memorial Day?
 By Rabbi Doniel Z. Kramer, PhD
  This issue of The Cloak      and sports.                      ence, liberty and freedom       thankful for those cher-
is due to arrive before           Interestingly, our Inde-      that we enjoy because of        ished and uplifting memo-
Memorial Day, and              pendence Day—July 4—is           the ultimate sacrifices that    ries.
memorialization is espe-       not marked much differ-          were made by others. The          May the memories of our
cially poignant for those      ently. Stores may be             celebration of the Israeli      departed truly be for a
involved in palliative and     closed, but it still is a time   Independence Day is not         blessing--Amen!
hospice care.                  for picnics and sports--with     only immediately pre-
  There is an interesting      perhaps a flag flying in the     ceded--but it is premised
contrast between Memo-         breeze.                          upon--the acknowledge-
rial Day observances
here in the US--and in
                                  I like the juxtaposition of
                               these holidays in Israel
                                                                ment of the sacrifices that
                                                                brought about their free-
                                                                                                VISN 3 Update
                                                                                                   Continued from page 1
Israel, both of which are      much more. There—                dom.
observed during the            Memorial Day is not only a          This is how we should be     interagency educational
month of May.                  solemn day for grave visita-     reflecting upon the lives of    program, the NY Harbor
  In Israel, where war         tions, but it is immediately     our veterans—to whom we         HVP is also planning a one-
and terrorism is so fresh      followed by the Israeli Inde-    rightfully have offered our     day modified EPEC pro-
in everyone’s mind, Me-        pendence Day. Since the          most heartfelt care during      gram on June 19, 2006.
morial Day is observed         Hebrew day begins and            their last months, weeks        Featured speakers include
as it once was in the          ends at sunset, the solem-       and days. With their fami-      Kathy McMahon, Deborah
US—with solemn remem-          nity of the 24-hour Memo-        lies—we mourn their pass-       Grassman from Bay Pines
brances of those who           rial Day transforms at sun-      ing; but hopefully, also with   VAMC, Bruce Jennings
have paid the ultimate         set into the boisterous, joy-    their families, we realize      from the Hastings Center,
sacrifice on behalf of their   ous and thankful celebra-        that we have much to cele-      and other members of the
country. Originally, in the    tion of Independence Day.        brate about their lives and     hospice community. We
US, it was a time to re-           There is an inherent les-    presence.                       look forward to similar local
spectfully DECORATE            son in the Israeli experi-          Mourn--we must--when         HVP EPEC programs tak-
the graves of veterans         ence. While it allows for        that sad time of death ar-      ing place at the other sites
and comrades. Unfortu-         appropriate memorializa-         rives; but let us also re-      in the VISN.
nately, today—our Me-          tion—it also realizes that       member the wonderful, life-        We once again thank
morial Day is often            these sacrifices were not in     giving experiences that         you, the PCCT members,
marked by sales, picnics       vain: that there is independ-    marked their lives—and be       for your commitment and
                                                                                                dedication to our VISN Pal-
                                                                                                liative Care Program and to
                                                                                                the high quality end of life
                                                                                                care that you deliver to our
         The Carol Selinske Founders Award goes                                                 veterans and their families.

         to VISN 2 & 3 HVP Partnership
         Recognized as the highest award given by HPCANYS, the
         Carol Selinske Founders Award was presented to Carol Luhrs,
         Therese Cortez, and Joe Striano on behalf of the VISN 2 and 3
         Hospice Veteran Partnership’s efforts of advancing hospice and
         palliative care in New York State. An awards luncheon took
         place on March 31, 2006 at the HPCANYS Annual Meeting.
           It was an exciting day for all the PCCT members who at-
         tended. This award is a recognition of all the work you have
         contributed toward the development and growth of the hospice
         veteran partnership.
                        Page 4                                           The Cloak

A Social Work Intern’s Perspective
By Devora Hoschander

     This past year I have       only of my immediate          adjusted to meet his or        whom lived out of state.
had the privilege of work-       supervisor but for the en-    her needs. In situations       Despite his scanty tradi-
ing as a social work in-         tire team. My comments        where there is often the       tional family support, Mr. V
tern in the Oncology and         were welcomed and care-       need to make difficult         was able to form a new
Palliative Care Programs         fully considered. My          decisions and face diffi-      family for himself com-
at the Brooklyn VA. Being        questions were answered       cult truths, the support       prised of neighbors,
a part of these interdisci-      with a thoroughness and       and care the Palliative        friends from his local com-
plinary teams, especially        enthusiasm that speaks        Team provides is invalu-       munity center, and movie-
the palliative care team,        strongly to the quality of    able.                          going buddies. Mr. V’s
has been an invaluable           the team members. In                One patient that         ability to keep busy and be
opportunity. Through my          addition, I observed again    comes to mind when             surrounded by the network
participation in palliative      and again, the support        considering the valuable       of friends he created was a
care rounds and palliative       and encouragement the         work of the Palliative         considerable strength. In
care consults I was able         team members gave to          care department is Mr.         addition, Mr. V had a dry,
to observe and learn from        each other in dealing with    V. I first met 86 year old     wickedly funny sense of
colleagues from many             such a challenging popu-      Mr. V towards the end of       humor, a significant coping
different disciplines, in-       lation. The weekly team       September of 2005              mechanism that gave him
cluding doctors and fel-         meetings are an opportu-      when I was brand new to        a venue through which to
lows, nurses and nurse           nity for workers not only     the VA. Mr. V was at that      talk about and observe the
practitioners, psycholo-         to review cases but to        time newly diagnosed
gists, social workers and        both vent their frustra-      with large B cell gastric
chaplaincy. Dedicated to         tions and share their suc-
alleviating physical, psy-       cesses.
                                                               lymphoma and was just                 The Cloak
                                                               beginning to receive ra-
chological and emotional             As an intern in both      diation treatment. My            The VISN 3 Palliative
pain, the Palliative Care
team exudes a potent
                                 programs, I saw patients      first impression of Mr. V         Care E-Newsletter
                                                               was of a true gentleman,
blend of confidence, com-                                      and my subsequent              Publisher
petence and compassion.                                        meetings with him only         James J. Peters VA Medical Center
                                                                                              Bronx-New York Harbor
     Interns are funny                                         furthered this notion. Mr.     Geriatric Research Education & Clinical
creatures, neither em-                                         V was well dressed, soft-        Center (GRECC)
ployees nor volunteers,                                        spoken, and unfailingly        Albert Siu, MD, MSPH
both workers and stu-                                          polite. At first a bit quiet   Director
dents; there is great po-                                      and reserved, establish-       Executive Editor
tential for an intern to feel                                  ing a therapeutic alliance     Judith L. Howe, PhD
lost, overwhelmed, and                                         with Mr. V was slow but        Associate Director/Education, GRECC
intimidated, particularly in                                   rewarding work. Over
a setting as clinically and                                    the next few months,           Managing Editor
emotionally challenging          on all levels of the care     through service referrals      Valerie M. Menocal, BS
as a hospital oncology/          continuum, and was able       and frequent casual            Education Coordinator/GRECC
palliative care depart-          to witness the continuity     meetings, I got to know
ment. While the profes-          of care that patients re-     him.                           Editorial Board
                                                                                              Therese B. Cortez, NP
sional expertise of the          ceived. The end stages          Mr. V lived alone in a       Louisa Daratsos, LCSW, ACSW
palliative care team won         of illness can be frighten-   trendy neighborhood in         Judith L. Howe, PhD
my respect, the personal         ing and overwhelming for      Brooklyn, and treasured        Carol Luhrs, MD
character and attitude of        patients and their fami-                                     Joan D. Penrod, PhD
                                                               his independent and
the team members se-             lies; the palliative care                                    John A. Sperandeo, LCSW
                                                               self-sufficient lifestyle.
cured my admiration and          team ensures the smooth       Mr. V’s social supports
esteem. It was clear from        transition from active                                       Phone: 718.584.9000 x 3800
                                                               were unconventional, but       Fax: 718.741.4211
the beginning of my in-          treatment to comfort care,    strong. Mr. V was di-
ternship year that my            providing the patient with    vorced and had an es-          Article submissions, e-mail:
educational experience           an individualized treat-                           
                                                               tranged relationship with
would be a top priority not      ment plan shaped and          his four children, all of
                                  Volume 3, Issue 2                                                          Page 5

A Social Work Intern’s Perspective                                  Continued from page 4
By Devora Hoschander
progression of his illness;     sobbed that all he wanted to          care social work and a deep
Mr. V would often joke          do was to die. As a man who           sense of respect and admi-
about his weight loss and       had always been very inde-            ration for the valuable work
his radiation treatment,        pendent, it was clear that Mr.        done here at the VA. Without
which he referred to as         B found his lack of control- “I       a doubt, my internship as
“getting zapped.”               don’t want to live like this! I’m     part of the oncology and pal-
  As Mr. V’s illness pro-       so weak I can’t even sit up!”-        liative care teams will have a
gressed he struggled with       terrifying.                           lasting impact on my future
weight loss, nausea and            As an observer and partici-        career.
weakness. He no longer felt     pant in Mr. V’s journey from
up to going to the movies or    diagnosis to death, I know
having friends over for         that Mr. V’s case will stay with
drinks, and his social circle   me for a long time as a diffi-
shrank. True to his inde-       cult but valuable learning ex-                Congratulations!
pendent nature, Mr. V in-       perience. Working in end of
sisted throughout that he                                                     Louisa Daratsos, LCSW for receiving
                                life care can be a painful and                a prestigious American Cancer Society
did not want homecare. On       challenging; I feel fortunate to
his last admission, Mr. V                                                     Dissertation Award. Louisa will focus
                                have had the opportunity to                   her research on end-of-life care for
came to the ER due to se-       work with an exemplary pal-
vere gastrointestinal bleed-                                                  veterans.
                                liative care team during these
ing. When I came to see         formative years of my profes-                 Carol Luhrs, MD on becoming a Fel-
Mr. V shortly after his ad-     sional life. This upcoming                    low of the American Academy of Hos-
mission the change in his       May I will be graduating, a                   pice and Palliative Medicine. This
mindset was significant.        newly minted social worker                    award was presented at the AAHPM
When he saw me, Mr. V           with a passion and vocation                   Annual Meeting on February 10, 2006.
burst into tears. Weakly he     for oncology and palliative

    Editor’s Note
    As this edition of The Cloak attests to, the VISN 3 Palliative Care Initiative continues
    its extraordinary work in providing optimal care for those veterans facing life-limiting
    illness. Having been part of the initiative from the outset, I am always struck by the
    innovation, energy, and commitment of all of the VISN palliative care team mem-

    I am pleased to be able to play a role in my capacity as GRECC Associate Director/
    Education in “getting the word out” about what the VISN is accomplishing in pallia-
    tive and end of life care. We disseminate this e-newsletter quite widely, including on
    the GRECC website through The Cloak ( and through VA web-
    sites. If you would like to forward The Cloak to any of the listserves that you are on,
    please feel free to do that. Just drop Valerie Menocal an email
    ( so we can “track” our impact. And if you have any
    other suggestions for The Cloak please let us know. For instance, the Chaplains
    have initiated a regular column beginning in this issue called “Words of Healing”.
    We like this kind of proactivity, and as always, submissions and updates are wel-
    come and published as space permits.
                                                                             Judy Howe

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