By Russ Granich, MD,
Chief Medical Officer of Palliative Care of the East Bay

Many people get upset if their doctor says she wants to refer them to palliative care, worrying that it will only mean end-of-life care. However, palliative care is quite different from hospice. Palliative care provides patients relief from their symptoms, helps them cope with their illness and plan for the future. It is specialized care for anyone, at any age, with a serious illness. As Dr. Michael Rabow of UCSF says:

The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a team of doctors, nurses, and other specialists who work with a patient’s other doctors to provide an extra layer of support. Palliative care is appropriate at any age and at any stage in a serious illness, and can be provided together with curative treatment.

The need for quality palliative care is growing. As a non-profit organization with a strong commitment to our community, Hospice East Bay has developed a palliative care program to meet that need. It is called Palliative Care of the East Bay. This program is team-based and includes a board-certified palliative care physician, certified nurse practitioner, social worker, registered nurse, and volunteers, as well as access to spiritual care and home health aides. An RN is available by phone 24 hours a day, seven days a week. Other team members are available during the day for visits and phone support.

The palliative care team will coordinate with your other health service providers and work with you to develop a plan for of care that involves all of your doctors and services, while ensuring that your needs and wishes are being met.

In addition, Palliative Care of the East Bay can help with filling out complicated medical forms, managing medications and prescriptions, educating family members and caregivers on how to give medications and use medical equipment, coordinating lab work, ordering necessary medical equipment. We also organize care conferences to help resolve family conflicts, arrange volunteer services to provide caregiver relief and friendly visitors, and assist with difficult emotional and logistical transitions, such as moving a patient to an assisted care facility.

Every person is different and so we treat each patient as an individual to help them reach their own personal goals. Some patients might still be receiving aggressive treatments, such as chemotherapy. Some might be winding down and just want to focus on comfort but are not ready for hospice. The real strength of palliative care is the flexibility to provide the care that is most appropriate for you and your family.

Palliative Care of the East Bay works with many insurance providers. Our coordinator can answer your questions about what is covered by your insurance and work to develop a program that fits your needs. Ask your doctor about Palliative Care of the East Bay or call us at (925) 852-0010.

Hospice Moments

Spiritual Care Counselor Bette Birnbaum is often moved to poetry by her experiences with families in hospice. Here is one of her recent poems:

Even now, when he is as slow of speech as Moses,
words matter to him.

placed with precision in the flow of conversation
and the cascade of prayer,
they are as honeyed as King David’s
and as wise as Solomon’s
each phrase a string of pearls in the ether.

Which is why,
when our pastor/patient prayed over our last visit,
over our time of holding his life to the light,
he startled from his close-eyed trance
when he heard his silver tongue speak:
“Dear Love.”

The words hung in the air.
He had meant to say, “Dear Lord.”
He unclasped my hands
raised a quizzical eyebrow,
and digested this most novel introduction to his prayer.

In the moments before he re-centered himself and took up my hands once more,
I wondered if he knew he accidentally shared the secret
that hospice, when it is humming,
is a divine embrace.


Hospice Moments

Spiritual Care Counselor Bette Birnbaum is often moved to poetry by her experiences with families in hospice. Here is one of her recent poems:

She learned early on not to throw away love
but rather amass, accumulate, assemble, and accrue it.
She remembers the painful ritual.
Every week her mother tossed her precious stuffed dog in the trash,
and every week she rescued the frayed toy from the bin
just moments before the garbage workers hauled it away.
Her mother chided: You don’t need that thing anymore.
And she would think while hugging the dog tight: Oh, yes I do.
Collecting was her best revenge.
Collecting full-bodied ceramic angels and Lladro nuns,
colorful teapots and figurines of beagle dogs,
penguins large and small, soft, porcelain, and plastic,
Snoopies, Belleek china, Warriors swag.
And even badgers, including the taxidermied, snarling specimen
standing watch over the stacks on her dining-room table.
Each piece has pride of place
in her house groaning with so much stuff that it would take a month to dust
and by the time you were finished you would have to start over again.
She collected relationships:
family members, friends acquaintances,
and was just tickled that 20 women with her same first name
regularly collected for coffee in a café near her country cabin.
It didn’t matter to her that she was too sick to go--
the gathering principle was thrill enough.
Now, bald-headed and burning-eyed,
she is dispersing her love.
Slowly, deliberately, she decides who will get what,
sharing the story of the items one by one
while she supervises relatives who carefully wrap them in tissue paper
and nestle them in their original boxes
which she saved, of course.
The objects become denser and weightier with the anecdotes
her people will repeat by heart after she is gone.
Long ago she learned that you don’t throw away love
but rather hold it close,
and when the time comes you make a gift of it,
because love is the gravity holding you here.

Our own Spiritual Care Counselor, Bette Birnbaum, submitted the following poem to the National Hospice & Palliative Care Organization creative arts contest and won! We are so proud and honored that’s she’s part of our team!


Initial Visit

The nurse says,
I will walk with you
through a land you do not yet know.
I will ease your pain
and help you breathe easy.
I will bind up your wounds
and be for you and the ones you love
a source of truth and succor,
a fount of compassion and confidence.

The hospice aide says,
I will be for you
like a mother eagle guarding her nest.
When you hunger,
I will provide food.
When you thirst,
I will provide drink.
I will dignify you,
smoothing your hair,
softening your skin,
and anointing you with fragrant oil.

The social worker says,
I will protect you as you journey
and keep you safe from all harm.
I will be for you
a sentry at your head and a guard at your tail.
With a strong hand and an outstretched arm
I will remove all obstacles in your way
and lift your precious beloveds
whenever they fall.

The chaplain says,
I will be an ear for your prayers
and a cradle for your comfort.
I will be with you
in the valley of deepest darkness,
a friend in green pastures and beside still waters.
I will share your overflowing cup
and together,
we will sip of your
deepest sorrows and greatest joys.

The patient says,
Here I am,
the beggar at the gate,
lame, mute,
my soiled rags
frayed and flapping in the hot wind.
With fear and trembling
I commit myself into your hands.

Teach me to number my days and shape a heart of wisdom
as you read me like a sacred scroll,
lauding and praising
glorifying and exalting
my Name.

Spiritual Care Counselor Bette Birnbaum is often moved to poetry by her experiences with families in hospice. Here is one of her recent poems:

He promised not to peek,
and she trusted him—
the boy from the neighborhood
whom she’d married when they were twenty-one
and lived with in a bubble of happiness ever since.

She set out paper goods
floral plates and matching napkins,
a tray of pineapple rings,
potted orchids (supplied by friends),
and their well-used sand chairs.

While his eyes were still closed
she worked an oversized beach towel beneath him
and didn’t take no for an answer
when she went to change him into his brightest bathing suit,
now several sizes too big.

When she let him look at last,
he beheld his second honeymoon.

They donned Ray-Bans,
slathered on coconutty sunscreen,
and sipped mai tais.
They snapped selfies to the strains of ukulele music.

They didn’t want the time to end
even though they never left the family room,
and he never left the hospital bed
where he was living – and dying – on hospice.


Green Leaf Closeup

In biology class, we learn how plants grow. A green plant uses sunlight to turn water and carbon dioxide into sugars that the plant uses as energy. We call this process photosynthesis, and it doesn’t happen without help. It needs a catalyst, something that helps to expedite the chemical reaction. In photosynthesis, the catalyst is chlorophyll, which absorbs the sun’s light and enables the transformation of energies to occur.

In hospice, the interdisciplinary team is a kind of catalyst. We enter into the lives of our patients and forge a relationship. Through that relationship, we help them face the task of completing a life mindfully, of bringing closure with loved ones. We help them lay the groundwork they need to walk toward that final door, open it and step across its threshold; we help their families wrestle with loss, grief and acceptance. Then, in the fullness of time, our work is done.

In the film Nanny McPhee, there is a scene in which the good lady explains herself. “There is something you should understand about the way I work,” she says. “When you need me but do not want me, then I must stay. When you want me but no longer need me, then I have to go. It’s rather sad, really, but there it is.”

So it is in hospice. We enter as catalysts into the process of dying—a process as spiritual as it is physical. At the beginning, we may not be wanted, but usually we are much needed. When the family’s grief has begun its slow march toward acceptance, when the patient’s prayers have been exhaled like a final, holy sigh—that is when the catalyst has completed its work. That is when we have to go.

Chlorophyl helps along the work of photosynthesis, over and over, without being consumed or altered—but it doesn’t work like that in hospice. The true gift of our work is that we do not emerge unaltered. The work works upon us. The patient teaches us. With each and every death, our spiritual capacity as healers is enlarged—and so we bear witness, with gratitude, to every soul entrusted to us at the close of life.

Spiritual Care Counselor Bette Birnbaum is often moved to poetry by her experiences with families in hospice. Here is one of her recent reflections:

Joe’s Bible is always nearby. It’s either resting in the bookshelf behind his recliner, or lying open on the table in front of him, or waiting on the nightstand next to his bed. He hasn’t been able to hold the book or turn the pages for a long time. He can’t reach for it, but he still keeps it close.

I read aloud from Joe’s Bible every time I visit.

We perform the same ritual. I ask him what he wants to hear. He grunts invariably, “Matthew. From the beginning.”

As I thumb to Matthew’s Gospel, I notice Joe’s scribbles overwriting multiple pages—his illness-inflected efforts to highlight key passages and jot reflections in the margins.

I say, “I write in my Bible, too.” His eyes beam.

I start to read: “The book of the generation of Jesus Christ, the son of David, the son of Abraham.” Invariably, a couple of verses in, Joe grunts again. But now he is forceful. And louder. He has pushed his chest slightly forward to get my attention. “Psalm 139,” he says. “It saved me.”

Since we’ve been through this drill before, I already have my finger in the page. I flip right to it, and begin.

We read that God knows Joe’s sitting down and standing up, Joe’s walking and reclining, and the very words on Joe’s tongue. We read that God fashioned Joe in his mother’s womb and that Joe, like all of God’s works, is awesomely and wondrously made. The sounds of Joe’s sister-in-law hustling and bustling in the kitchen, and his brother-in-law rustling at his desk, fade back. Even the insistent blare of Fox News recedes, and soon it’s just the three of us. Just Joe, and me, and the Book.

“God, You hedge me before and behind,” I read. Joe radiates bliss. He holds this truth, and it holds him. For a transcendent moment, I catch a glimpse of faith.

This is the same moment when our ritual becomes valent, when our miraculous pas-de-deux, even though Joe cannot move, makes an unrehearsed pirouette. As Joe’s health grows poorer, our ballet grows richer. Which is why it never feels routine to dance with Joe and his Book.