Eighty-seven-year-old Dorella Johnson is tired.
She's tired of suffering through multiple blood-draws every day to treat the chronic illnesses that have landed her in Providence Medford Medical Center. Her deep and fragile veins make it difficult to insert needles into her arms. Her arms are splotched with large purple and black bruises that stretch from her wrist all the way past her elbow.
She's tired of spending her days in a hospital bed and not at the Medford home she and her late husband of 68 years, Roger Johnson, lived in for several years.
Her sister Ruth Wineteer came to Medford from her home in Eastern Oregon to be there when a decision was made on Johnson's fate.
"She told me that she didn't want any more shots, no more poking," Wineteer said. "She just said, 'No more. It hurts.' "
Johnson knows she has reached the end of her life and she wants to live out her final days in relative comfort, away from hospitals and doctors.
It is the job of Providence's palliative care program to ensure that Johnson's wish is granted.
"I'm going back home," she said.
Providence is expanding its palliative care program with help from a $205,000 grant from the Cambia Health Foundation, said Vicki Chamberlain, Providence's marketing and public relations director.
Part of the grant will go toward educating local residents on what palliative care is, and what it provides for the community, Chamberlain said.
Some are under the impression that palliative care deals only with end-of-life issues such as untreatable cancer, end-stage diabetes and Alzheimer's disease.
Palliative care, which is sometimes confused with hospice care, refers to the overall attention physicians pay to patients' suffering and treatment. Many of these patients are not terminally ill but have debilitating symptoms or are enduring grueling treatments such as chemotherapy. To be sure, hospice is under the palliative-care umbrella.
"We have patients who are receiving very aggressive chemotherapy treatments and they suffer from things such as depression along the cancer journey," Chamberlain said.
"What we do is get them help to deal with this pain, so that it will improve their treatment outcome. Many of these people will make a recovery from the cancer."
People who suffer from the effects of their disease lose jobs and can become withdrawn from their families, said Michael Christensen, a nurse practitioner brought in from Stanford University's hospital to become Providence's palliative care coordinator.
"We work to treat any life-limiting or life-threatening issue and get the patient in the process as early as possible to keep up their quality of life," he said.
The goal is to get patients out of intensive care sooner, instead of letting people languish with chronic diseases.
Christensen believes palliative care will continue to grow as a medical specialty because medical advances have prolonged patients' lives.
"We can save you from the massive heart attack and cure other serious illnesses that would have been fatal several years ago," he said. "But now we see people living long enough to where they suffer from chronic diseases toward the end of their lives."
Sometimes, as in Johnson's case, these ailments stack up on patients and ruin their enjoyment of life. They may decide that aggressive treatments in a hospital are not worth the pain and anguish.
"We want to make sure that we are not sacrificing quality of life for quantity of life," Christensen said. "For Dorella, her type of treatment would involve these very painful blood tests."
When Johnson made it known she no longer wished to endure the treatments, a meeting was called with the hospital's palliative care team, which consists of doctors, a social worker, a psychologist and a chaplain for spiritual guidance.
The team meets with the patient and his or her family and a decision is made on how best to make the transition from treatment to hospice care.
"We want to involve the family as early as we can," Christensen said. "But ultimately, it's the patient's decision."
Wineteer was at the meeting with the palliative care team and Johnson. She said the final decision was "hard," but she respects her sister's right to live out her life on her own terms.
"She was very clear about what she wanted," Wineteer said. "I was impressed by the process and I think it's the right thing to do."
Providence's palliative care team visits with about 20 patients per week. Most are people suffering from chronic lung diseases brought on by smoking or exposure to harsh chemicals while at work.
"We have a lot of people who worked at mills years ago when they didn't have the safeguards they do now," Christensen said. "They have shortness of breath and want to see their quality of life improve."
Oregon is among the leaders in the United States for palliative care.
A poll released in 2011 by the National Journal showed that Pacific Northwest residents largely support end-of-life care.
In addition, the National Palliative Care Research Center gives Oregon an "A" for the access its hospitals provide to this care.
Rogue Regional Medical Center in Medford received a $238,000 grant from the Cambia Health Foundation (previously the Regence Foundation) (name has been clarified) in April 2011 to start its own palliative care program. Hospital staff at the time said the goal was to help more than 500 patients over two years.
Palliative care programs remain popular in the West and in many parts of the Midwest and East Coast. The rural South struggles with maintaining such programs, according to the National Palliative Care Research Center.
Palliative care requires expensive resources up front because it involves treatment from several different professionals.
"You have a group of people providing you care and each one of them involves a charge," Christensen said. "Ultimately, palliative care will end up saving money because people won't be receiving treatments that won't do anything to increase quality of life. There also won't be unnecessary lab tests and time on a respirator."
In other words, the palliative care team educates patients on the path they can choose at the end of their lives. Many people choose not to continue with heavy treatments that will do little to make their final days pleasant.
The specialty has been available for hospital board certification in Oregon for just four years, Christensen said.
"I think you're going to see more doctors get involved in palliative care as it becomes more popular across the country," Christensen said.
In the meantime, Johnson was released from Providence last week and is at home. She is receiving hospice care to alleviate her pain and suffering.
"She has her family around her and is getting good care," Christensen said. "And she is not facing any more needles."
Reach reporter Chris Conrad at 541-776-4471 or firstname.lastname@example.org.