A nurse’s nurse—that’s how Paul and Tessa Miller describe their mother, Fran, who succumbed to cancer in February. Fran spent 40 years serving the community as a psychiatric nurse at Alta Bates Summit Medical Center’s Herrick Campus, inspiring both of her children to pursue careers in nursing.
I’ve seen many changes at Sutter over the years, and this is by far the best one
“She was such a strong force throughout our family,” Paul says. “There is no doubt that our mother’s determined dedication and example in nursing led my sister and me down the same path.”
Paul has already spent 25 years at ABSMC, attending nursing school at Samuel Merritt University on the hospital campus and taking his first job in respiratory care and intensive care before transitioning to the emergency department. Tessa followed in his footsteps just a couple years later, ultimately joining the behavioral health team in 2000, where she had the pleasure of working with her mom. Paul even met his wife, fellow nurse Teresa, on the job 17 years ago.
When Fran was diagnosed with sarcoma—cancer of the bones and connective tissues—in November 2018, her clinical experience and stoic nature led her to seek out the latest treatments and investigate clinical trials. It was a challenging time, but December 2020 finally bought encouraging news.
“It was a good Christmas present to see some positive scans,” Paul says, with Tessa and Teresa jumping in with similar reactions. “It seemed we had finally landed on a combination of drugs that allowed us to see some cancer regression for the first time in two years.”
That joy would be short lived. Fran suffered a fall on December 31, leading to three days in the hospital to tend to her injuries, which put her on an unsteady and unfamiliar path. “There was an obvious shift in her condition and outlook, and we weren’t sure what would happen next,” Teresa says. “We emailed her primary care doctor, Samara Nebenzahl, M.D. with Sutter East Bay Medical Foundation, right away to ask about palliative care.”
The close-knit family of nurses felt that the established medical system of specialists and emergency care—and even primary care—lacked the holistic, coordinated approach needed for patients facing serious illness and debilitating disease. The Millers were referred to Sutter Health’s Palliative and Advanced Illness Care, an outpatient palliative care program that launched at ABSMC last summer thanks to a $3.5 million grant from the Stupski Foundation.
“I’ve been waiting 25 years to see this kind of outpatient palliative care available for Sutter patients,” Paul says proudly. “I’ve seen plenty of changes at Sutter over the years, and this is by far the best one.”
The next hurdle the Millers faced was convincing Fran that palliative care was the right solution. “We all knew Mom thought palliative care and hospice care were the same, a common misperception, even though she spent her career in healthcare,” Tessa explains.
Palliative care and hospice care are indeed different, an important point that the Millers want to stress to the community. Palliative care can be provided at any time during a patient’s illness whereas hospice is specifically designed for the end of life, once other medical interventions and treatments have stopped.
Grounded at Home
Fran and her husband, Randy, lived in the same Alameda house for more than 50 years. Their children referred to them as “Frandy” because the couple was seldom separated. They would have celebrated their 56th wedding anniversary in April, so keeping Fran home during her final weeks gave everyone a chance to be themselves and enjoy time together as a family.
Though Fran was initially reluctant to receive palliative care, the Millers say it took just one home visit from nurse practitioner Sophie Stewart, FNP, MSN, to put their mom at ease. Stewart took the time to listen, hold Fran’s hand and make her feel empowered.
“I love when you come to see me; your visits are so unstructured and unconventional,” Fran told Stewart during one visit. To Stewart, this was validation of the program. “Fran was such a gem!” she says. “Seeing how a patient lives and what is and is not important to them gives me insight into each patient and their family members as I observe the dynamics and spend as much time as needed on the visit.”
Paul, Teresa and Tessa would often remind Fran of Stewart’s words to her: “You are the bus driver; we are just the passengers. You are in charge to give us the GPS coordinates to tell us where you want to go.”
Reflecting on their impactful experience with the palliative care program, Teresa and Paul liked it to something they strive for as emergency department nurses: the perfect call, meaning the ideal flow of events during a single patient encounter. Emergency medicine can be chaotic, taking many unexpected turns, but if all steps are followed to ensure high-quality care, then they’ve achieved the perfect call.
“Despite the fact that our mom is not with us anymore, our experience with palliative care was the perfect call,” Paul concludes. The Millers feel that when all else was failing, palliative care allowed them to recapture some of their humanity. Freed from problem-solving, they were given the gift of being a family, happy to be home and grateful for Fran’s care.
Outpatient Palliative Care in Alameda County
Thanks to a three-year $3.5 million grant from the Stupski Foundation, Sutter Health’s Palliative and Advanced Illness Care program launched at Alta Bates Summit Medical Center in 2020. PAIC has four key components—specialty palliative care, advance care planning, family caregiver support and links to social services—each adding an extra layer of support for patients.
Made up of five interdisciplinary caregivers, the Sutter East Bay Medical Foundation (SEBMF) PAIC team, located at the Alta Bates Summit campus in Oakland, helps patients facing serious disease navigate the medical system in a way that honors their values and wishes as they set goals for care. They expertly manage patients’ symptoms and other medical needs alongside their regular providers while also providing psychosocial support. For all five caregivers, this is a labor of love.
“Our role is to listen to what is important to a patient when they are struggling with disease and may not feel like themselves anymore,” explains Andrea Thach, M.D., PAIC leader at ABSMC. “We are lucky to have an empathetic team, each one a star who goes the extra mile to advocate for patients and their loved ones.”
Unlike hospice care, palliative services are available to patients at any stage of disease. “I want to deconstruct the myth that palliative care comes when there are no other choices,” says Lisa Edwards, LCSW, PAIC social worker. “We don’t have an agenda for care, but the team offers many services that improve a patient’s quality of life.”
For example, Dr. Thach has joined patients on medical visits with oncologists. Nurse practitioner Sophie Stewart, FNP, MSN, has followed an established clinical patient into the intensive care unit to be a familiar face and advocate when coordinating with the inpatient doctor. And because roughly two-thirds of PAIC patients are at risk for spiritual distress, the team has a chaplain on call.
“It’s powerful when you see this working and see how it benefits patients and their families,” Stewart says. “Working in any aspect of healthcare, time is never on your side, and it’s a struggle to help one patient and then move onto the next. But because of this philanthropic gift, we are able to spend an extended amount time on each case. It has been exciting to be a part of the palliative care team—this is exactly what I was meant to do in medicine.”
Close alignment with oncologists and other subspecialists, primary care physicians and chaplaincy teams has already led to more than 125 referrals to PAIC. About one-third of these referrals come from primary care physicians, who often recognize that their patients are struggling emotionally and physically with issues that can be more effectively handled by the palliative care team and perhaps a home visit.
“Every single visit, I learn something that I wouldn’t have known if I hadn’t seen their home life, and that tells their story just as much as their disease,” Edwards says. “This is my dream job.”
The physicians who partner with PAIC also benefit. For instance, before the formal program existed, oncologists who felt passionate about offering an outpatient bridge of care had to do so on their own time.
In 2020, the Stupski Foundation made an additional grant of $225,000 to help overcome challenges brought on by the pandemic. The funds provided mobile-enabled iPads for video consults and access to an advanced care planning video library to enhance patient care and improve planning for inpatient and ambulatory palliative care teams across Sutter’s Bay Area footprint.
With the grant money, PAIC will expand further across northern Alameda County in the coming years. This summer, the SEBMF program will add a new team to support Eden Medical Center. Once the expansion is complete, PAIC programs will help an estimated 60% more patients through enhanced services and capacity and improved coordination across the county.