When Karie Praszek, MD, a hospitalist at the University of Texas Health Center at Tyler (UTHCT) found out this past fall that she was being considered for the position of medical director of the hospital’s planned hospice inpatient unit, she went home after work and cried. These were tears of happiness because she was finally going to be able to combine her two loves as a physician: hospital medicine and hospice care. “It was like coming full circle,” she explains.
The seven-bed hospice unit at UTHCT opened in partnership with Hospice of East Texas in Tyler in November, following renovations to create more comfortable and spacious rooms. It is one of a growing number of collaborations between hospitals and community hospice programs to provide institutional beds for terminally ill, hospice-enrolled patients in need of short-term inpatient care for symptom management.
In many hospitals, hospitalists are well positioned to provide planning, leadership, hospice referrals, or medical management of hospice units in the hospital. But few of them will follow a path like Dr. Praszek’s to the medical leadership of the hospice unit.
The Needs of End-of-Life Patients
Dr. Praszek’s commitment to the needs of patients facing the end of their lives took her from Texas to Oklahoma to Oregon and back to Texas. She has been a practicing hospitalist at UTHCT since 2004, but medicine wasn’t her first career. In the 1980s, as a computer expert for the U.S. Postal Service, she helped to automate postal facilities. She was well paid, she says, but something was missing in her life.
Wanting to make a meaningful contribution, Dr. Praszek became a volunteer candy striper at a hospital in Dallas. She learned about hospice while assigned to the oncology floor.
“When I started doing hospice care, I fell in love with it, and used volunteer work to hone my skills,” she says. She quit her job and moved to Oklahoma to attend a seminary with a specialized curriculum in death, dying, and grief counseling, all the while volunteering with hospice patients.
The family room at UTHCT.
“They even trained me to be a certified nurse’s aide,” she says. “I just wanted to do whatever they needed—to do what no one else wanted to do.”
As a volunteer nurse’s aide she cleaned bedpans, changed diapers, and gave bed baths to hospice patients. “I didn’t mind it because it meant I could have more time to talk with the patients,” explains Dr. Praszek.
A turning point came while she was on a hospice wing of a nursing home, working with a patient who had metastatic prostate cancer and was in excruciating pain. “You could hear this gentleman moaning when you entered the building,” she recalls.
The nurses on the unit turned to Dr. Praszek and asked her to call the patient’s physician for an order for more pain medications. “I said, ‘I’m just a volunteer,’ but they told me, ‘You’re our last hope,’ ” recounts Dr. Praszek. “So I called the doctor, and he said he wouldn’t order any more pain medications because he didn’t want the terminally ill patient to become an addict. Then he said, ‘I’m the doctor and you’re not,’ and hung up on me. I thought, well, you so-and-so. I’ll go to medical school instead of nursing school, which I had been considering, so that nobody can ever pull this kind of thing on me again.”
Dr. Praszek completed her pre-med courses, but put off applying because she was afraid that she was too old or not smart enough. Finally, with her husband’s encouragement, she applied to Oregon Health Sciences University and, on her 40th birthday in 1996, received notification of acceptance. Looking for students with significant life experience, the medical school offered Dr. Praszek a full scholarship. She graduated at the head of her class.