San Francisco General Hospital
Ms. G was a 66 year-old woman with a history of psychotic disorder, seizure disorder, and metastatic breast cancer, which had recently spread to her brain. According to Ms. G and a caseworker who knew her for many years, Ms. G chose to live on the streets of San Francisco, where she felt most comfortable, despite many attempts to get her permanent housing.
Staff at the Supportive and Palliative Care Service (SPCS) at San Francisco General Hospital first consulted with Ms. G to help manage her symptoms and clarify her goals of care, as her disease was already quite advanced. During her initial consult, Ms. G said she was aware of her breast cancer and described a good, longstanding relationship with her oncologist.
In discussing her wishes for the duration of her life, Ms. G was quite clear about her desire to focus on "quality of life." When asked about what quality of life meant to her, she pointed toward the stethescope that hung around her doctor's neck and said, "I don't want that."
Just days after this thoughtful discussion of her wishes, Ms. G became increasingly aggressive and agitated. She raised her voice, became belligerent, asked staff to leave her room, refused all medications and accused the staff of causing her harm. Ms. G was clearly distressed by her psychotic symptoms, as was the hospital staff who cared for her.
Though patients' wishes and autonomy are made priority, the courts in this case required Ms. G be maintained on long-acting anti-psychotic medications. With this intervention, Ms. G again became the articulate, reflective woman she had been before. She had a period of several days in which she read the newspaper – special deliveries of The New York Times from a social worker – and appreciated many visits from the hospital's Catholic priest.
Not unexpectedly, her disease continued to progress and her hours were more and more dominated by sleep. It became clear that she was transitioning into the period she'd previously referred to as "a pit stop between life and..." Since she had no home to go to, SPCS continued to care for her and the focus shifted to help with the next, very important transition in her life.
Exactly one month after Ms. G came under SPCS care, San Francisco General Hospital’s 2-bed palliative care unit – the "Comfort Care Suites" – officially opened. With grant funding and support from the hospital's administration, two formerly double-occupancy rooms were converted to private rooms to accomodate not only patients, but also their families. Ms. G was the first patient to stay in one of these newly-decorated rooms, and it could not have been a better fit.
A local nonprofit organization called Healing Environments donated consulting time, furniture and artwork to create a peaceful space for patients and families. This allowed staff to replace all unecessary medical equiment and outdated furniture with beautiful wooden tables, low-light lamps, and sleeper sofas and couches. At the foot of Ms. G's bed hung a beautiful painting, Arbol de Vida ("Tree of Life") and an African wood carving was visible just over her right shoulder. Ms. G felt so comfortable in this room -- she loved her surroundings and she finally seemed to be at peace in a room that reflected her spirit.
Ms. G eventually died peacefully and without pain in the Comfort Care Suite late one February evening. The SPCS team feels honored to have helped facilitate the last stages of her journey, and hopes she enjoyed the final "pit stop" under their care.
A Look at
San Francisco General's
Comfort Care Suites
