When Mohana Karlekar, MD, was hired in October 2006 as medical director of the adult Palliative Care Program at Vanderbilt University Medical Center, her 10-year goal was to establish a dedicated inpatient Palliative Care Unit (PCU) so clinicians specializing in palliative care could better respond to patients’ needs.
Then, Karlekar and just a small handful of providers made up the Palliative Care team. Because Vanderbilt University Hospital is a Level One-verified trauma center and the intensive care units care for the sickest of the sick, requests for palliative care consults came from every corner and at all hours.
A decade ago, just more than 50% of hospitals in the United States had an established palliative care service. The VUMC Palliative Care team members were often explaining to patients and families, as well as to fellow clinicians, exactly what palliative care means. It is holistic, multidisciplinary care focused on improving quality of life through pain and symptom management as well as psychosocial interventions for individuals who are seriously ill or injured.
Hospital leaders noticed the Palliative Care team’s efforts and recognized the need for a home unit. On Sept. 27, 2012, a nine-bed unit on the fifth floor of the Round Wing in Medical Center North opened, and patients moved in the next day.
“So, we got a Palliative Care Unit before we even asked for one,” Karlekar told team members as they gathered to celebrate a decade of service. “We got this unit because the hospital leadership thought it was a good idea. We have gone through a number of milestones, both enormously happy and sad. We lost our nurse case manager who began this program, Gina Turner (Turner died in 2016), and this day is here, in large part, because of Gina’s work.
“I am personally grateful that we have a Palliative Care Unit as these are not common nationally. This unit not only provides a space where we are able to provide outstanding, patient- and family-centered care for patients nearing the end of life but also a space for students, housestaff and nurses to learn how to manage these patients.”
Patients typically come to the PCU with a heavy symptom burden, but with good medical management, the Palliative Care team can often alleviate the symptoms, allowing the patient to return home and continue with medical treatments, work and important life experiences. The space is also a quiet space for families to be with loved ones at their end of life.
The Palliative Care Unit’s staff break room has a wall papered with thank you cards and notes from patients and families who often express gratitude for having a place to go that eased their anxiety. On the PCU, there is a sense of calm and purpose. And a guitar sits ready at the nurses’ station at the core of the circle of patient rooms — on hand for a gentle lullaby or an upbeat tune, depending on requests.
Karlekar told the PCU staff that a recent patient’s wife had brought home-baked cookies to the unit as a thank you to the staff. Her husband had suffered a significant brain bleed due to a fall, and he died at the PCU while with family.
“She was so grateful to have a space to spend time with him,” she said. “She raved about the nurses and the care they provided, and about how kind everyone was. She came out of it healing because of this place. So, thank you for all you do.”
Both the unit and the Palliative Care staff, who now provide both inpatient and outpatient service, have grown over the decade.
Today, the unit has capacity for up to 11 beds. Nine faculty (4.8 FTE), four advanced practice providers (3.0 FTE), a licensed clinical social worker, a chaplain and case managers (1.8 FTE) make up the multidisciplinary team.
In 2021, the group provided 2,827 inpatient consultations. Those were conducted for patients in the trauma, cardiovascular, medical, surgical and burn ICUs, in gastroenterology/hepatology, general medicine, medical oncology, pulmonology, neurosurgery, gynecology, nephrology, infectious disease, emergency department and for patients with COVID-19.
“I was especially proud of how our team ramped up during COVID, caring for patients dying of COVID early on, before vaccinations, and ensuring not just that our patients had a peaceful death but that their families felt supported and connected,” Karlekar said.
In 2004, Melinda Bailes, LCSW, was working with oncology patients alongside Turner when, with the support of oncology nurse administrator Carol Eck, MBA, RN, the pair started the Palliative Care program to help medical teams better transition patients to hospice care. More than a decade later, she can’t imagine being anywhere else.
“Being a member of this team has enriched my life in immeasurable ways,” Bailes said. “They have been part of my entire family’s life and experiences. They mentored my children, walked with me through the loss of my brother, father and niece, and broadened my approach to grief and bereavement support. The team is, in no uncertain terms, my family.
“I have been a most fortunate person to have worked with such an amazingly talented and loving group of people. It is truth that when you love what you do (with people you love and admire), you never work a day in your life.”