Dr. Catherine Deamant of John H Stroger Hospital addresses end of life care and more in Cook County’s Safety Net Hospital

Dr. Catherine Deamant is the director of Palliative Care Services at Cook County Health and Hospital Systems. Based on Chicago’s near west side, the 464-bed Stroger Hospital is dedicated to the health care needs of Cook County’s underserved population; its emergency department treats more than 110,000 patients each year.

Why did you pursue palliative care, and why do you practice in a public hospital?

I did my residency at Michael Reese Hospital in Chicago, and I had young patients with HIV. There was no clinic or care system for them. I come from a liberal framework and have always believed I should serve and respect those in need. I’m now a Unitarian Universalist, but when I was a resident, I had been looking at different spiritual communities and found a very liberal Methodist church. The minister there challenged me to think about what am I going to do in the world. He suggested Cook County Hospital, and I loved the idea. I had a mission, because you don’t work here for the ambience.

Being a lesbian, I had always felt drawn to care for gay men. The principles of respecting the worth and dignity of each person and our interconnectedness is important to me. So when I started at Cook County Hospital in 1990, I joined as an internist in general medicine doing primary care and HIV care. At that time, HIV care was a lot of palliative care because there were not a lot of treatment options. I did that for a decade, and I was asked to teach end of life care to the residents.

Palliative care wasn’t an accredited field of medicine until 2008- I was eventually grandfathered in- but we started a palliative care program here in 2001. It is one of the older palliative programs in a public hospital system.

Describe Cook County Hospital’s palliative care department

We did 850 inpatient consults last year, and we have four ambulatory palliative care clinics. We do about a day and a half of home visits each week. Our team includes seven physicians, but they are not all full-time in palliative care. Some are geriatricians and some practice hospital medicine. We have an advance practice nurse, a social worker who is also a bereavement counselor, and we are going to add to more advance practice nurses to expand our ambulatory palliative care. We are looking to hire an advance care planning counselor.

Our department has been valued and supported because Cook County leadership has always believed that palliative care is the right thing to do. It has never been about the finances of it. Palliative care has always reflected the mission of the hospital.

We received a Circle of Life Citation of Honor from the American Hospital Association for developing a staff morale model for other palliative care and hospice teams, which includes monthly reflective reading and discussion sessions.

My colleagues nominated me for the 2014 Hastings Center Cunniff-Dixon Physician Award, which I won for modeling skill and compassion at the bedside. That was the greatest honor to have my own team feel that about me.

We have a high quality palliative care program, period. Not just for or in a safety net hospital. We do it all in an under-resourced area, and we exceed quality standards compared to other university hospitals here in Chicago. We have always been very well respected, we have always looked toward our standards, how we are communicating and how we are providing services. Many of our providers have been here for many years. We had a core team that cared from the very beginning, and we kept adding layers to it.

There’s a quote that holds my program together, you can see it on the Louis Pasteur Memorial Statue in front of the old County Hospital. Pasteur said, “One doesn’t ask of one who suffers, what is your country and what is your religion? One merely says, you suffer. This is enough for me, you belong to me and I shall help you.”

We are committed to serving all patients with respect and dignity.

Do you find that the patient population you serve would typically have a tougher time of receiving palliative treatment and adequate pain management than other populations?

Some of the barriers and disparities around pain management have to do with how people obtain information from patients, interpret what they are saying, hear how they describe their pain. Yes, physicians are less likely to prescribe pain medications for minorities. That’s not the case here.

Do you find that the typical stereotypes surrounding end of life care and minority patients hold true at Cook County Hospital?

In literature about black patients, they would be considered less likely to accept hospice care and more likely to die in intensive care units. That is not our reality.

I had an abstract at the American Academy of Hospice and Palliative Medicine in 2010 and am now preparing a manuscript on this. About 30 percent of U.S. adults have advance directives. Among our black cancer patients here, we had 90 percent completion of advance directives and decisions for natural death and acceptance of hospice.

What’s the difference? We think it’s about health literacy. It is not the problem of patients. It is our role to address misconceptions of hospice and be honest and empathetic when you communicate prognosis. Many of my patients have not had access to care, and many present at a very late stage. They are so overwhelmed by complex psycho-social issues. The reason for palliative care consultation in other places may be pain management, but for us it is almost always defining the goals of care and complex decision-making.

Thirty percent of our patients have limited English proficiency. It’s always important to use an interpreter, because patients want to know what is happening, they want to make decisions and they want to hear the information correctly.

What do you hope to achieve in each patient encounter?

I would hope to give them the time and attention and listen to what is most important to them. I would hope that I can share the information they need to make informed decisions. I come from a place where I have all the information to share, and if they want to hear it- I am happy to tell them everything I know. The buck stops with me. There’s a “shoulda, woulda, coulda” mentality sometimes among physicians that the other guy can talk to the patients about the important stuff, but it ultimately is my job.

I am actively listening to patients, hearing what their concerns are and what they are hoping for. I hope that I have addressed those worries and given them the information they want and identify with them what their priorities and plans are.

It cannot be my agenda. I don’t have any trouble giving a recommendation, but I want what the patient wants. The vast majority of patients want to be home at the end of life, to be comfortable and have a natural death. I help make that happen.

What have been some of the most gratifying parts of your work?

We have so many patients who come to Chicago from other countries to work. When they are terminally ill, we work to facilitate their return home if that is their goal. You will never hear of us sending patients back like you hear sometimes at private hospitals.

The Mexican consulate and Polish consulate have been tremendous advocates and resources. The consulates have purchased one-way tickets if the patient’s family cannot afford the cost of travel.

We are very intentional about ensuring that patients are medically stable to travel. Some people are too sick to be able to return on a commercial flight, but I often see patients’ will and desire to come into play.

We have helped 60 patients return home in the past two and a half years. When they go and succeed, it is such a privilege. When they don’t make it, it is devastating.

What would you change about health care delivery at your hospital?

We must advocate for more parity in health care delivery. Undocumented patients in renal failure can get dialysis in Illinois. However, if you are a green card holder for less than five years, you cannot access insurance under the Affordable Care Act.

We have to get rid of the politics. I am treating a woman now who has ALS and has been a green card holder for three years. She will not be able to qualify for public aid, but she will die.

Why can’t we expand Medicaid coverage? If you are a green card holder for less than five years and have a terminal illness, you need to be covered and qualify for hospice. Not qualify for hospice under charity care. That’s an advocacy piece of my work towards justice in health care that I am going to continue to work towards.

What’s next for you?

I have been at Cook County for 24 years. I have twins in the 8th grade, and I leave for work before they wake up and I return from work after they have had dinner. I am retiring from Cook County at the end of December, going to work closer to home in Evanston at NorthShore Health System. The patients will be very different, but my goal will shift to serve the community in which I live. There are many universalities in palliative care and the end of life, and those are what I will address in my new role at NorthShore.