Comfort, compassion and communication
Palliative care might not be what you believed.
Don’t be afraid of palliative care.
That’s a key message Lauren Nicholls, MD, a Geisinger physician specializing in palliative and hospice care, wants to share with patients and their families.
While palliative care is always part of hospice care, the two things aren’t synonymous. Palliative care isn’t just for people with a terminal illness. It’s about providing support and relief from pain or discomfort for anyone with serious or life-limiting conditions, especially cancer, but also health issues like heart failure and ALS.
“We’re not scary,” says Dr. Nicholls, whose department, part of Geisinger’s Cancer Institute, was founded 10 years ago. “Attitudes have changed a lot in the last decade. Very clear research shows that patients who receive palliative care live longer.”
Dr. Nicholls and her colleagues focus on symptom management and emotional support. “Anything that bothers a patient — that bothers me,” she says.
A palliative care specialist may have solutions to problems that patients might otherwise simply accept as part of treatment for a serious condition, like itching related to dialysis, a strange taste in the mouth during chemotherapy, or diarrhea related to cancer treatment.
“It never hurts to ask” about possible relief, she says. “Oncologists do not receive specific training in aggressive symptom management.”
Finding a life purpose
Dr. Nicholls decided she’d be a physician at age 5 and was drawn to palliative care after watching side effects of her mother’s cancer treatment limit her life for over a decade. Palliative care finally helped ease her mother’s symptoms — just 2 months before her death.
Today, Dr. Nicholls tries to help every patient in her care live their best life, particularly during cancer treatment. “No one does cancer treatment to sit at home,” she says. “They do it to go out and live their lives.”
Dr. Nicholls is also an assistant professor at Geisinger College of Health Sciences, and she’s helped introduce a new palliative medicine fellowship to train future specialists in the field. But she stresses the importance of understanding palliative medicine — and how to have difficult conversations with patients and their families — to everyone she teaches.
“I always challenge medical students to show me a specialty where you don’t have to have a difficult conversation,” she says. “I have yet to have a student come up with a field.”
Crossing cultural and age gaps
Dr. Nicholls notes that, along with becoming “comfortable with the ‘D’ word,” or death, palliative care specialists need to be alert to patients’ backgrounds and personal circumstances.
“We talk about goals of care and make sure the care we give always aligns with a patient’s values,” Dr. Nicholls says. “Part of our training is cultural humility and learning that globally, there are very different viewpoints on the end of life.”
That can be as simple as avoiding colloquialisms — a patient’s family member once misunderstood Dr. Nicholls’ use of the term “passing.” Or it may be as complicated as making sure a Nepalese patient’s jewelry and cash weren’t removed from her body after death, in keeping with tradition.
Dr. Nicholls also works with pediatric patients and their families. “People don’t give kids enough credit for what they know,” she explains, adding that young patients are usually good at facing reality — and fighting illness. “Young people don’t fade away,” she says. “When they die, it’s usually a battle.”
Treating not just patients, but people
Is it draining to care for patients who face pain, perhaps fear and in many cases death?
Dr. Nicholls says no.
Initially trained in family medicine, she didn’t find her passion until she focused on palliative medicine and hospice. In palliative medicine, she found meaning in helping people improve their daily lives.
“I felt like I was helping people, even if it was just asking who they are as a person,” she says. “I get to learn people’s stories. And people are incredible.”
She exudes warmth that is no doubt comforting to her patients, and she smiles broadly as she adds, “Humans are so cool.”
This story originally appeared in the fall issue of PA Health, our quarterly full-color magazine filled with wellness tips, inspiring stories and more.
Sign up to have PA Health sent to your mailbox or inbox 4 times a year, for free.
The wellness you need, in a style you’ll love — delivered.
Making sure ‘No One Dies Alone’
As part of her work with Geisinger School of Medicine, Dr. Nicholls facilitates a chapter of No One Dies Alone. The group’s volunteers — all medical students — sit vigil with actively dying patients at a Scranton hospice. The volunteers' presence provides solace, so no one faces their final moments in solitude.
Student volunteer Katelyn Whetstone, MD ’28, says the experience has helped her confront her own ideas about mortality. “I gained a profound understanding that medicine is not solely about healing, but also about providing comfort and presence in life’s final moments.”