During the years of my medical career, when I treated patients (always in hospitals), I was one of those rushed doctors who focused on efficiently formulating and implementing diagnostic and treatment plans rather than on the patient’s emotional needs. The latter is especially important in end-of-life care, which is the focus of a wonderful project at UCLA Health in Los Angeles.
The “3 Wishes Program” is a palliative care initiative in which clinicians inquire about and implement final wishes for patients who are expected to die imminently. As their mission statement says, “By celebrating lives and dignifying the dying process, the goal of the program is to improve the end-of-life experience for all stakeholders, including the patient, the family, and the clinicians.” It recognizes that in their final hours, most people have fears, regrets, and maybe a last, often simple wish. 3 Wishes has fulfilled almost 5,000 wishes for more than 1,400 patients.
I became aware of it by following on Twitter Dr. Thanh H. Neville, Associate Professor and ICU physician at UCLA Health. Some of the 3 Wishes stories are very affecting reminders of how meaningful small kindnesses can be.
Several examples from the 3 Wishes website:
- “One of our patients transitioned to hospice care and requested only to be married to his long-term girlfriend while in the hospital. Along with the Palliative Care and Social Work teams, the 4SW nursing staff came together to create a special ceremony for our patient, which included an officiant at bedside, decorating the room with string lights and a hearts banner, granting the number of requested visitors to be present, and providing a beautiful cake and flowers to aid the celebration. The patient, now wife, and family were grateful for the team’s efforts and eternal memories created in these lasting moments.
- “This patient had a beloved teddy bear named “Candy Marshmallow” that the ICU team became familiar with because he always kept it at his bedside. Right before intubation, when the patient was hypoxic and decompensating, he placed the bear’s paws together and prayed with his mother. This was an incredibly heart-wrenching moment for everyone who witnessed it. He was intubated and on life support for a few weeks; the bear and his mother never left his side. When the patient was at the end of life, his nurses, Kristin and Noelle, wanted to support his family as much as possible. They obtained his fingerprints, and Jade (volunteer artist) used a picture of the teddy bear to create this wonderful painting for his family.”
"A Special Teddy Bear"
- “This patient was only in his 30’s and his wife (Sandy) knew that neither of them would want his final moments to be within the 4 walls of the ICU room. The 3W team made it possible for him and his wife to spend his last moments outside during sunset (which was an important time for them). Right before terminal extubation [removal of the breathing tube], Dr. Neville gave Sandy a blanket and Sandy crawled into bed with him and snuggled with him as he died. She told Dr. Neville that she sleeps with that blanket every night.”
- "The patient was only 50 years old and was dying of devastating infection. Her loving family was always at the bedside and remained so incredibly grateful for our care. They were a very close-knit family and only hoped to maximize their time with her. It was our privilege to care for her and provide 3WP for her and her family. Wish 1: heartbeat recording and music therapy, Wish 2: see her dog, Wish 3: go outside. Music therapist, Jenna Bollard, brought her guitar, sang at the bedside, and with the family, wrote lyrics for this song. The patient loved the outdoors, gardening, Fleetwood Mac." Here is the touching video: https://youtu.be/QUvU_sDnSK0. The “drums” in the background are the sounds of her heartbeat.
- [Tweet by Dr. Neville] "The patient's days were numbered. He asked for a 'reverse funeral,' where he can celebrate his life with his family & friends. This makes so much sense to me. The @3wishesproject_picnic was complete with #love, #laughter, & colorful tortilla chips! Shared w/ permission."
Another recent example that really got to me was this Tweet from Dr. Neville:
We don't often think about it, but prolonged #hospitalizations can mean that the #patient hasn't felt #sunshine or fresh air for months, sometimes until their #death. Here, we grant the #EOL [End of Life] wish for some sunshine therapy. Shared with permission.
Imagine: In your last hours of life, wanting simply to feel sunshine once more on your face and having your ICU team make it happen.
The practice of end-of-life medicine isn’t for everyone, and my admiration and gratitude go out to those who do it -- especially to those few who go far above and beyond for their patients and their families, like the 3 Wishes team. They are genuine heroes.
Henry I. Miller, MS, MD
Henry I. Miller, MS, MD, is the Glenn Swogger Distinguished Fellow at the American Council on Science and Health. His research focuses on public policy toward science, technology, and medicine, encompassing a number of areas, including pharmaceutical development, genetic engineering, models for regulatory reform, precision medicine, and the emergence of new viral diseases. Dr. Miller served for fifteen years at the US Food and Drug Administration (FDA) in a number of posts, including as the founding director of the Office of Biotechnology.
