Support available to help family, physicians with end-of-life care discussions

Wendy Walters, left, and Miriam Bleich

When a patient comes into UAB’s Medical Intensive Care Unit or Heart & Lung Transplant Intensive Care Unit, Sonia Vishin, M.D., knows there will be one of two outcomes.

“Some admissions are simple,” says Vishin, assistant professor of medicine in the Division of Pulmonary and Critical Care Medicine. “Some people come to the ICU and they get better and they get out. But after a day or two, if it appears that things don’t look good for the patient and death is likely, that’s when we get Wendy and Miriam involved.”

“Wendy and Miriam” are Wendy Walters and Miriam Bleich, UAB Hospital’s family support coordinators. In a sense, they are two-way translators, making sure doctors and a patient’s family speak the same language. Because these conversations are centered on end-of-life care, it sometimes can be a traumatic time both families and physicians. Walters and Bleich are the calm voices and ears in the storm.

“Our skill set enables us to translate information both to the families and the doctors,” Bleich says. “We translate the medical information to the family so they can have a concrete understanding of what is going on with their loved one. And we translate family information back to the medical team so they can understand how decisions are being made.”

“Miriam and I translate to the teams the morals and values of a family, how they are using their faith to make decisions, how they are using the concurrent crises going on in their life to deal with the situation and their past coping abilities,” Walters says. “We do a very thorough assessment of what we need to be working from in a psychosocial family systems model, which we then translate to the primary team.”

Walters was hired as UAB Hospital’s first family support coordinator more than six years ago to provide families with increased emotional support and counseling as they work through making end-of-life decisions and begin the grief process. Bleich, who was a psychiatric social worker in the Community Psychiatry Program, joined Walters this past October in the same role.

Calming influences

Vishin says the need for the services provided by Walters and Bleich are vital to her ICUs. “I couldn’t go a month in the ICU without the two of them,” Vishin says.

Most of the patients Vishin treats are on a ventilator. Because doctors are relaying so much information to the family, it’s helpful to have the bridge that Walters and Bleich can provide. They are new voices — calming influences — who can pull information from family members that doctors often can’t.

“I’ve worked with Wendy for years, and she has this ability to put people at ease talking about difficult things,” Vishin says. “That’s not an easy thing to do, but it improves the communication between the medical team and the family almost infinitely. Sometimes it’s hard for doctors to convey what they want to families, but she has this sense about her that makes it easy for patients to understand.

“And when they are put at ease, the family can ask better questions,” the physician explains. “When that happens, the family member is more informed and therefore happier and more satisfied with the care. They understand better what is going on, and they aren’t shocked if their family member doesn’t improve and, ultimately, dies.”

Trauma Surgeon Sam Windham, M.D., co-medical director of the Surgical Intensive Care Unit (SICU), also has used the expertise of Family Support Services since its inception.

Windham says there are times when he is not equipped to ascertain information about the patient from family members — an obstacle that can make it difficult to provide the best care. Opening up that line of communication is vital to overcoming that complication.

“My focus is the patient,” Windham says. “I do try to talk to the families each day, but Wendy and Miriam’s focus is on the family and supporting them. And it can be a challenge for the family sometimes because their loved one may be in the ICU for weeks or months. The relationships she builds with those families are very helpful to them and to me as the patient’s physician.”

Windham recalled one complicated case this past year with a patient who spent almost five months in SICU. Windham developed a strong relationship with the wife of the patient, but he knew there were aspects of the stress she was going through that he couldn’t understand.

Walters was able to develop that bond with her, and it led to one particularly memorable moment at one point during the patient’s stay in ICU. Walters learned that the family enjoyed karaoke, and she encouraged the patient’s wife to bring their karaoke machine to the hospital one day. She did, and everyone — Windham included — took their turn at the microphone.

The gesture brought a smile to the face of the patient and his wife and created a positive, lasting memory for the family before he died.

“Wendy and Miriam have a focus and understanding on the death and dying of a patient, but I view their role as more than that,” Windham says. “It’s more about how they support families, and that’s a key component to providing our patients comprehensive care.”

Supporting families, training faculty

Walters and Bleich spend the bulk of their time in the ICUs, and while their focus is working with families likely to face the death of their loved one during the course of their hospitalization, they also are available to help on other fronts.

They can provide assistance to families who have had a loved one diagnosed with a terminal illness but may not die in the hospital during their stay. The support Walters and Bleich provide involves helping patients talk with children, access community support resources and provide counseling and emotional support to both the patient and family.

Walters started a bereavement program that follows families for the first year after the death of a loved one, providing a series of mailings, including cards and informational materials. There is also a library of grief-specific materials (death of a spouse, parent, traumatic loss, suicide, etc.) that the family support coordinators provide to families. And a biannual memorial service provides comfort to family members who come to a service of celebration of their loved one.

The coordinators also can counsel employees who are affected by the death of a special patient or co-worker — things that happen on a regular basis in an organization as large as UAB Hospital.

Walters, with an interdisciplinary committee, also has overseen two grand rounds series. The Schwartz Center Rounds series, part of a national program, meets the fourth Friday of every month in the Margaret Cameron Spain Auditorium and aims to increase compassion among health care workers. The popular series has more than 200 attendees each month.

With co-chair Melvin Rodgers, D. Min., of Pastoral Care and a committee, Walters co-chairs the Psychosocial and Spiritual Grand Rounds, which sprang from Schwartz Rounds as a forum to provide a regular teaching opportunity to hospital staff on how to best address the psychosocial, emotional and spiritual needs of families. It’s all part of a goal to better implement the whole patient family care-centered model.

Using their clinical social work perspective, Walters and Bleich add a unique viewpoint to the collective skills and knowledge of the team of physicians and healthcare professionals in caring for the patient and family. Their training and experience enables them to teach physicians end-of-life communication skills, and provide a spectrum of training to a variety of disciplines and trainees across the hospital, both in aspects of end-of-life care and family systems.

While the family support coordinators do spend the bulk of their time in ICU settings, Bleich says, “We want our providers on every level to know that we are here and available to help in a variety of ways.”

Providers can page Walters (9419) or Bleich (6004) or make referrals through IMPACT.