The Surgical Palliative Care Podcast

Dr. Balfour Mount: The Father of Palliative Care

January 10, 2020 Surgical Palliative Care Podcast Season 1 Episode 1
The Surgical Palliative Care Podcast
Dr. Balfour Mount: The Father of Palliative Care
The Surgical Palliative Care Podcast
Dr. Balfour Mount: The Father of Palliative Care
Jan 10, 2020 Season 1 Episode 1
Surgical Palliative Care Podcast

#001 - Join host Dr. Red Hoffman and co-host Dr. Matt Nielsen for the premiere episode of The Surgical Palliative Care Podcast as they interview Dr. Balfour Mount, the father of Palliative Care in North America.  Bal discusses his early days as a urologic oncologist, his work with Dame Cicely Saunders, his palliative care pilot project at the Royal Victoria Hospital and his experiences as a surgeon providing palliative care to his patients.   Prepare to be inspired!

To learn more about the surgical palliative care community, visit us on twitter @surgpallcare.

Show Notes Transcript

#001 - Join host Dr. Red Hoffman and co-host Dr. Matt Nielsen for the premiere episode of The Surgical Palliative Care Podcast as they interview Dr. Balfour Mount, the father of Palliative Care in North America.  Bal discusses his early days as a urologic oncologist, his work with Dame Cicely Saunders, his palliative care pilot project at the Royal Victoria Hospital and his experiences as a surgeon providing palliative care to his patients.   Prepare to be inspired!

To learn more about the surgical palliative care community, visit us on twitter @surgpallcare.

Red:   0:12
Surgical palliative care may seem counterintuitive, but surgeons have a rich history of palliating both their patients and their families. I am Red Hoffman, an acute care surgeon in Asheville, North Carolina, and one of 79 surgeons currently board certified in hospice and palliative medicine. Join me as I interview the founders and the leaders of the Surgical Palliative Care Movement, a diverse group of surgeons dedicated to providing  high quality palliative medicine to all surgical and trauma patients. Welcome to the surgical palliative care podcast. We heal with more than steel.

Red:  Hi, everyone, This is Red My co host today is Dr Matt Nielsen. Matt is a urologic oncologist at the U. N C. Lineberger Comprehensive Cancer Center in Chapel Hill, North Carolina. Thanks for joining us, Matt.

Matt:   1:22
Thanks for it is great to be here.

Red:   1:24
Matt and I are so honored and excited to be interviewing Dr. Balfour Mount.   Bal, as he likes to be called, is also a urologic oncologist and is considered the father of palliative care in North America. Bal, thank you so much for speaking with us today.

Bal:   1:41
Oh, it's a pleasure. An honor for me. Thank you. Both of you

Red:   1:46
So Bal, as we're getting started, can you tell Matt and I a little bit about yourself? Where you grew up, where you trained and how you decided to become a urologist?

Bal:   1:58
Uh, yes. I'm a Canadian. Born in Ottawa. Uh and after medical school at Queens University, I did my residency at McGill in Montreal and then following that fellowship with  Willett Whitmore at Memorial Sloan Cancer Center in New York for two years and then came back to McGill as a urological oncologist. Sill living in Montreal, and, uh, that I suspect sums it up.

Red:   2:53
What drew you specifically to urology?

spk_1:   2:57
I was interested in a surgical specialty rather than general surgery.   I was interested in the scope that urology and urologic oncology offers. And that led me to urology and then training at Memorial.

Red:   3:48
So I read that you were initially influenced by the work of Dr Kubler Ross. Can you tell us a little more about that?

spk_1:   3:58
Um, yeah. Um, in 1972 um, there was a gas selector on that was that was Elizabeth or E K. R. We know, uh, and I had absolutely no idea who she was, but, uh, went to, um uh attended them the session and was stunned by the fact that in the largest medical amphitheater of Miguel, all seats were taken. May words three or four, uh, standing here for deep in the back and two or three setting on each step. So clearly others knew more about her than I did. She had written on death and dying. It was published in 1969 and this was 1972. Elizabeth was one of the most skilled communicators I've I've ever heard. It was really that, um, lecture. Um, that prompted me Thio. I think, um uh, that it would be interesting to do a study of how we handle people with far advanced disease at the Royal victor. Um, the Royal Victoria Hospital is one of McGill's teaching hospitals. It was a man about 1000 beds. The study we did, um I had 200 respondents and, uh, we documented some 26 deficiencies in the care they were receiving at our hospital. Uh, which we, uh we're really quite stunned by because it's a really first class institution and there's a lot of pride about the quality of care, and you certainly weird up to what we thought we were it to the standard that we thought we were. There was significant problems out of that, uh, those findings I I shared them with Elizabeth and and, um, added off for London to, uh, uh, ST bruised of your jobs. But in London were Dean Compound Not not being says, believe in that or said Cicely Saunders and started this absolutely suburban program for caring for people that were German Lee out and it all progressed from there.

spk_0:   7:23
I have chilled listening to that. I feel like we're listening to our history. Thank you.

spk_1:   7:29
Well, it's It's been, ah, very inspiring journey for me. And I feel very fortunate, though it wasn't the journey I thought it would be on looking back if I'm if I'm doing my math right, it seems like Ah, you were sort of embarking on this journey. Um, really, in sort of the prime of your career and your, uh maybe in your forties, early forties, late thirties. Uh, early, Uh, late thirties, late thirties. And so it sounds like, uh, that sounds like that direction was not part of your long term plan. So, for for those of our listeners, like red and I, who are sort of in a similar phase of life, um, how did you navigate? Um, you know, those changes. It seems like this was this was something that was really powerful and spoke to you and lead you to London. Um, was that Ah, difficult challenge for you in terms of changing the course of your career? Well, um, I certainly, uh, enjoyed urologic oncology, and, uh, and the privilege of working with wit and memorial. Uh, that was just, uh, a life defining experience for sure. So I had Absolutely, I was very happy as a surgical oncologist, that Miguel. And this was just one of several studies that I had going Life became fairly complicated When, um, the findings of our the clarification of our deficiencies, um, was evident as we planned our pilot project at the Royal Vic Pilot project of, uh, for a palliative care programs. Mmm. Started, uh, in 1975. And, um, we undertook then, too. I have, uh, a program that included, um, award about it is care unit, a consultation service to the active treatment wards of this roughly 1000 bed hospital. Another patient clinic, Ah, home care program and a, um, bereavement follow up program, as well as research and teaching activities. So it was a rather extensive mandate that we set for ourselves. Meanwhile, I was busy as a surgical oncologist. So it was, um it was It was a busy time and very, uh, fulfilling. I guess you'd say in the my first visit to ST Christopher's and getting to know Cicely Ah was in, uh, uh, 70 three, I guess. Then, in the 70 summer of 74 um, Sicily, um invited me to come back. Uh, she and her call a colleague, Tom West. Whereas she said we shall be birding in Switzerland. I wasn't exactly sure what that meant, but it meant that they were Goering in search of the birds indigenous to Switzerland.

spk_0:   11:49
And they died. This

spk_1:   11:50
Tom incessantly left. And you spent the summer with the family at working and living at ST Christopher's. And that was, um, most, uh, rewarding and and, uh, stimulating time. um that then led to the to your pilot project of Miguel. Well, at the big, um And, uh, it all evolved from there, and I remained active A surgical oncologist, Um, for some time. But, um, gradually, the palliative care demands, uh, and all it was involved in that began to take over.

spk_0:   12:51
Can you tell us a little bit about how you came up with the term palliative care

spk_1:   12:57
we had Thio? Uh huh. Uh, the idea of having a program in, ah, teaching hospital. Um, that was, um, designed for people who were dying was at its radical. I mean, do the to the goals of institutions. And, uh and, uh So what to call the programs really was an issue, And I thought one, we'll call it a hospice program. Uh, there isn't a snowball's chance in hell that anyone will ever the term a hospice, so Well, uh, big call it on spurs. And to my surprise, our Francophone colleagues said, Oh, my goodness, you can't do that. You go back because the other the term a hospice, as used in France at the time add a very pejorative, um, reputation for, uh, a very mediocre kind of, um, care that no one could recommend. So a hospice, uh, couldn't be used in Quebec and that at Miguel's and, um, s so then looking for terms? Uh, I've, uh, thought of, um, uh, palliative, as in non curative as in palliative radiation therapy, for instance. And, um, and then thought, um, palliative care, um would define, uh um, quite nicely what we were about. It's about, um I'm curious. Uh, Dr Whitmore, Unfortunately, I never had a chance to meet him, But I've grown up hearing really sort of inspiring things about him from many of the leaders in our field. And I'm I'm curious. Uh, how what? What? His reaction was to this direction your career took and in general, how your surgical colleagues, uh, received your interest and whether they were supportive of that. Um, Whit was, uh, first of all, I need to say, probably I was going to say the most fully rounded, um, Olympic stature human that I think I've met. Uh, he was a man of great intelligence and insight. He was suburb's urgent. He was at broad interests, and, uh was always pleasant, generally smiling, but he was at the same time. Very frank. And he had a pleasant way of telling, uh, telling you the pleasant isn't a straightforward, but, um um acceptable and gentle. Almost. Wait. Well, gentles not right of telling you that you steered the train up the drags

spk_0:   16:56
e. Um, he

spk_1:   16:59
was, Ah, an excellent surgeon. Uh, when I left at the end of the fellowship, uh, hey invited me to, um um doo doo to come back and stay at Memorial on. And, as you can imagine, that that was their huge honor. Ah, great privilege on Duh. But I, uh I had, uh, other quite considerable ties that Miguel and, um, wit was, um he had such, um, active and mind and was progressive and positive. Um, hey, he was interested in, of course, and in the career, James than ever that certainly initially it was a project that I was involved in. And, uh, I don't remember any, um um, any ever comment, uh, of his That wasn't, uh, um reinforcement of anything that lead to growth in the in health care. And it certainly wasn't what we, uh what we had initially I thought would be happening. He understood that on it was sympathetic. And in some ways, um, already looked at the surgical oncology as calling forth, um, the having concern for the therapeutic dry add of station family members and caregivers as a dynamic unit Dry head. He was very conscious of that. It wasn't about in it was about the pro size. He was in his own way. Um, very aware and attended to, um, what we would come to think of his old person care with, um, by the physiology in the physical prominent, but with psychological, social and existential slash spiritually concerns essential for quality care. And so all of that was second nature in a way to four wits. But he wouldn't have, um, articulated it quite like that. But it was the way he waas. He was a giant.

spk_0:   20:28
Did you find that? Once you started the quality of care for this, have surgeons in your hospital were were referring patients to you or were consulting you?

spk_1:   20:41
Uh, yeah. When we had the pilot project, which was 1975 76 that two year period, it was a time of great fiscal, um, tightening of budgets and and, um, pressure on beds. I mean, it's always like that. I realize that. But it was certainly like that

spk_2:   21:13
at at the vic then. So there was a great deal of, um, resentment from my colleagues about the program. Uh, these were, uh, teaching beds. These were research beds. These were this was in an underfunded a teaching hospital on, So, um, it was, uh, a very busy Hi. Oh, but teaching hospital. So the idea of doing this was in the eyes of many, Um um, bordering on the bizarre, because a CZ we can recall. And as is still a case, um, academic institutions, medical teaching hospitals are for investigating, diagnosing, prolonging life in curing, and, uh, and two squander the the, uh, all too thinly spread beds. On such nonsense is what came to be called palliative care that they should be cared for. It was the thought of the day at I'm in nursing loans, uh, or somewhere else. And and it's, uh, bless you, my son. But don't do it at our hospital. And that was the preeminent theme. Really? And it was This was tough. I mean, it was there were no other programs in any academic centers, medical school anywhere in the world that had done it, or I don't say that that's not that's just fact. And so there was nothing one could turn to. Uh, certainly I had and have every every respect for CeCe lease excellence in, uh, in making ST Christopher's Center of Academic Excellence. No questions. But she didn't do it in, uh, in in a teaching hospital with all the pressures on academic centers of excellence. Same too.

spk_1:   24:04
So about I'm curious as you embarked on this program with the pilot and your work with, um, name Saunders and others you were still maintaining early on your you're busy practicing urologic oncology And could you reflect for us a little bit on sort of how that affected Ah, your approach to your patients or your practice over

spk_2:   24:26
time? Um oh, I think, um, it had a great effect, and I went into such detail about my own health issues, um, to reflect that they also were helpful in It wasn't hard for me to imagine what people were going through, uh or, yes, I'm sure it always is not understandable what the guy beside used going through that, um, clear But, um uh, I'm having been a patient and a family member. And, um, and caregiver, um, in all part. In other words, all part of that therapeutic triad has been helpful. I think, um, and I'm and I I'm just, um, in awe of the potential of the human spirit And, um, on the potential of for grace and for, uh, you know, we could Yes, we can make a difference. Uh, when we can do a suspect, me and Ilia conduit, urinary diversion or right Bernie lymph node dissection and chemotherapy and whatever. We make a huge difference. Uh, but we can make it just as striking a difference, if not more striking because of the battlefield on which it's being played. When we are taking part in helping people who are at the end of life challenges, um are peculiar that setting. Uh, but the rewards are certainly, um they're in spades.

spk_0:   26:56
I think it's It's so lovely. You know, we talk about that idea just skating with patients and kind of just the difference that even to sitting on the bed and holding hands can make. But I think it's so lovely to hear those words coming from someone who's a surgeon because the reality is is we can make such a difference with what we do in the operating room. But it's so important to remember as surgeons how much difference we can make just sitting in holding space for someone. And it's, I think, especially poor training, sometimes so easy to overlook that because they're so busy trying to acquire all the skill excellence you need to save someone's life. But it's so important to remember. So thank you for that reminder.

spk_2:   27:42
I found it challenging, uh, to slow down and to, uh, do just what you said Red too. I realize that if you just sit there and old and you'll be amazed what may unfold palliative care entails, Jed, uh, of a spectrum of input that's so different from the therapeutic, um, equation that, uh, that we have a CZ as surgeons, you know?

spk_0:   28:35
Now what? When we're talking about palliative care especially, you know, we talk about it now. We talk a lot about the importance of an injured disciplinary team, But I'm wondering when you started, did you have a full complement of providers as a team with you, like nurses and social workers and the chaplain, Or were you mostly by yourself?

spk_2:   28:58
Oh, well, no. For the battle for the two year pilot project, we had the full ball of wax, including, I mean, uh, if you all of the those you mentioned, but in I, as an example of, um, that comes to mind because it made the cover of the Canadian Medical is a voter drive in the cover. The Canadian Medical Association Journal. Then, uh, was that occurred to me? Oh, that, um, since we so are so responsive as a species to music. Uh, what about a music therapist? Well, that sounds totally crazy. D'oh. Unwashed. But we, uh But I, through personally experience, had met a couple of very highly trained a music therapist. So we had as part of the team, not only a psychologist or psychiatrist and nurses in that very well trained, superbly trained volunteer program at rigorous. They had reading lists. They do have read and makes ad interviews and continuing education programs and stuff live. The volunteers were incredible. And of course, that was a problem because that caused friction with the nurses.

spk_0:   30:40
You know,

spk_2:   30:41
it's the same old same old in

spk_0:   30:43
some ways, but but

spk_2:   30:45
into that mix, you're you're throwing a what? A music therapist. What is that thing you know? So, yes, we sure had very well rounded the multi disciplinary team. I can tell you. So we're very fortunate. Dude have pulled that off because we learned a lot of lessons. We learned a lot of lessons about the fact that we really are physical, psychological, social and spiritually. And that's not just romantic gerbil e gut. That's just the way it is. And if you leave out one of those domains Ah, and leave one of those domains on the team. Uh, and as you know, the existential spiritually domain is in the one that, in my experience, gets left at most because who in the world even understands with that is with involved there, if you play lip service Oh, yeah, well, at our hospital, we do have a chaplain. You know, that doesn't cut it. You need tohave somebody who's really, um really as a profound and deep understanding of the, um the issues that we all share in that domain. You know, as a surgical oncologist, I was pretty interested in cutting out the problems. And and, uh, it was always both surprising and exciting, uh, to um, see the rich mix of all these domains that that that we have, whether we're in health or illness or actually dying that make any sense.

spk_0:   33:14
Yeah. Oh, yeah. I listen to you talk all day.

spk_2:   33:23
Could I get you? Just do record that for my wife.

spk_0:   33:30
I knew the whole reporting and she could live. Uh, thank you

spk_1:   33:37
so much, bell for this really, really great conversation. I know on behalf of Red and I and all of our listeners, I mean, this is just priceless. I'm curious if you have any thoughts about sort of them the most important next steps or future directions for the field to make the most of where you've launched this over the past 40 years. Where where should we be aiming? Are our ship for the next 40 years

spk_2:   34:08
mad? I don't, um I think the my my fundamental concern from and it's just speaking from perspective, huh? My superficial on knowledge of the day to day experience of I'm thinking of, uh, do three programs that I know about excellence. Sicily didn't attempt to start a movement or, uh, she didn't have her sights set on a global or defining a, um, defining a career path or ah, new field of care that was under site. She captures site fixed on the particular individual, Uh, that whose bedside she was sitting me side. That sounds corny, but it's but the point being that I think the biggest challenge and it's an immense challenge in all programs of palliative care is to keep looking back at two basics. Two begin to understand the contemplative domain, the contemplative prose as that is fundamentally, that that fundamentally defines how we, whether we're patients, family members or caregivers we experience health and illness of when I'm struggling to try and express is that the success of a program and the goals for the future, I think should be the same goals? Says Aly Ad. The basic thought and concern should always be with that one person. You're whipped at a deep level, and and of course, that kind of dark sounds lighter, romantic or fuzzy and fluffy. It's not, it's tough and it's sharp edged, and it's profoundly important on dhe. So what? I think if we oh began to understand the contemplative, um, dimension of presence to one another. Ah, that would be a place to start. But whatever our global dreams or professional aspirations as a field, yeah, uh, that they're all sort of beside the point. What really is important is what she or use and I'm holding and sitting there listening to, uh, what is their inner journey at this particular moment and not, And, I mean, there's so much to think about, isn't it? It isn't about enforcing my view of the interview journeys. And that's always the danger, of course. And it really day depth listening in depth presence, radical presences. I like to call it to get past my own, my own preoccupations and fantasies about, uh, what he or she needs, uh, and really, really understand, Uh, as much as one can, uh, the nature their needs in all those oh, are not needs the nature of their situation in each of those Dummy,

spk_0:   38:46
that's such a great reminder. Thank you. Now, as we're getting ready to wrap up, I'm wondering, is there anything else you'd like to share with us? I know you've shared so much already.

spk_2:   38:58
I, um just applaud what you're doing. And I, uh I'm I'm writing a I've been well the last 10 years. I've been writing a bit an autobiography that really is the my my memory of the path, uh, that pilot of care has had over the past decades. And, um uh, it, um uh, as been wonderful project for me because it's been that a new, cute reminder of the richness Um, um, that's there for anyone who it becomes interested in this field. Yeah. And, uh,

spk_0:   40:01
I just want to thank you so much, Val for talking with us today. I have to say personally, as both a palliative care, but especially as a surgeon, I'm so honored more about you. And I'm just I just want to express my deepest gratitude for all the work you've done and for the very rich legacy that you've bestowed upon the surgical palliative care community. Obviously, we wouldn't be here without your work and your vision. And it's just been an honor to get to hear your story. Thank you.

spk_1:   40:35
Echoed that. Thank you, Belle. It's really has just been amazingly inspiring from someone who is already a hero to just get to know you and hear, Hear it in your own words has really been terrific. So thank you so much.

spk_2:   40:47
Well, I forget how much I had to pay you to say, Oh,

spk_0:   40:51

spk_1:   40:54
send along my last

spk_2:   40:56
installment in the sea right away And all good wishes Do you read into you, Matt? It's been fun to chat. Appreciate it.

spk_0:   41:08
Thanks. Now, have a great game. Okay. Thank you for joining us for another episode of the surgical palliative care podcast. Be sure to subscribe to stay up to date on the latest episodes. Toe. Learn more about the surgical palliative care community. Follow us on Twitter at Serge pal care. If you'd like to get more involved with the surgical palliative care social media team, please reach out on Twitter or via e mail at surgical palliative care at gmail dot com. Lastly, take good care of yourselves and take good care of each other.