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Palliative care receives recognition and a professorship

Medicine@Yale, 2019 - November December


Kapo’s work highlights the importance of easing pain and discomfort of illness

When Jennifer Kapo, MD, arrived at Yale in 2012, palliative care was widely considered an afterthought, a therapy reserved for terminally ill patients who had exhausted both options and hope. After she became inaugural chief of the Yale Palliative Care Program and the Yale New Haven Hospital Palliative Care Service, Kapo built the program from a four-person unit that received roughly 300 consults per year into a service that has received national renown. Her interprofessional team now consists of 30 people, including two social workers and two chaplains, and other professionals including an art therapist.

All deliver the essence of what palliative care is—a specialized form of medical care focused on relieving the symptoms and stress of a serious illness. It is appropriate at any age and at any stage, and one can receive it along with curative treatment. The goal is to improve the patient’s quality of life. Today, Kapo’s program treats more than 3,000 new patients per year at 13 sites across Connecticut.

Among the patients Kapo cared for at Yale were Sherwin B. Nuland, MD ’55, and Michael K. Vlock. These men would serve as the inspiration for Yale’s first endowed professorship for palliative medicine, a position to which Kapo was appointed in April of this year.

Nuland, known as Shep by those who were closest to him, was a professor of surgery at Yale School of Medicine and also was a best-selling author and bioethicist. In addition to mentoring medical students, he taught a freshman history of medicine seminar at Yale College. Nuland’s book How We Die: Reflections on Life’s Final Chapter, winner of the 1994 National Book Award, candidly demystified, organ by organ, the process of dying and challenged the American health care system’s bullish obsession with fighting death. During the last year of his life as he battled prostate cancer, Nuland received palliative care from Kapo and her team.

“Having been with Shep in all that was going on, I was used to being in the clinic, and it’s one of the most dehumanizing places in the world,” says Sarah Nuland, his widow. “Jen Kapo came into the room, and the temperature changed. She was warm, kind, thoughtful. And she didn’t look at the computer. She looked into the eyes of my husband.”

As he wished, Nuland died in his home in Hamden on March 3, 2014. Inspired by Kapo and seeking a way to commemorate her husband, Sarah Nuland decided to start the Nuland Foundation, a nonprofit dedicated to advancing palliative care’s role in health care and to educating underserved communities about it. Emblazoned as the organization’s motto are words she had found scribbled into an advance print edition of How We Die, tucked away beside her husband’s chipped pine writing desk: “The purpose of the art of medicine is not primarily to cure disease or to fight death, but to relieve human suffering.”

One of Sarah Nuland’s chief goals for the foundation was to establish an endowed professorship of palliative medicine at Yale. She approached many of her close friends for funding. One was Karen Pritzker, a local philanthropist and investor. Pritzker and her husband Michael Vlock had previously supported Yale New Haven Hospital’s neonatal intensive care unit, as well as other organizations including Teach for America and the Michael J. Fox Foundation for Parkinson’s Research. Pritzker and Vlock discussed Nuland’s request, and agreed they should contribute.

Nuland’s cause soon became personal to them. In early 2017, Vlock was diagnosed with mesothelioma and began a treatment plan at a hospital in New York. Seeing her husband’s vitality fading from the brutal intensity of the treatment, Pritzker sought out Sarah Nuland for advice. Nuland gave her Kapo’s number, and Vlock was brought back to New Haven, where Kapo cared for him until his death on September 29, 2017.

“Anyone who knew Michael knew he was an individual person and had his own way of doing things,” Pritzker said. “Jen met him where he was and helped us navigate that phase.” Inspired by the impact of palliative medicine on her husband’s final weeks of life, Pritzker decided in June 2018 to expand her initial gift and endow the professorship.

On a warm-winded June 25, 2019, some 150 people from across the Yale community, including the families and friends of Kapo, Nuland, and Vlock, gathered under the dark timber beams of the Harvey Cushing/John Hay Whitney Yale Medical Historical Library to celebrate the establishment of the Sherwin B. Nuland and Michael K. Vlock Professorship of Palliative Medicine.

Robert J. Alpern, MD, dean and Ensign Professor of Medicine, warmly remembered the two men, recalling Nuland’s strong-willed commitment to medicine and Vlock’s dedication to the New Haven community. He also commended Kapo for expanding and strengthening Yale’s palliative care program. “It is Jen’s clinical excellence that really helped to inspire the gift today,” he said.

It was within the cancer program at Yale New Haven Hospital that the Palliative Care Program began in 2007. Charles S. Fuchs, MD, MPH, Richard Sackler and Jonathan Sackler Professor of Medicine (Medical Oncology), director of Yale Cancer Center, and physician-in-chief of Smilow Cancer Hospital, said, “Today’s celebration recognizes the fundamental principle of patient-centered care as a foundation of medicine. I would suggest to you that few fields exemplify patient-centered care better than palliative medicine.”

The event’s keynote speaker, Diane E. Meier, MD, a geriatrician at Mount Sinai Health System in New York and founder/director of the nationally recognized Center to Advance Palliative Care, stressed the importance of training physicians in palliative medicine and applauded Yale’s efforts. “This is a commitment from Yale School of Medicine to say this is a core part of the practice of medicine and health care. It is as important as the management of hypertension or diabetes.”

For Kapo, the professorship is a mark of legitimacy for palliative care at Yale. “We will be able to think about palliative care as woven into the fabric of the standard of care that we provide for all patients,” she said. “It’s not just a specialty to which we refer patients when there’s nothing left to do, but rather one that’s truly integrated throughout the courses of all serious illness.”

“There is a lot of work to do to meet that goal,” she cautioned. “But with this endowed chair, we’ll be able to work toward that.”