Patient Dawn Dillard talks with palliative Dr. Linda Smith at Providence Hospital in Anchorage. Photo by Annie Feidt, APRN – Anchorage

Doctors deal with death all the time. But they still struggle to tell a patient they’re dying or help them live with a terminal disease. A specialty called Palliative Care is trying to change that. It’s been around since the 1990s. But a lot of people, even in the medical profession, still don’t know it exists.

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Dr. Linda Smith walks into a room at Providence hospital ready with a stethoscope and a huge grin. She teases that Dawn Dillard’s spiky hair recently resembled a faux hawk.

Dillard found out she had uterine cancer a year ago, on her birthday. By the time she got the diagnosis, the cancer had spread to her liver and lymph nodes. Her oncologist gave her a year to live. The 57 year old beat those odds. But now her kidneys are failing. After the laughs are over, Smith sits down on the edge of Dillard’s bed, leans in, and starts talking about a procedure Dillard will have.

Smith is a palliative care doctor, a specialty that is growing rapidly in the U.S. The idea is to help patients cope with a terminal or life altering illness. And unlike hospice care, it is not offered only in the final months of life. Smith works on pain management, coordinating care and even does some counseling. Her goal is to improve her patients’ quality of life. She calls it “whole person care.” Dillard thinks that’s accurate:

“I can’t even say how much she’s helped me. Just little things. You know, showing me things like breathing techniques. Sort of like mediation, just ways to focus on things that are positive and happy rather than focusing on your sickness and how crappy you feel.”

Two years ago, Linda Smith was a very different kind of doctor. She worked in the Emergency Room, where the goal was to quickly stabilize a patient and move on. But two decades into her career, she started to question how she was caring for patients at the very end of their lives. She remembers putting patients on breathing tubes, and hearing family members say things like, ‘I know dad didn’t want this, but we’re just not ready to let him go.’

“I started to have a lot of regret about doing things to people that were painful and uncomfortable and were prolonging their suffering. And if I only had the time to sit down with the family, I probably wouldn’t be doing these things.”

Reporter: And did you know about palliative care?

Smith: “I’m laughing. The answer is no. I didn’t know. And in fact when I started looking into palliative care, I got online… and low and behold I saw that we had a palliative program here at the hospital I was working at.”

In the summer of 2011, Smith enrolled in a one year palliative care fellowship at Providence. It wasn’t easy at first. She wanted to roll up her sleeves and start helping right away. Her mentor, Dr. Steven Rust wanted her to wait. He remembers it this way:

“When she started, she would literally say to me, and she’s the only person that calls me this, she’d say, Boss? Put me in the game. And gently I hope, I just said, ‘let’s wait a little bit longer.’”

Smith had a lot to learn. She was a bad listener. And she was busy. As an ER doctor, sometimes she didn’t even sit down to deliver devastating news:

“I can remember saying to families things like, ‘I’m sorry there’s nothing more I can do.’ And I realize now that sounds like abandonment to many people when you say you can’t do anything more. And the reality is I may not be able to do anything more to the patient that will make them survive, but there’s a lot more that I can do. I always can do more.”

A lot of what Smith does is talk to people. She doesn’t advocate for or against treatment, but she wants patients and their families to understand their decisions. If a doctor puts in a breathing tube, for example, that may extend a patient’s life, but they won’t be able to eat or talk. If they die with a tube in, the family will miss hearing their last words. So now Smith sits down for hard conversations and looks patients and their family members right in the eye. Earlier this year, she was called in to consult with the wife of a patient who was dying:

“When I entered the room, the wife said to me, ‘I know who you are.’ And I said, ‘oh. ok’And she said, ‘I don’t want to talk with you and I don’t want to like you because you’re here to talk about death and dying aren’t you?’”

Smith had a short conversation with the woman, and left her a book on difficult end of life choices. She went back to visit her the next day:

“And she said, ‘you know, I so tried not to like you. And what you had to say. And I really realize that we need to have this discussion now, don’t we?’ And I said, ‘when you’re ready, we’re ready to have that discussion.’ and she said, ‘I’m ready now.’”

Smith was planning to return to the Emergency Room. But interactions like that one persuaded her to stay in palliative care. Now she works more and makes less money. Some days, she wonders if she’s crazy. But then she gets to visit a patient like Dawn Dillard. Back in her hospital room, Dillard asks Smith if she really needs to have yet another procedure.

Smith gives Dillard a hug and plants herself at an empty desk at the nurses’ station outside her room. She calls Dillard’s other doctors and realizes the second procedure isn’t really necessary after all. So instead of staying another night in the hospital, Dillard and her husband are back home by the end of the day.

This story is part of a reporting partnership that includes APRN, NPR and Kaiser Health News.

The U.S. Senate is expected to a pass a sweeping bill authorizing dozens of water projects on Wednesday.

A provision is included that Alaska’s senators say could ease the way to an Arctic port.

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When voters head to the polls next year, they could be faced with questions on oil taxes, the minimum wage, and the use of recreational marijuana. But one thing that won’t be on the ballot is a referendum on a controversial bill concerning cruise ship waste. APRN’s Alexandra Gutierrez explains why.

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Now that it’s summer, cruise ships carrying thousands of passengers loom over Juneau’s waterfront. Just a few months before, the showers, the sinks, and yes, the toilets aboard these massive vessels were a top concern for lawmakers. They passed a bill rolling back parts of a citizen’s initiative governing wastewater standards.

But not everyone was happy with that legislation.

“We were surprised, shocked, disappointed, and we felt betrayed by the whole thing.”

That’s Chip Thoma. He’s the president of Responsible Cruising for Alaska, and he was one of the lead organizers of the cruise ship initiative that passed in 2006.

On top of implementing a head tax, the citizens’ initiative also required cruise ships to meet wastewater standards at the point of discharge. Basically, any water they released had to be fully treated. That portion was struck down by the legislature in February, with the cruise industry arguing that those standards were impossible to meet.

Thoma thinks that change ignored the will of voters. Even so, he doesn’t plan on taking the issue back to the ballot box. He says his group ultimately chose not to go ahead with a referendum repealing the wastewater discharge bill.

“We decided it’d be extremely expensive, extremely hard to gather the signatures in 90 days for our initiative.”

By his estimate, a campaign would have cost his group at least half a million dollars. Thoma says they would have needed to launch a huge voter education effort, especially since there are so many other issues that could also be on the ballot.

“It’s a lot simpler if people know that it’s a ‘giveaway’ of oil and there should be recreational use of marijuana — things like that. Those are clear-cut issues. This one on rolling back the water standards or making them comply with the copper standards, it’s just a little too complex for most people to address.”

Thoma says that his group is now focusing its attention on a lawsuit concerning the enforcement of an emissions control area off Alaska, which would require vessels to use more expensive low-sulfur fuel. The State of Alaska filed the lawsuit against the federal government last year, on the grounds that “there is no environmental justification” for the area and that such policy requires congressional approval.

As far as how the wastewater discharge bill has been implemented, not much has changed so far.

“This season, the cruise ships are operating under exactly the same permit they’ve been operating under since 2010,” says Michelle Bonnet Hale, who directs the water division at the Alaska Department of Environmental Conservation. “So, the only difference this season is that we were able to extend that permit.”

If the wastewater discharge bill hadn’t passed, cruise ships would have needed to renew their permit if they wanted to release waste in Alaska waters. The permit would have essentially been issued under the same legal framework, but there would have been a public comment period, and there’s the possibility that cruise ships would have seen the permit tweaked.

Hale says that the major effects of the legislation will be seen over the next couple of years, as her division considers authorizing “mixing zones,” where waste from cruise ships would be diluted. DEC is currently examining the impact such mixing zones would have on water quality and fish habitat.

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Kali, the orphaned male polar bear cub that has been kept at Anchorage’s Alaska Zoo, spent Tuesday afternoon waiting patiently in his carrier for boarding on a UPS cargo jet bound for the East Coast. Kali is heading to his new permanent home at New York’s Buffalo Zoo.

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A herd of musk oxen was seen on the frozen Kuskokwim River recently. It’s a sign that the population is expanding in the region.

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Two Bering Sea groundfish catcher-processor vessels have been accused of tampering with the scales used to weigh their harvest. As KUCB’s Stephanie Joyce reports, the alleged violations carry hefty penalties for the vessels’ parent company, American Seafoods.

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Governor Sean Parnell is in New York meeting with banks and rating agencies about Alaska’s budget and economic outlook.

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As federal agencies are beginning to furlough employees because of sequestration, the long-term unemployed in Alaska are about to see a reduction in their unemployment benefits.

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Paul Liedberg, recently retired from the USFWS, finds time for “citizen scientist” work around Dillingham. KDLG photo

Some invasive species of bark beetles, if they make it to Alaska, could pose a serious threat to our trees and forests. In ten years of surveys, none have been detected, but state and federal forestry officials are coming to rely on volunteers to help monitor for them across the state. KDLG’s Dave Bendinger reports on one such volunteer who’s keeping an eye out the beetles around Dillingham.

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Individual news stories are posted on the APRN news page. You can subscribe to APRN’s newsfeeds via email, podcast and RSS. Follow us on Facebook at alaskapublic.org and on Twitter @aprn.

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Bill Could Ease Way To Arctic Port

Peter Granitz, APRN – Washington DC

The U.S. Senate is expected to a pass a sweeping bill authorizing dozens of water projects on Wednesday.

A provision is included that Alaska’s senators say could ease the way to an Arctic port.

Cruise Ship Waste Referendum Won’t Be On Ballot

Alexandra Gutierrez, APRN – Juneau

When voters head to the polls next year, they could be faced with questions on oil taxes, the minimum wage, and the use of recreational marijuana. But one thing that won’t be on the ballot is a referendum on a controversial bill concerning cruise ship waste.

An Anchorage Doctor Learns How To Talk About Death

Annie Feidt, APRN – Anchorage

Doctors deal with death all the time. But they often struggle to help patients live with a terminal disease. A specialty called Palliative Care is trying to change that. It’s been around since the early 1990s. But a lot of people, even in the medical profession, don’t know it exists.

Rescued Polar Bear Cub Heads To New York’s Buffalo Zoo

Ellen Lockyer, KSKA – Anchorage

Kali, the orphaned male polar bear cub that has been kept at Anchorage’s Alaska Zoo, spent Tuesday afternoon waiting patiently in his carrier for boarding on a  UPS cargo jet bound for the East Coast. Kali is heading to his new permanent home at New York’s Buffalo Zoo.

Musk Ox Herd Spotted Along Kuskokwim River

Angela Denning-Barnes, KYUK – Bethel

A herd of musk oxen was seen on the frozen Kuskokwim River recently. It’s a sign that the population is expanding in the region.

Two Bering Sea Catch Processors Accused Of Tampering With Scales

Stephanie Joyce, KUCB – Unalaska

Two Bering Sea groundfish catcher-processor vessels have been accused of tampering with the scales used to weigh their harvest. As KUCB’s Stephanie Joyce reports, the alleged violations carry hefty penalties for the vessels’ parent company, American Seafoods.

Parnell Meets In New York About State’s Economic Outlook

The Associated Press

Governor Sean Parnell is in New York meeting with banks and rating agencies about Alaska’s budget and economic outlook.

Long-Term Unemployment Benefits To Experience Cuts

Joaqlin Estus, KNBA – Anchorage

As federal agencies are beginning to furlough employees because of sequestration, the long-term unemployed in Alaska are about to see a reduction in their unemployment benefits.

Dillingham Volunteer Monitors For Invasive Beetles

Dave Bendinger, KDLG – Dillingham

Some invasive species of bark beetles, if they make it to Alaska, could pose a serious threat to our trees and forests. In ten years of surveys, none have been detected, but state and federal forestry officials are coming to rely on volunteers to help monitor for them across the state. KDLG’s Dave Bendinger reports on one such volunteer who’s keeping an eye out the beetles around Dillingham.