A Patient’s Last Wish

A BOWL OF ICE CREAM. A MARIACHI BAND. A WORD CLOUD.

When patients in end-of-life care were asked if there was one wish they’d like to have fulfilled, those were some of the simple requests that came forth.

“It makes you reflect on what becomes important to people at the end of their life,” notes Minh-Chi Tran, MD, clinical assistant professor of medicine and director of the Wish Project at Stanford Health Care–ValleyCare.

In 2018 Tran launched the Wish Project to bring comfort to the dying by celebrating their lives and passions and to ease grief for families.

“We do this by granting wishes to those who have little time left with us and hope our small acts are able to leave a lasting and memorable impact on all those involved,” she says.

The germ for the idea was an article in the Aug. 18, 2015 issue of Annals of Internal Medicine.

That article described the 3 Wishes Project at St. Joseph’s Healthcare in Hamilton, Ontario, Canada. The project tried to bring peace to the final days of critically ill patients and to ease the grieving process by eliciting and implementing a set of wishes identified by patients, families, clinicians, or the project team.

Tran received funding from the ValleyCare Charitable Foundation to start a similar program at Stanford Health Care–ValleyCare Medical Center, where she is one of 13 hospitalists on staff.

“It was very low key at first, and I just started doing the projects with my patients on occasion here and there. Then I opened the program to my fellow hospitalists, and now the program has expanded to the whole hospital after we received a grant from the ValleyCare Foundation. What’s great is that everyone’s been so excited about it, especially the ancillary staff and hospital volunteers,” she explains.

While Tran has no formal goals for expanding the program, during the fall of 2019 she started building a component for high school student volunteers so they can become more involved in this aspect of medicine and health care.

When staff members in the hospital have a patient they think is nearing the end of life, they can refer the patient to Tran or her fellow clinical assistant professors of medicine Silvia Loica-Mersa, MD, and Kathleen Jia, MD. One of those three hospitalists then works with a Wish List program volunteer to pair them with the patient.

“What makes the program work so well is our 10 volunteers—especially Betts Cravotto, our lead volunteer. She generally spends an hour or two at a time with the family, just talking to them. And I think that the time she spends with them is probably more important than the wish itself,” Tran says.

“It’s an honor when families trust me and allow me into this very personal time, this sacred part of their lives,” Cravotto says.

One wish she granted was setting up a romantic dinner for a couple whose wedding anniversary was a month away—too long to wait when the husband was only days away from the end of his life.

“It’s an honor when families trust me and allow me into this very personal time, this sacred part of their lives

“The wife brought nice clothes from home for her husband to wear, and she dressed beautifully. The nurses brought flowers and decorated the table, which made for a charming setting for their special dinner. That was just such a blessing to them, but what moved me the most was hearing the wife say that we gave them something to be happy and excited about amid all the negative and depressing things they had been living with for months,” Cravotto says.

In the program’s first 15 months, 26 wishes had been granted, with most wishes costing less than $30.

The wish from the program’s first patient was for a copy of his favorite movie, “The Graduate.” Volunteers acquired a copy of the film, and the patient watched it after being transported home. He was also given CDs with mixed compilations of his favorite music, which were played in his hospital room with a sound system donated by a volunteer.

One patient asked for a glass of root beer as his last wish. In that instance Betts provided a variety of brands of root beer. Because the patient had a difficult time swallowing, she and hospital staff saw that a thickener was added to the root beer to prevent choking. A family member later thanked Betts and the staff, saying that “it was the first time [my] father had eaten in days, and it made the event a special and memorable day.”

On two occasions, families held brainstorming meetings with a volunteer and developed “word clouds” that used typography to create artwork composed of words the families use to describe the patient based on their reflections and memories.

Then there was a patient’s request for a mariachi band, which volunteers arranged in April 2019, when the patient was on comfort care.

Despite many advancements in medicine, all patients and their care teams must face death as an eventual reality. While the medical profession often turns to facts, science, and evidence before making decisions and taking action, the Wish Project is based on something else.

“I guess in terms of the actual science of it, it’s kind of hard to quantify,” Tran confesses.

This is an aspect of medicine that is tough for all those involved—family, friends, providers, staff, and the patient.

“What appealed to me, and why I found the project so rewarding, is that there’s a lot less science to it. It’s more humanistic, and just about caregiving. Something I found surprising about the project is that it takes very little to give families and people the feeling of being heard,” says Tran.

“I feel like we’re always running around trying to follow the latest guidelines in medicine and making sure we’re giving everyone the most up-to-date care. But often what people really want is just a feeling that someone cares and that someone knows a little bit more about them,” she says.

“It’s providing something surprisingly simple yet meaningful that honors or memorializes their loved one,” adds Cravotto.

“It makes me learn a lot about my patients on a personal level that we don’t usually get into as their doctor on a busy day,” says Tran. “But I like the pause that it makes us take by just asking what they care about, and what they want to have at the end of their life.”