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As I arrived at the Balm of Gilead, a palliative-care unit on the fourth floor of Cooper Green Hospital in Birmingham, one of the nurses was blowing her nose. Arnold Smith (not his real name) died that morning. Three nurses had gathered behind the nurse's station. "When people die, it is not unusual to find the leadership team in the nurse's station in a huddle, crying and praying," says Edwina Taylor, R.N., nurse practitioner and go-to person at Balm of Gilead. "Our faith holds us up."

Palliative care is not hospice care, though the two can easily be confused. Hospice care typically takes place in the dying person's home, or in a home-like setting. According to the National Hospice Foundation (NHF), it is a team-oriented approach of medical care, pain management, and spiritual support that is tailored to the patient's needs and wishes. Hospice care, the NHF says, upholds "the belief that each of us has the right to die pain-free and with dignity."

The same can be said of palliative care, with a notable difference: through pain and symptom control, palliative care readies dying patients to move from impersonal institutional settings into the gentler environment of hospice care—whether at their home, in a nursing facility, or, if necessary, in the palliative-care unit itself. Dr. Amos Bailey, Balm of Gilead's former medical director, highlights the point that "75 percent of the people who die in the United States die in medical institutions." Fifty percent die in hospitals, another 25 percent in nursing homes. These "institutional" deaths are often painful, lonely, and isolated.

Palliative care is trying to change that picture. One might think of it as the meeting ground between hospice and institutional medical care. ...

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October 22, 2001

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