Marion Delimat’s caregivers at Baystate Medical Center describe her health as being unique compared to most 90-year-olds. After almost a century of life, she hasn’t had many serious illnesses, takes little medication, has a healthy blood pressure, and was actively bowling up to a year and a half ago. Up until recently, her only issue was moderate Alzheimer’s dementia. Then doctors discovered a large malignant (cancerous) tumor in her belly.
“We knew if nothing was done,” says Dr. Nicolas Jabbour, chair, Department of Surgery, “in weeks, if not days, Marion would begin experiencing the painful complications of her progressively deteriorating condition.”
Immediately, Dr. Jabbour gathered a comprehensive team of specialists at Baystate to help Marion’s supportive family understand the care options.
CAREGIVERS FROM MANY DEPARTMENTS COME TOGETHER
Along with surgeons, anesthesiologists (who needed to adapt care for her dementia), and Marion’s cancer doctor, Dr. Robert Byrne, Dr. Jabbour reached out to geriatrician (physicians who specialize in the health care needs of older adults) Dr. Maryam Hasan and Peter DePergola, PhD, director of clinical ethics for Baystate Health. “It was like an orchestra. We looked at this patient holistically and brought together everyone who should play a role in her care,” says Dr. Jabbour.
“We are so much more when we come together,” agrees Dr. DePergola. “My role as a member of the team, in clinical ethics, is to understand in medicine we can always do one more thing, but to further ask - is that one more thing better or reasonable?” He sat with Marion’s family and they talked about her values and the person she imagined herself to be in the future. This conversation helped the family be more at peace with what Marion would want. In the end they knew surgery was the right choice.
LIFE-SAVING PROCEDURE OFFERED AT BAYSTATE MEDICAL CENTER
During Marion’s procedure, Dr. Jabbour removed the tumor and performed a complex procedure called a Whipple, which can be lifesaving for people with pancreatic cancer. Baystate Medical Center is one of the few hospitals in the area that can do this operation which removes the head of the pancreas, part of the small intestine, the gallbladder and bile duct and reconnects the remaining organs to allow the patient to digest food normally.
“During the procedure and after, the team took into account both the medical and social aspects of Marion’s care,” said team member Dr. Hasan. “Patients with dementia can tend to experience delirium, or an acute state of confusion, and so the right dose of anesthesia and medications is essential for these patients,” explains Dr. Hasan. “With Marion, we also identified things that could set off her state of confusion so we could take them away. We made sure she had a room in a quiet area, her favorite word search puzzles, and her hearing aids were in place so she could feel as normal as possible. Preventing Marion’s delirium during her hospital stay helped her recovery and improved her health outcome.”
NINETY LOOKS DIFFERENT ON DIFFERENT PEOPLE
Marion’s surgery was extremely successful, the tumor was removed and Whipple procedure completed. She had no ICU stay, no blood transfusions, and recovered so well she was discharged six days after surgery. “Ninety looks very different on different people,” Dr. DePergola says. “Marion was so extraordinary; the procedure seemed very ordinary.”
“Geriatric care is becoming more prominent in our increasing aging population. This is a story of great clinical care and our ability as a team to provide the best care for this patient and her family,” says Dr. Jabbour.