Celebrate Summer! This is the current welcome sign on my front lawn in Carson City, NV. June can be hot, even in northern Nevada, but air conditioning and the lack of high humidity make it comfortable. Summer is not a place of comfort outside in my Alabama homeland. This year I am traveling a great deal of the time as a representative of the ACOI. Sometimes I get a special seat on my preferred airline due to my miles status. It is called a comfort seat. More leg room, drinks, snacks are nice. I fondly call it comfort care seating.
In the years of my residency training, comfort care was something else. For most patients, we did everything. When it was clear that aggressive care would not be curative and life was near its end, we discussed comfort care with the family and patient. Keep the patient comfortable, pain free. All of that usually came at the very end. Early on, we did not even have the terminal wean. At that time, I understood that once the patient was hooked up to the ventilator, it could not be stopped. I remember one patient who came in at the apparent end of life. He had been intubated, but had not been hooked up to the ventilator. I asked the technician to manually ventilate the patient while I talked to the family. They agreed to comfort care. The patient was placed on a T-piece and later expired.
Hospice has been a choice for many patients over the years of my career. Terminal cancer has been the usual diagnosis for hospice. In recent years, hospice and palliative care have taken new meaning. Skillful physicians in this area of expertise now include diagnoses other than cancer. A few years ago, I had one such patient with congestive heart failure. It was apparently terminal in that all avenues of care had been expended. This was a surprise to me, as he was fairly well on routine clinical exam in my office. He was placed on hospice and expired shortly after.
Getpalliativecare.org reports of palliative care, “This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.” Palliative care can be provided along with curative care. This is the new comfort care. As osteopathic internists, we are the champions of the care of serious illness. I am an old school osteopathic internist. Do everything. Get to the bottom of it. Aggressive care is the only way. That does not set well with every patient. Some patients indicate to me and my staff that my aggressive approach is unwanted. To other patients, I am just what they desire in healthcare.
Aggressive care of diabetes can be in some ways palliative. Painful neuropathy, for example, can be greatly improved by control of glucose values. Wounds, sometimes painful, are more easily healed with better glucose values. Vision complications get better, and cardiac status can improve.
We are trained as osteopathic internists to consider body and spirit in the healthcare of our patients. We understand that one tenet of osteopathic medicine is rational therapy. The definition of rational therapy takes on new meaning with modern hospice and palliative care. Sometimes rational therapy in my office means an insulin pump in a 75-year old patient for better diabetes control. Sometimes rational therapy means to stop all insulin and diabetes medication. That is a hard one for me, but I am willing to work with the hospice and palliative care team for the good of the patient in the best standard of care. We must individualize care. We must stand up for the life, comfort and peaceful death of any given patient.
At the ACOI, we are here to support the osteopathic internist. We are working hard to represent our members. We are here to lead osteopathic internal medicine into the future. Let us know how we can help you.
God bless Osteopathic Internists.
Osteopathic Internist in the Trenches
Reuben Eliuk, DO, is a classic Osteopathic Internist born in Alberta, Canada. After completing high school to get off the farm, he moved far away to train in physical therapy in California. Dr. Eliuk graduated with a Bachelor’s degree from Loma Linda University, College of Allied Health Professions. He took a job in Bay City, MI, and later advanced to head of PT at Saginaw Osteopathic Hospital. That was his first exposure to Osteopathy. He learned some spinal manipulation from the Interns, which was helpful in PT.
In Saginaw, Dr. Eliuk began completing pre-med requirements and was introduced to schools of Osteopathic Medicine. His father-in-law, who was CEO of Garden City Osteopathic Hospital, was of great influence. Dr. Eliuk completed his Osteopathic Medicine degree in 1977 at MSU-COM in a pilot program that allowed him to complete his degree in 36 consecutive months.
He completed an internship at Garden City Osteopathic Hospital in 1978. He then went directly into general practice in Caro, MI for four years. Realizing that residency training was a must, Dr. Eliuk proceeded to the Internal Medicine residency program at Garden City Hospital. He completed the program in 1986.As Dr. Eliuk reports, he worked as a hospitalist “…back when being a hospitalist was not cool, especially as a DO. People would always ask me ‘Where is your office?’ “
Dr. Eliuk was board certified in 1987, which was the “…first year that there was no oral portion to the boards!!!” For over 20 years, he worked at Garden City Hospital as IM program director, IM Department Chief, Chief of Staff and on the Board of Trustees. He has been awarded the well-deserved Intern Trainer of the Year, Resident Trainer of the Year, and Humanitarian of the Year recognitions.
Dr. Eliuk chose to limit his professional responsibilities in December 2012, when he became employed by the Bronson Healthcare Group in Kalamazoo, MI. His plan is “never” to retire, as he thoroughly enjoys caring for hospitalized patients and the challenges that this provides in today’s health care environment. Dr. Eliuk’s group is now associated with the relatively new Western Michigan University School of Medicine, and he reports that it is refreshing to see the young medical students with their short jackets and loads of enthusiasm.
Dr. Eliuk is in a loving marriage with his wife Janice for 45 years. They have three grown children and four grandchildren, whom they enjoy greatly. His son, Brett, is also a graduate of MSU-COM and is a cardiologist in the Bronson Hospital System. The senior Dr. Eliuk reports that it has been rewarding to see his son progress through the same professional roles that he had the privilege of filling.
Dr. Eliuk says that: “Osteopathic Internal Medicine has been extremely rewarding to me personally, and I still say the best all-around physician is a DO-trained Internist!” Please, Join me in celebrating Dr. Reuben Eliuk as the June 2017 Osteopathic Internist in the Trenches.
Peace to you,
John R. Sutton, DO, FACOI