Palliative Care: Simply Put
Real Stories from Specialists
Two Sides of the Same Coin: From Intensive Care to Palliative Medicine
A case report by Dr Yulia Streletskaya, Kazakhstan
Real Stories from Specialists
Two Sides of the Same Coin: From Intensive Care to Palliative Medicine
A case report by Dr Yulia Streletskaya, Kazakhstan
My entire medical career was built on defying expectations. ‘Medicine? Never!’ ‘Intensive care? Far too demanding!’ Yet thirteen years later, I—an intensive care physician and neurologist—found myself in a place I least expected: paediatric palliative care.
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In intensive care, everything was clear-cut. Breathing problems—insert a tube. Cardiac arrest—resuscitate. Every stabilised patient was a personal victory, an adrenaline rush. I had developed a classic ‘rescuer syndrome’: either you had saved someone or you hadn't done enough. My self-worth was measured solely by the number of lives saved.
Yet intensive care physicians are more likely than others to move into palliative medicine. Why? Because we see the other side of the fight more clearly than anyone else. We know when aggressive treatment does more harm than good.
The transition to palliative care was a shock. Here, you cannot simply ‘fight’—you must learn to compromise. I had once thought of a hospice as a place of death, but it turned out there is far more life here than anywhere else in medicine. My motto changed: there is always something more you can do, even when it seems nothing can be done.
One day, a four-year-old boy with spinal muscular atrophy was admitted to our care. He had severe respiratory failure. At that time in our country, children like him were intubated and left in intensive care for the rest of their lives, or given a tracheostomy and sent to a hospice. Nobody gave any thought to the child’s or his family’s feelings, or to what it means to live in a hospital with a tube in your throat.
Yet intensive care physicians are more likely than others to move into palliative medicine. Why? Because we see the other side of the fight more clearly than anyone else. We know when aggressive treatment does more harm than good.
The transition to palliative care was a shock. Here, you cannot simply ‘fight’—you must learn to compromise. I had once thought of a hospice as a place of death, but it turned out there is far more life here than anywhere else in medicine. My motto changed: there is always something more you can do, even when it seems nothing can be done.
One day, a four-year-old boy with spinal muscular atrophy was admitted to our care. He had severe respiratory failure. At that time in our country, children like him were intubated and left in intensive care for the rest of their lives, or given a tracheostomy and sent to a hospice. Nobody gave any thought to the child’s or his family’s feelings, or to what it means to live in a hospital with a tube in your throat.
Photo by PACED
The hospital administration insisted on a tracheostomy. The boy's mother rang me in tears. I asked her not to sign the consent form and spent a long time persuading my colleagues to try a different approach: to give the child a chance to go home. We sourced the necessary equipment, removed the breathing tube, avoided surgery entirely, and discharged him.
He is now at home with his family. Thanks to home respiratory support, he has not been admitted to intensive care since then. When I see the photos his mother sends me, I tell my colleagues: ‘This is what a victory feels like.’ We did not cure the disease, but we gave him back his childhood.
In intensive care, death is the enemy. In palliative medicine, I learnt that patients' families can be grateful to you even after a patient has died. I came to understand that sometimes the best thing a doctor can do is stop. Intensive care and palliative medicine are two sides of the same coin. In one, you learn to fight; in the other, you learn to let go. My rescuer syndrome never went away. Only now do I work not towards a heartbeat, but towards a child's right to live free from pain, surrounded by those they love.
He is now at home with his family. Thanks to home respiratory support, he has not been admitted to intensive care since then. When I see the photos his mother sends me, I tell my colleagues: ‘This is what a victory feels like.’ We did not cure the disease, but we gave him back his childhood.
In intensive care, death is the enemy. In palliative medicine, I learnt that patients' families can be grateful to you even after a patient has died. I came to understand that sometimes the best thing a doctor can do is stop. Intensive care and palliative medicine are two sides of the same coin. In one, you learn to fight; in the other, you learn to let go. My rescuer syndrome never went away. Only now do I work not towards a heartbeat, but towards a child's right to live free from pain, surrounded by those they love.
Photo by PACED
Dr Yulia Streletskaya's conclusion:
Palliative care is not a refusal to fight—it is a shift in what you are fighting for. When we stop fighting physiology, we start fighting for humanity. A doctor's victory does not always mean recovery; sometimes it is the chance for a child to be at home rather than in a sterile intensive care unit.
Palliative care is not a refusal to fight—it is a shift in what you are fighting for. When we stop fighting physiology, we start fighting for humanity. A doctor's victory does not always mean recovery; sometimes it is the chance for a child to be at home rather than in a sterile intensive care unit.
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