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A wish to remember: Penn Medicine program fulfills patients’ last requests

A patient sits in a wheelchair outside, surrounded by a crowd of people, some of whom hold balloons.
Overnight, the Three Wishes Project organized a surprise birthday party for patient Devyn.

The patient was dying of cancer. All options for saving or prolonging their life had been exhausted. Now, the patient most wanted to spend one more carefree, joyous day with their grandchild. 

Ramy Sedhom, MD, director of Medical Oncology and Palliative Care at Penn Medicine Princeton Health , couldn’t do more medically for the patient. So, he did what he could to support their emotional needs: Sedhom and his colleagues bought amusement park tickets for the patient and their extended family. The patient was able to take a day off from focusing on the bleakness of the situation, and the child made memories with their grandparent to last a lifetime.

This is just one example of the last requests granted through Princeton Health’s Three Wishes Project. On paper, it’s about performing small gestures that bring comfort and meaning to patients at the end of their lives. In practice, it’s about so much more—providing a sense of hope and closure, not only to these patients and their families, but also to staff.

“We focus on living, not necessarily dying, even at the end of life,” explained Sara Snead, MSW, LSW, an inpatient palliative care social worker at Penn Medicine Princeton Medical Center. “We ask these patients, ‘Is there anything that would make this easier? Bring you joy?’”

Generous gifts

The project, inspired by a similar program at the University of California, Los Angeles, and funded by the Princeton Medical Center Foundation, supplies resources to grant the final wishes of patients served by Princeton’s palliative care team, in the ICU and in other inpatient settings, and in outpatient cancer clinics. The wishes are generally small and easy to accomplish, like buying the patient’s favorite chocolate truffles or cookies. Sometimes there’s no cost involved—playing comforting music or creating a lasting keepsake, like a fingerprint or an EKG readout, for loved ones left behind.

Efforts like this to bring joy for patients experiencing difficult situations, whether or not they’re at the end of life, abound throughout the health system. For example, Neurology residents at the Hospital of the University of Pennsylvania created a program to provide small gifts like warm socks, puzzles and books, and beloved treats to long-term patients. Likewise, there are more ways that Penn Medicine hospitals help caregivers and staff cope with the challenges of the end of life. Pennsylvania Hospital has put together a “bereavement box” that provides staff with resources to help them cope when a patient dies, as well as sympathy cards and a bereavement booklet for families. And neonatal ICUs across Penn Medicine offer similar tokens of compassion for families saying their last goodbyes to infants.

For every formal program like this, though, there are many behind-the-scenes efforts that staff undertake on their own. Notably, the Penn Medicine Hospice team recently won a PMX Advocacy Award for their collaborative effort to gift a patient who loved sloths with an up-close encounter at a local zoo.

It’s just one high-profile example of what caregivers do every day, according to Snead. “People will just pay out of their own pockets to do these things for their patients,” she said. “Bringing in a program and trying to formalize it brings attention to it, which can help us gain support to help more people.”

The birthday party

People like Mimi Raji from Monroe, New Jersey. 

Her daughter Devyn was an oncology nurse studying for her master's when she learned she had breast cancer. After a year of treatment elsewhere, Devyn came to Princeton Health through an emergency department visit and switched her care to Sedhom. “He gave her so much hope, she was doing great, and her cancer was shrinking,” said Raji. “Then her cancer spread to the liver, and she couldn’t do chemo anymore.” 

It was a few months before Devyn’s 30th birthday, and her family had a surprise party planned for her at a country club. But she didn’t have that much time left. According to Raji, Sedhom said, “Why don’t we have a birthday party for her here?”

Within one day, the Three Wishes Project mobilized its volunteers across the hospital and its pool of resources to fill Princeton Health’s Healing Garden with balloons, food, cake, and Devyn’s loved ones. In addition, staff from the cancer care program—from doctors to secretaries to nurses—came to the party to celebrate Devyn’s life and hug her. “It was beautiful, but so extremely painfulit was a goodbye party,” reflects Raji. 

After the party, one of Devyn’s favorite nurses wheeled her back to her room, bathed her, and dressed her. And then Devyn closed her eyes for the last time, passing the next day within minutes of her younger sister saying her final farewell.

While Raji was devastated by her daughter’s death, she was amazed and deeply touched by the opportunity for one last loving celebration. She got to feel the warm spring breeze on her skin one more time,” said Raji. “For that, I am grateful.”

Granting hope

While throwing a spur-of-the-moment surprise party was one of the more involved and expensive requests fulfilled by the Three Wishes Project, many of the more than 20 patients served in the program’s first year had humbler desires. One wanted to taste lobster one last time; the program made it happen. An inpatient wished to see beloved pets at home, so Three Wishes supplied a pet camera that dispensed treats and allowed the patient to see and talk to the pets from the hospital room. Volunteers also arranged for a dying patient to be able to hold their newborn great-grandchild.

“These things are small, but they have a tremendous impact,” said Snead. They help patients feel like people. And we get to focus on the good instead of the scary and sad.”

Granting wishes gives staff a chance to care for both the patient and the patient’s family during a difficult time. And it provides them with a way to do something positive, however small, when few such moments are left in a patient’s life.

“We come into this profession because we want to help, and many things feel out of our control when a patient is dying, said Snead. “This gives us something that we sort of have control over; we can absolutely make an impact in this way, even if it's not the way that we want to be helping.”

Three Wishes, which its leaders would like to expand to other units and services at Princeton Health, also introduces the idea of hope, even when the prospect of recovery appears lost. “We try not to have a hope anchored on a scan or on use of a treatment,” said Sedhom. “What can we do for these patients to give them hope?”

Mission accomplished for Devyn, according to her mom. “What cancer patients are is scared of death, and they made that transition so much easier for her,” Raji said, referring to her daughter’s care team. “Forever grateful I will be that they were exactly what my daughter needed. It wasn’t just medical treatment, but it was so much hope and so much love.”

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