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A Staff Dialogue on a Socially Distanced Patient: Psychosocial Issues Faced by Patients, Their Families, and Caregivers

The Kenneth B. Schwartz Center, Massachusetts General Hospital, Hematology-Oncology Department, Boston, Massachusetts, USA

Correspondence: Richard T. Penson M.D., MGH Cancer Center and Hematology-Oncology, Cox Building, 100 Blossom Street, Boston, Massachusetts 02114-2617, USA. Telephone: 617-726-5857; Fax: 617-726-6974; e-mail: rpenson{at}partners.org

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a non-profit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members.

The following case of an HIV-positive woman who was diagnosed with cervical cancer during a twin pregnancy was discussed at the May, 1999 Schwartz Center Rounds. The patient was in drug rehabilitation having been dependant on crack cocaine, with a past history of syphilis and gonorrhea. She was single and her other children were in foster care. Initially she was suspicious and non-compliant. A plan was negotiated to biopsy the cervical lesion after cesarean section and with confirmation of malignancy she underwent radical surgery and subsequently radiotherapy. Despite the almost insurmountable social and educational distance between her and her caregivers, they managed to bond and facilitate care. Although there were compromises with which staff were uncomfortable, the relationship was maintained and continues.

Key Words. Cervical cancer • Pregnancy • Drug abuse • HIV • Caregivers • Psychosocial • Palliative care

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A Staff Dialogue on a Socially Distanced Patient: Psychosocial Issues Faced by Patients, Their Families, and Caregivers

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