A gentle guide at life’s end


LAS VEGAS, Nev. — Dr. Warren Wheeler begins his workday with morning rounds. Accompanied by a handful of students and medical staff members, Wheeler visits his patients and greets them by name, introduces himself and asks how they feel, whether they are experiencing any pain and whether they feel comfortable.

They’re the sort of questions most doctors ask patients during rounds. But it takes a few minutes to notice the small touches of dignity and compassion that Wheeler weaves into each patient interaction.

A brief touch of a patient’s arm. The reassuring tone he uses to speak to patients who aren’t able to understand him. His interest in a stuffed animal held by a too-young patient. The way his hand casually moves to smooth a rumpled bed sheet.

Each decidedly human touch has nothing to do, technically speaking, with the practice of medicine. Wheeler incorporates them seamlessly into his daily routine.

But his rounds are a bit different: Just about every patient Wheeler saw on this particular set of morning rounds a few weeks ago either has died or is expected to die soon.

Wheeler is medical director of the in-patient unit at Nathan Adelson Hospice’s Swenson Street facility and medical director of palliative medicine at the hospice. He also serves as Sunrise Hospital’s palliative care director.

At the hospice, Wheeler helps terminally ill patients face their deaths free of pain or discomfort and flush with dignity. As a palliative care specialist, he treats patients with incurable conditions who are not necessarily facing imminent death.

Next month, Wheeler will be among 30 palliative care specialists from across the country who will be honored as “visionaries” in the field by the American Academy of Hospice and Palliative Medicine.

It’s a well-deserved honor, says Pam Cate, advanced nursing practice manager at Adelson Hospice, who has worked with Wheeler for about seven years. Beyond his medical expertise, Cate says, Wheeler “has such a respect for each person and treats everyone with dignity.”

“I think that’s one reason why he chose this profession, but also why he’s the epitome of the profession, because he looks at a person not just as ‘a renal failure’ or ‘a heart disease’ or whatever. He just looks at them as persons.”

Wheeler says that’s probably a reflection of both his experience and his training.

“When I first got involved in hospice, the emphasis was on personhood,” he says, “in other words, treating the person with the disease and not the disease in the person.”

Wheeler says palliative care involves the treatment of people with incurable and life-threatening diseases. While pain management is a big component of palliative care, he says, it also involves managing symptoms of the disease that cause discomfort, treating such allied conditions as nausea or delirium, and even addressing psychosocial issues that can be associated with serious long-term illness.

“Palliative care,” Wheeler says, “is a continuum of care, from diagnosis to death, for people with incurable, life-threatening, chronic illness, but there’s no time frame (of life expectancy).”

Wheeler notes that patients with, say, diabetes — which is incurable, chronic and potentially life-threatening — or who have suffered heart issues or strokes, or who have such conditions as Parkinson’s or Lou Gehrig’s disease or lupus, also can be candidates for palliative care.

Then, lying “at the end of the continuum of palliative care,” Wheeler says, is hospice care, for people who are expected to live six months or less. When death is imminent, palliative care seeks to enable terminally ill patients to experience comfortable, pain-free deaths.

Palliative care in hospice involves no curative intent, Wheeler adds, but exists to maintain comfort by treating pain and symptoms.

On this particular day, Wheeler’s patients at the Adelson Hospice’s in-patient facility include a 54-year-old man with lung cancer, an 84-year-old woman and a 67-year-old man with congestive heart failure and a young woman barely in her 20s with malignant cancer.

“Do you have any pain?” Wheeler matter-of-factly but gently asks the 54-year-old, whose cancer has metastasized to his brain. “Are you comfortable?”

The man responds with a faint grunt.

Wheeler gently moves the man’s leg, eliciting what sounds like a weak cry of pain. “I’m sorry,” Wheeler tells him. Then, to staff members accompanying him on rounds, he adds, “That’s an indication we need to go up on the pain meds.”

Wheeler examines the man for a few more minutes. Later, he’ll note that the dark brown urine the man is producing is a sign of kidney failure.

“He’s aware he’s dying,” Wheeler says. “He’s been here the last two days. He’s really taken a turn to the worst in the last 24 hours.

“Maybe a few more days.”

It’s a short — perhaps five minutes, at the max — encounter but a powerful one. Thanks to Wheeler’s compassion and skill, it’s also surprisingly calm and, even, life-affirming.

Wheeler was born in Spring Valley, Ohio, a small town near Dayton. His dad was a barber, his mom was a housewife, and Wheeler was one of five children. By the time he was in high school — there were just 12 students in his senior class — Wheeler already had decided that he wanted to go to college.

At first, Wheeler wanted to study horticulture. “I was in love with horticulture,” he says. “Ever since I was, like, age 8, I just loved to be outside, working in the dirt.”

Then, during his sophomore or junior year, a friend, a local attorney, asked him what he wanted to do after high school.

“I told him, ‘Well, I want to go into horticulture.’ He said, ‘Where are you going to get $20,000 to build a greenhouse?’ And back then, $20,000 sounded like $20 million. I said, ‘I never thought of that.’”

The friend suggested that Wheeler instead study law or veterinary science or medicine. Then, he said, Wheeler could make enough money as an attorney, a vet or a doctor to buy a greenhouse and pursue horticulture as a hobby.

Wheeler thought that becoming a doctor, in particular, was absurd.

“I thought, ‘Oh my God, I could never do that,’” he says. “But then I got to thinking about it and said to myself, what do I have to lose?’”

Wheeler completed premed studies at Ohio State University and medical school at Tulane University School of Medicine in New Orleans. After a year of internship at Riverside Methodist Hospital in Columbus, Ohio, he spent two years in the Army — one as a battalion surgeon in Vietnam — then returned to Columbus to complete his residency.

After completing a two-year fellowship in medical oncology at the University of Texas’ MD Anderson Cancer Center in Houston, Wheeler returned to Ohio to open an oncology practice.

But just two years into his practice, Wheeler had a career- and life-changing experience.

During his training, Wheeler had been taught to treat cancers with an “extremely aggressive” approach — cancer kills, so kill the cancer.

“My house staff and I were walking down a hallway and we heard my patient screaming in her room. We walked into the room, and this woman had metastatic breast cancer. Both lower extremities had become gangrenous, had just become black, and she was in excruciating pain.

“Her two daughters were at the foot of the bed, and they looked at me and said, ‘Doctor, how could you let my mother suffer like this?’

“It was humiliating,” Wheeler says. “I was in front of my house staff, I thought I was a hot dog oncologist, and then I realized that I didn’t know how to comfort people. I didn’t know how to control pain at all. All I knew was how to give strong chemotherapy and try to kill the cancer.”

Just a week later, Wheeler was approached by a woman seeking his help in founding a hospice. Wheeler had heard about the still-new hospice movement in the United States. But, he says, “I thought it was hokey-pokey. It was outside the medical community, and a grass-roots movement, and I thought it was like all this complementary this and that.

“But when this woman called me and said she was interested in starting a hospice, I said, ‘What have I got to lose? What I’m doing now isn’t working.’ ”

In 1978, Wheeler became founding medical director of Hospice of Columbus, the first hospice in that city and only the 13th in the country. In 1985, he served as founding medical director of Hospice at Riverside and Grant, also in Ohio.

Wheeler continued his oncology practice until 2002, although he “wore two hats,” striving to treat not just cancer but the person with cancer, too, and recommending hospice care to patients who “had not a chance in hell of surviving cancer, and (for whom) chemotherapy was worse than the disease.”

Throughout his career, Wheeler has been instrumental in working for passage of state and national legislation that advanced the hospice movement by, for example, permitting physicians to more effectively address end-of-life issues patients face. Since 2002, Wheeler has devoted his full professional attention to palliative medicine and hospice care.

In 2007, Wheeler moved to Las Vegas.

“I hated the cold weather,” he says, and “being a horticulturist, I came down and saw all these gorgeous flowers bloom and thought it was wonderful.”

Wheeler says physicians spend too little time during their training learning about end-of-life issues and medical education still focuses largely on “treating the disease.”

“An unknown author said … the real meaning of a physician is not clear until one must treat without the hope of a cure,” Wheeler says. “And physicians and pharmacists and nurses, still the emphasis in those professional schools is on treating the disease. Yet, we all die, and you’d think they’d put more emphasis on end-of-life issues, but they don’t. We keep trying to penetrate the medical schools … but it’s a very slow movement.”

He concedes that his work can be emotionally wearing.

“I guess you just sort of get used to it.”

It helps that Wheeler remains passionate in believing that the work he and others in his field do has real importance.

“Doctors will say, ‘What do you get out of that? Everyone dies. Isn’t that depressing?’ ” Wheeler says. “I say, ‘Well, you know, I’m human and I’m going to die someday, and I sure as hell hope the physician at my bedside makes sure that I’m comfortable on my way to the journey of death.”

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Contact Las Vegas Review-Journal reporter John Przybys at jprzybys@reviewjournal.com