Palliative care is one of those areas of Medicine that evokes reactions of fear and confusion among Patients and their families. It also presents challenges for Doctors. When Dr. Ileana Leyva was a pediatrician in the intensive care unit of one of Chicago’s city’s hospitals, a 10-year-old boy with cerebral palsy and pneumonia had been placed on BIPAP despite being a DNR to try and get him through the pneumonia.
“His mom was livid!” Leyva recounted. “She asked me, ‘Who are you to contradict 10 years of my decisions? He has a DNR—why did you change it? You kept him alive to live like this?’”
Levya reveals in a testimonial for VITAS Healthcare, “I had no answer. I had never thought of it that way. I didn’t even know what palliative care was.” However, she made it her business to find out and immersed herself in a program that focused on the discipline.
One of the reasons Physician Outlook is featuring Dr. Leyva this month is she freely admits she thoroughly loves her job. It seems counterintuitive in an era when stories of Physicians that are burnt out and tired of Medicine are so common. Further, she works in a field that might seem depressing and unfulfilling to the uninformed.
“When people ask me ‘Why Palliative Care?’ I tell them that they don’t know what they are missing.” She sees it as an honor to help someone “lighten their load” and “walk with them” in some of the most challenging times. “Yes, it’s challenging to talk about what could be the final outcome of a very ill patient, but it is all of our ‘final outcomes’ at some point. The fact is that life can change on a dime for all of us. It’s an opportunity to force some difficult conversations and have others see the value in having those conversations. It’s more about in that time that they have left, what are their wishes, values, needs...what would they prefer for pain control or do they want to visit their horse—you never know what someone may want to experience or not.”
Dr. Leyva is no stranger to exploring and mastering new situations. In fact, it runs in her family. Her parents made a new life in the U.S. in 1959, leaving their home in Cuba to flee Fidel Castro. Born in Florida and fluent in English, young Ileana was gifted at science, and to augment her education, she regularly read medical books that belonged to a Physician friend of her father. That Doctor sat her down one day and predicted she’d eventually become a Physician. She did not disappoint. After earning a bachelor’s degree in biology from the University of Miami, she followed that up with an M.D. degree from Central Eastern University in the Dominican Republic and completed her Graduate Medical Education (GME) at the Lutheran General Hospital in Park Ridge, Illinois.
She believes that her life experiences have forged a strength and independence that have allowed her to practice Medicine on her own terms, which is another source of her professional happiness. She says, “Physicians have regrettably handed over their profession” to hospital administration that do not understand Medicine, which leads to unsafe/bad Patient care.
How do Physicians get back the power and joy of their profession? Dr. Leyva says, “involve yourself in committees and leadership to have a voice in what is happening at the administrative level. We don’t like these obligations, but they are necessary in decision-making. Also, learn to say ‘no’ when appropriate. Finally, don’t let the administration suck the love out of what you do. Remember why you became a Physician.”
Dr. Leyva thinks it’s important to train future Physicians how to care for others in a “pay it forward” kind of way, because, she says, “they could one day be caring for you or your family, or me and mine.” 3
