Dr. Michael Karagiozis has a simple mission: He wants to stop end-of-life suffering.
Karagiozis, medical director of Nathan Adelson Hospice, oversees the care of more than 400 patients a day. From basic nursing to support services such as counseling, music therapy and pet therapy, Karagiozis and the hospice explore virtually every approach to easing patients’ physical and emotional pain.
But Karagiozis’ commitment to hospice is more than career-deep. He placed in hospice this year alone both his husband, Lance, who died in March of congenital heart disease, and his aunt, Beverly, who died of cancer the day we interviewed him.
Karagiozis offered his interview in memory of his aunt, who opened his first office and paid out of her own pocket for patients who couldn’t afford their medications.
Question: Your grandmother’s death from cancer convinced you to change course from veterinary to human medicine. Why did her death affect you that way?
Answer: When you’re young, you don’t really have an appreciation for mortality, and you don’t really understand the disease state. When my grandmother got cancer — we’re talking 30 years ago — cancer therapy was really primitive compared to what it is today. Even then, my mother and I could tell it was not state-of-the-art. That was the transformational moment for me. I went to med school just when HIV was coming out. I spent a large part of my career researching HIV. I just had this whole idea of attacking difficult-to-treat diseases.
Question: You gravitate toward needier populations: Prisoners, the mentally ill, the dying. What draws you in that direction?
Answer: That’s a really fun one. My grandmother was a huge believer in astrology, and she told me my sun was in the 12th house. And she always said the 12th house ruled outcasts, prisoners and the mentally ill. She always claimed that was the reason I gravitated toward needier people.
Also, I was raised between the Greek Orthodox and Roman Catholic churches. So I was exposed early in my life to that philosophy of helping the needy. I guess either way you want to look at it, I was destined to take care of people who were on the outside or suffering.
Question: What’s your goal as a hospice doctor?
Answer: My primary objective is to keep people from suffering. At some point, you need to get people to accept that their illness is terminal, and you’re not going to be able to do anything to materially change the outcome of the disease. But you can care for patients, and bring patients to a place where they’re comfortable, at peace and not fearful.
Question: Why does our culture avoid confronting or talking about death?
Answer: Americans basically have this attitude that we’re invincible. I think our physicians are a product of that culture. As Americans, we just don’t believe in losing. But the reality that is accepted in almost every other culture is that everyone dies eventually. When I do palliative-care consults, I see the difficulty that internists, specialists and interventionists have giving up when patients have reached the end of any reasonable return. America has the best interventionists in the world, but that doesn’t mean every individual can be saved.
Question: What do we need to change as a society about how we deal with dying?
Answer: There’s this very strict and arbitrary definition of who can be a hospice patient. You have to be within six months of a prognosis of death. That’s absurd. Florida passed legislation that gave patients a year, which is much more reasonable. But really, once you know a patient is terminal, that’s when hospice should begin. Many studies show that benefits increase the earlier the patient is admitted to hospice. The journal Circulation looked at patients who had stage 4 heart disease, some of whom were admitted to hospice and some of whom were not. Patients admitted to hospice lived an average of 81 days longer, because of the constant nursing and ancillary support patients got. When they would go into little health crises, nurses would correct the problems before the patient went into full heart failure.
People think the purpose of going into hospice is to die. But it’s not. The purpose is to live well until you die. If there were a single thing I could change, it would be to help people understand that.
Question: You recently lost your husband and your aunt. Are you able to be more clinical and objective about death? Does it affect you less than it might affect others?
Answer: With my aunt, she was older and she had cancer. I really feel that for her, dying was a lifting of a burden.
When Lance died, I was devastated. We (doctors) remain human, and the beauty of hospice is that we can accept death. Nothing you do changes your humanity. All it does is allow you to put your humanity in perspective. And that perspective allows you to integrate and rationalize it better, so you may move through the stages of grief faster, but yeah, you go through all of those stages and at the same intensity as everyone else. And now, when I tell my patients and their families that I know what they’re going through, it’s an honest statement. It allows me to tell them it will get better. There is a light at the end of the tunnel. You just have to hold on until then.
I know some doctors may be aloof, but if they are, it’s because they’re trying to protect themselves from these feelings everyone has. I don’t know any doctor who isn’t that way.
Question: What do you like best about your job?
Answer: I like teaching students and residents that death is a natural process. I like them to understand that it’s OK to care for a patient who has no positive prognosis.
The other thing I love most is bringing patients to peace with their diagnosis. I hate it when people are broken up and sad, and feeling existential suffering, because again, death is a natural part of life. The death rate is still 100 percent. So I love being able to bring people comfort and peace, and allowing them to enjoy the good death. A happy death is really a peaceful and painless death after a life well-lived.
Question: What do you not like?
Answer: The way the funding paradigm is in the United States right now doesn’t really recognize the importance of palliation. Existential suffering is as bad as any physical suffering. Yet, that’s not really accepted in our society or in medical administration. It’s just not really recognized that death is a genuine and tragic source of pain. I’ve seen existential suffering far worse than any physical suffering. Nobody questions a morphine order for physical pain, but if you want to bring in a psychiatrist, they say, “Oh, that’s not a covered benefit.”
Question: Doesn’t the Affordable Care Act have rules to help change that?
Answer: In theory. We’ll see how it pans out. Medicare is the largest provider and biggest driver of hospice, so Medicare is the (group) that would have to seriously look at it.
Question: You’ve helped establish the state’s first fellowship program in hospice. What’s the best solution to Nevada’s medical-education issues?
Answer: Shelley Berkley, the provost at Touro University, said it best at a (May) graduation ceremony. The problem with medicine in Nevada is not that we don’t graduate enough doctors. It’s that we don’t retain enough doctors. We have lots of medical-school seats, so we can graduate enough doctors. But we have a severe shortage of graduate medical education programs (residencies). That’s why medical students leave — to go find graduate medical education. And most doctors end up staying where they train. To retain physicians, we need to train them here.
My personal opinion is that we don’t need another medical school if we don’t have graduate medical education programs. People would study here and then leave.
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