Morelli, 88, had been in the hospital five times since March. The single-spaced list of his admissions in 2010 filled a full computer screen. He had chronic lung disease, and had been treated for bladder and prostate cancer. He had been in a nursing home since June.
That morning, the nursing home had called Morelli's wife of 60 years, Anna Marie, and told her he was in distress. Did she want him to go to the hospital? He had Do Not Resuscitate and Do Not Hospitalize instructions, but she said yes, in case this was a new problem.
By the time Greene met Anna Marie Morelli outside the emergency department, her husband had already been given intravenous fluids and antibiotics for sepsis, a blood infection. Orders had been sent to move him to a telemetry room, where he would be monitored by high-tech equipment and receive more antibiotics and fluids.
Anna Marie Morelli and Greene would decide whether he stayed on that path. It would probably make him well enough to return to the nursing home, but he would be back at Bryn Mawr soon for more of the same. The alternative was to focus on drugs that would help him breathe more easily - and let him die.
Palliative care, which focuses on treating the symptoms of diseases either fatal or curable, has become increasingly common in U.S. hospitals. According to the Center to Advance Palliative Care, the percentage of hospitals with palliative-care teams jumped from 24.5 percent in 2000 to 63 percent in 2009. But emergency departments are a new frontier for a specialty more commonly seen in intensive care or oncology units.
"I would say, over the last five years, the conversation and growth around palliative care in the emergency department has been exponential," said Tammie Quest, an Emory University doctor who is board-certified in emergency medicine and palliative care.
