Steve Eveland
August 2018
Palliative Care
University of Maryland Medical Center
United States




Steve Eveland visits patients, families and team members to facilitate communication and advocate for patient preferences and wishes; he is always bringing what means most to the patient to the forefront. This engages all in attending to the 'person' in the bed, realizing their personal responses to illness and treatment. It enables others to 'think outside the box' to identify possibilities to meet most meaningful patient-family needs.
This was recently illustrated when Steve visited with Mrs. F:
Mrs. F. was suddenly confronted with an accelerated progression of her comorbid illness, due to chronic respiratory and heart failure she was facing impending death. She was extremely symptomatic with weakness and breathlessness. She seemed shocked and incredulous that she couldn't "bounce back" as she had in the past, although she reflected upon recent weeks and months of decline in ADL and instrumental ADL performance, as "can't do near as much as I used to". She described recent hospital admissions and otherwise being mostly homebound with her two dogs while her husband and adult son were out "working all day". She spoke at length and with some urgency about, "I just have to see them," referring to her dogs. She expressed serious concern for their well-being; one dog was reportedly "depressed and not eating".
On repeated encounters, Mrs. F would share her distress, sense of loss and incapacity, which became a metaphor for her leaving all those that needed her and missing the love and comfort of family and home. Steve visited Mrs. F and engaged her in what mattered most to her as he empathized with her and learned about her "twin Chihuahuas" actively listening and witnessing her concerns. He championed her wishes with the team and more importantly aligned these wishes with the nursing assessment data to encourage the team to find a discharge alternative or a safe transition across settings that would meet all of her "aggressive symptom management" needs. That includes geographic proximity to home, high flow supplemental O2, respiratory therapy and medications for breathlessness, supportive ADL care, and a setting that would allow family visiting, including her dogs.