Between Life and Death: An Interview with Kashyap Patel, MD

Dawn Holcombe, MBA, FACMPE, ACHE
Editor-in-Chief
President, DGH Consulting, South Windsor, CT

Each individual can choose the way he or she reacts to the topic of death; it is a unique journey for each of us. In general, our experiences can be divided into 2 types: coming to terms with our own death and experiencing the death of others. In his newly released book, Between Life and Death: From Despair to Hope, Kashyap Patel, MD, explores both of these perspectives as he recounts the story of a terminally ill patient named Harry, who has decided to accept death with the fullest spirit and without hesitation, and who tries to prepare for his own death by learning about other patients’ experiences.

The story is told from Dr Patel’s lens as a practicing oncologist with more than 30 years of experience treating patients in India, the United Kingdom, and the United States. A quadruple board-certified oncology specialist who is CEO and Managing Partner of Carolina Blood and Cancer Care, Rock Hill, SC, Dr Patel has been a keynote speaker at numerous medical conferences and has authored several articles on death and dying in national journals and magazines. As chief medical officer for one of the largest hospice care agencies in the United States, he is responsible for the care of more than 1000 patients at any given time. Dr Patel deals with cancer and death on virtually a daily basis, and trains other physicians on how to initiate discussions about death and dying with their patients.

I had the pleasure of interviewing Dr Patel soon after the launch of his book in early September 2020. We explored some of the backstory of this compelling tale, which not only takes us through the journey of several patients facing end-of-life choices, but offers an intriguing view of the role that oncology providers play in the quality of their patients’ experiences as they weigh their options for treatment or alternative strategies.

Ms Holcombe: What prompted you to write this book?

Dr Patel: Having lived on 3 different continents and practiced medicine in the field of oncology for more than 3 decades, I discovered that none of the training programs I underwent prepared me for initiating conversations or supporting patients as they faced the transition out of their physical body. Although the only certainty in life is that we all are going to die, there is a stigma around even starting a discussion about death. Our societal norms have stigmatized acceptance of disease progression as “losing the battle” to cancer. Remember when President Nixon declared war on cancer?

I felt there was a need to pen a learning experience from the common person’s perspective. I came across a perfect individual—one of my own patients, Harry. Diagnosed with terminal cancer and facing imminent death, he had planned his own exit strategy, but said that he needed to prepare his family for his departure. I decided to work with him to share my experience of helping many other patients leave this world gracefully.

Ms Holcombe: Are the conversations in the book prompted by actual conversations with Harry or are they a compilation of your vast experience with patients with some literary liberties to shape the flow?

Dr Patel: The book is actually based on my conversations with several real patients and the sharing of their journeys, which enabled Harry on his own final journey.

Ms Holcombe: How did the families feel about you including their stories in the book?

Dr Patel: None of the families objected to me sharing these stories. Of course, I have altered names and other personal information whenever requested.

Ms Holcombe: You are one of the rare physicians who still makes house calls. It seems as though there are very few opportunities for physicians to share and sort through the details of end-of-life patient care, or to have an outlet for their own grief. Is that accurate? How does this affect the cancer care delivery process?

Dr Patel: I have always believed that if I maintain my perspective as an average human being rather than as a detached third-party witness, I can serve my patients well. In the book, I describe instances when I have found myself torn between special events with my family and requests to tend to dying patients. On one occasion, when called to the bedside of a dying patient, I felt compelled to cancel plans that I had to attend the wedding of a close friend’s daughter, even though I was not on call. I felt a sense of fulfilment when the patient passed away in my arms. I needed to ask for forgiveness from my wife who had to attend the wedding alone, but I felt that on the balance, honoring my duty to support a dying patient was all-worthy of the compromise I made. Nevertheless, as a society, we need to expand support systems that will allow oncologists and other providers in highly stressful jobs to maintain their physical, emotional, and spiritual health.

Ms Holcombe: Despite the fact that there is a national focus on costs of care and removing the “perverse incentives” of fee-for-service, are we losing sight of the personal touch and the time needed to help patients be informed, feel empowered, and make good decisions? What improvements can we make?

Dr Patel: I think we need to transform our care delivery system. In addressing a diagnosis of cancer, we run the risk of reducing a human being to a piece of aberrant tissue. We forget that this patient is a husband, wife, friend, lover, brother, sister, cousin, etc. If instead of using a fragmented approach, we define patient-centered care as holistic care with human beings in the center, and fix aberrant tissue as a part of the ecosystem, rather than just focusing on cancer tissue, we can serve patients better. Instead of checking boxes as “value-based care,” we can better achieve our goals by having transformative experiences for patients and their families as truly “value-based care delivery.”

Ms Holcombe: What is it like to launch a book that deals with such a delicate, yet crucial, discussion in the middle of a pandemic?

Dr Patel: The Covid-19 pandemic has taught me to be adaptable and flexible. There has not been a single day that I have not seen patients. I have learned ways to survive and thrive throughout this crisis.

The book launch itself took place organically. I was fortunate that so many volunteers from across the world rallied to support the launch. We had viewers from 4 continents and 7 countries. I was surprised and grateful to see such an outpouring of support and responses.

Ms Holcombe: Have you had any discussions with payers about the issues raised in the book? Is there an opportunity for this information to improve the level of care for patients in new ways?

Dr Patel: I am working with a few payers to take this to a logical next level with them. I plan to start a burgeoning movement around “Living to the fullest and leaving gracefully.”

Between Life and Death: From Despair to Hope is available from Penguin Random House India.

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