This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Laura Gelfman, MD, MPH, was selected based on her involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. The honoree was then asked who inspired her over the course of her career. We are sharing some of her answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
My experience caring for Ms. R, an older woman with metastatic breast cancer and severe post-herpetic neuralgia, continues to shape my approach to palliative medicine. I cared for Ms. R throughout my clinical fellowship, through multiple hospitalizations and ultimately, I cared for her at home until she died.

These experiences taught me the importance of finding ways to ensure Ms. R’s voice was heard throughout her illness, which slowly diminished Ms. R’s closely guarded and highly valued independence. When her oncologist offered her more chemotherapy, Ms. R could not say “yes” because she suffered from her previous chemo and she could not say “no” because she was afraid of what the future might look like. Her sons and her doctors all agreed that her decision to not decide was a decision that we would support, all the while working to control her symptoms.

Our symptom management focused on the ebbs and flows of her somatic and neuropathic pain, opioid-induced constipation and acute delirium, each critical to her care. This required effective communication and care coordination among her care team, including her oncologist, homeopathic doctors, family and home care team. I witnessed firsthand the devastating effects and unmatchable joys of caregiving. Through my continued relationship with her family, I have come to appreciate the waves of bereavement and the meaning of sharing memories. When I look back at my fellowship, I realize that Ms. R taught me the fundamental tenets of palliative medicine, and the intense satisfaction and privilege of providing our care to patients with serious illness and their families.

Where do you see yourself in 5 years?
In 5 years, I plan to transition from a mentored K23 funded investigator to an R01 funded independent investigator whose research improves the care of older adults with advanced heart failure. Under future NIH career development funding, along with my Hartford Centers of Excellence Collaborative Pilot Award, I will design and pilot test an intervention to improve the communication skills among heart failure clinicians. With future R01 support, I will conduct a randomized controlled trial to test the intervention. Improving communication skills of heart failure clinicians has the potential to better outcomes of patients living with heart failure by aligning treatments with their goals of care. I will continue to leverage national funds to build a coalition of both funders and key stakeholders within HPM as well as outside of HPM to be able to move the field forward. I will use these awards to ensure that I improve the quality of care for patients living with serious illness and their families, and advance the field of HPM.

What is the best advice you have ever received?
Throughout my childhood, when I faced a challenging decision or problem, my parents encouraged me to take a step back with the simple phase that my father learned in the Navy “KISS: Keep it simple stupid.” To this day, I remind myself of this advice as I sit down to write a grant or a manuscript, to break bad news to a patient or a family member, teach medical students the fundamentals of pain management, or encourage a fellow to practice a new communication skill. By breaking down a complex problem into smaller pieces, I have come to realize that these challenges become more surmountable, not only for me as a clinician, educator or researcher, but for patients, families, learners, trainees and mentees.