AAHPM Visionary: Michael J. Nisco, MD MBA HMDC

Michael J. Nisco, MD MBA HMDC
Medical Director, Vista, San Francisco Bay Area, CA 

Who has most influenced your work and what impact has he or she had?
My mother went to nursing school when I was in third grade. She graduated and took a job at the hospital across the street from our house, and I spent many afternoons and evenings visiting her. My mother became the director of Med/Surg by the time I was in eighth grade, and convinced me to become a volunteer at the hospital. By the time I graduated high school I had spent thousands of hours in the hospital, often helping out as a runner for the emergency room, but my favorite job was sitting with patients who were often critically ill and didn’t have family. Sometimes the patients were trauma victims who were afraid, and alone while waiting for their family to arrive at their side. Other times I had the privilege of sitting with older patients who were terminally ill and didn’t have close family to visit them.

I was very young to be doing this, but my mother was always there for me as a guide. She taught me how to sit down at the patient’s side at eye level, to focus my attention on the person and not the disease, and he most difficult of all…how to accept the silence between the words.

My mother died at the age of 62 after an unusually difficult struggle with a terrible neuroendocrine hormone secreting carcinoma that ravaged her body and mind for one and a half years. By this time, I was a family physician in private practice doing part time hospice work, but when my mom died my wife sat me down and insisted I should apply for a fellowship position in hospice and palliative care, that despite the financial difficulties due to my income dropping by two-thirds during training, she would work harder to support me because she could see that hospice is truly my calling.  Becoming a clinical fellow at the Harvard Center for Palliative Care was truly a life altering experience, after which I committed my career full-time to using my new skills to improve care for patients and families struggling with life-limiting and terminal illnesses.

Norma Nisco’s career as a nurse inspired me to become a physician. Her life and death as a loving mother inspired me to become a hospice physician.

What does it mean to you to be named a Visionary in Hospice and Palliative Medicine?
I once had a patient who was famous in Fresno for his generosity. He was widely loved for the selflessness and devoted way he dedicated his life to helping those with addictions. When he was literally within days of dying, he shared with me he was at peace and knew for certain there was a God who would welcome him on the other side.  He said as an addict himself, he knew he was a weak man who was not capable of helping himself much less others. He said it was simple math. He said that all he had to do, was to look back on his accomplishments, and subtract his capability, to see the difference that is proof of God’s existence.

Similarly, when I consider this visionary award, I see that it is in my name, but was earned by many people, including my wife, my mother, my son, many countless wonderful colleagues, as well as by the grace of God and his influence on my life.

What is your vision for the future of Hospice and Palliative Medicine?
It is essential as caring human beings that we provide or best, most supportive services to the most vulnerable amongst us. Those who are dying, and their loved ones, clearly deserve access to the full spectrum of care that is provided by hospice and palliative care services at all stages of their illness.

I believe for this to happen we must continue to work closely together as a community to advocate for improved systems of care, and better payment models. In an age of budget cuts and administrative decisions based on return-on-investment determinations, our community needs to have clear and consistent messaging to governmental agencies, regulators and payers of how and why it is not just beneficial, but essential to have expert hospice and palliative care available to every patient and family in need, not just those determined to be in the last 6 months of life.

I am very encouraged by the increased collaboration I have seen over recent years between the AAHPM, the NHPCO and other leading hospice and palliative care organizations. I believe our coming together as a community is crucial to our success.

Michael J. Nisco is one of 30 individuals who have been named a Visionary in Hospice and Palliative Medicine by AAHPM for their 30th Anniversary in 2018. Learn more about the Visionary recognition and view a list of all current and past Visionaries.