Hunter Groninger, MD FAAHPM – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Hunter Groninger, MD FAAHPM, was selected based on his 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 him over the course of his career. We are sharing some of his 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?
One of my favorite aspects of our field is the diversity of the professional base: people don’t come to HPM because they love a particular organ system; they come because of their own personal and professional stories. Because of this, so many rich experiences inform folks moving into the field. I can think of a dozen individuals who have significantly impacted my work and it would be difficult to choose the one who has influenced me the most.
But here is one of those rich experiences that stands out: as a fourth year medical student, I did a rotation in palliative care with Dr. Daniel Fischberg. One day, we were rounding on a patient, an elderly woman dying in an intensive care unit. Her large family was gathered around the bed, trying to accept the inevitable decline of this matriarch. Understandably, they were so incredibly sad. It was palpable in the room. I remember feeling paralyzed, like there was nothing more to be done that might help them through this time. Then, in the middle of talking with some of her children, Dan gently moved the conversation to life before this hospitalization. What did she like to do for fun? What gave her joy or excitement? Within a few seconds, the room filled with laughter and storytelling. The gathering suddenly seemed like a celebration. I was stunned to witness this simple magic, and I knew I wanted to be able to help patients and families just like this.

Where do you see yourself in 5 years?
I see myself exactly where I am now: serving the community of the Washington, DC, metro area. When I arrived here in 2006, the city of Washington, DC, had one of the lowest hospice utilization rates in the nation and one of the highest rates of in-hospital death. Patients and families were just beginning to learn of the supportive benefits that palliative care can provide. Since then, many HPM clinicians have worked hard to change this for the better, but there is much more to do. I aim to see palliative care deeply implemented into the inpatient and outpatient fabrics of my hospital; our current project to integrate palliative care upstream with advanced heart therapies is one part of that. I also want to create strong partnerships with community-based HPM providers to make this care truly seamless. And we need to study what we implement so we can always improve and extend these benefits.

What is the best advice you have ever received?
Founder of the Zen Hospice Project Frank Ostaseski has developed five precepts that he uses to teach caregivers of the dying. They are all important to me, but one in particular I find myself practicing many times a day: find a place of rest in the middle of things. Working with seriously patients and their families could not be more rewarding. It can also be very challenging work. Then put this hard work in the context of the rest of life – family, friends, financial responsibilities, hobbies, spiritual life – and it can be tricky not to feel pulled in too many directions. I remember talking with Frank about this specific precept. His suggestions were simple: pause and breathe before entering a patient’s room; enjoy a red light instead of being frustrated by the commute; when you wash your hands dozens of times on hospital rounds, just focus on washing them, and let your mind relax rather than race from thought to thought. When I follow this advice, I feel focused, energized, and present to these special moments with our patients. I can bring more to my work, but I also take away more from these rich experiences and look forward to the next encounter.

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