palliative care, fortune cookies

Pre-Consult Fortune Cookies Make Palliative Care Team’s Job Easier

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VALHALLA, NY – Fortune cookies with hospital meals?  That’s what the palliative care team at Rainbow Valhalla University Hospital (RVU) is doing before formal consults to discuss end-of-life issues.

palliative care, fortune cookies
“Well, I don’t want to be a glutton.  Thanks, fortune cookie, you’re the best!”

“We had to get creative,” said Dr. Ferry Charon, director of palliative care at RVU.  “The primary care team just orders the consult but never tells the patient that we will be visiting.  There we are, supposed to talk about hospice to someone who is totally dumbstruck and unprepared for our visit.  We were spending an inordinate amount of time at each initial consult explaining to the patient why we were there.  Surely, there had to be a gentle way to get patients prepped for our visit.”

So Dr. Charon, with assistance from Keenan Nguyen, a line cook in the hospital kitchen, created a series of fortune cookies indistinguishable from those from Panda Express but with existential fortunes enclosed.  A handy Epic order automatically linked to the consult request for Palliative Care ensured that a fortune cookie was on each patient’s meal tray for 24-48 hours before the actual consult.

Fortunes include pithy advice like, “The wise one has advance directives,” “It is the quality of one’s life, not the quantity,” “Good men are never burdensome to family,” “Only a glutton would want every medical intervention possible,” and “Do not buy any long-playing records.”

“We are on to something,” Charon proclaimed.  “Since we started pre-consult fortune cookies, we’ve had much more productive, focused palliative care visits.  After getting that subliminal advice, the patients seem to be ready for our visit rather than appearing like deers in headlights, admittedly morphine-fortified deers.”

His conclusions were apparently corroborated by comments from Mrs. Maude Lynn, an 88-year-old with end-stage CHF, end-stage renal disease, DM, HTN, and severe COPD, recently admitted with Klebsiella urosepsis and now with a DVT, a sacral decubitus ulcer, and profound deconditioning as well.  “Those fortune cookies are a nice touch, something I would never expect on a hospital meal tray.  And Lord knows, I’ve seen plenty of those!  Those fortunes, you know, they really made me think.  After all, I have had a good life and we all have to go sometime.  And I know that if I break my hip, that would be ‘curtains’ anyway.”

A similar strategy for pain management consults to Dr. Charon’s team was, sadly, unsuccessful.  Those patients uniformly dismissed fortunes like, “Be strong, grin and bear it,” “One’s mind is always stronger than one’s pain,” “Opiate is the religion of lesser humans,” and “Dilaudid makes you stupid.”  As Rocky Bumstead, admitted for his biweekly bout of subjectively excruciating but objectively unexplained diffuse abdominal and low back pain, opined, “What the hell?  What idiot would put fortune cookies on the menu here?  They don’t even have Chinese food, anyway.  Where’s my nurse?  She’s late with my round-the-clock scheduled Dilaudid!”

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