Interview by Merin C. MacDonald
Sunita Puri Leans into the Big Human Questions
In this month’s Chair’s Spotlight, we highlight the work of Sunita Puri, MD, MS, director of the Hospice and Palliative Medicine fellowship and associate professor of medicine in the Division of Palliative Care Medicine. She is also a writer of nonfiction and memoir. We recently sat down with Dr. Puri for a conversation about what drew her to this work, what inspires her, and what her hopes are for the palliative care fellowship as she steps into the role of fellowship director. The conversation has been edited for length and clarity.
What drew you to want to go into this field?
My mom is an anesthesiologist. She was and still is very immersed in what it means to practice medicine well and compassionately. I wanted to be just like her so I went into medicine, but when I was in my training I found that there were times when we were very good at doing things to people, but not necessarily doing the right things for people - with the “right things” being defined through a conversation between doctors, patients and their families. I struggled a lot in my training because I knew that I had to have these discussions but I had absolutely no preparation on how to do them well. What drew me to palliative care is the ability to doctor better by asking people clarifying questions: do you understand what is happening to you? How are you making sense of what is happening to you? Who are you as a person? What is the life you were living before you were sick and how can we help you keep living the life you want when you’re sick? I think those kinds of big human questions were always the most compelling to me. I do this work because I get to engage with those big human questions, while also distilling those answers into ways that I can actually help people medically, and that has always been very fulfilling to me.
What inspires you in your work?
Being both a writer and a doctor involves two big things - close attention to language and close observation of human beings and human nature. I think there is a huge link between language as a writer and language as a doctor because we need to explain things to people in a way that makes sense to them so they can be empowered to make the right medical decisions for their own lives. It also involves listening closely to what patients tell us and why. I don’t think that is a straightforward skill. We assume that we know how to talk to people in medicine, but I think we struggle to have high-stakes conversations because our field minimizes the importance of communication, in general, and maximizes the importance of being able to do procedures or think about the next intervention that we need to offer. I have seen how trainees and colleagues alike struggle when talking with patients who call themselves “fighters” or who want “everything” done and hope for “miracles.” I find it inspiring and fulfilling to validate their struggle while helping them find ways of understanding what people mean when they use these words and how they can have productive and compassionate discussions by seeking first to understand what this language means. It makes me so happy to watch someone learn to have these discussions by themselves.
I have always been a bit of a rebel and I think palliative care exists to correct medicine’s blind spots. Our field asks tough questions of medicine – why isn’t quality of life as big of a focus as it should be? Why do we ignore the fact of mortality and who are we really serving in doing that? What does it mean to truly take care of a whole human being? It’s kind of in my nature to ask tough questions in medicine and in writing. Palliative care challenges our beliefs about what medicine’s role is in our lives; our beliefs about what it means to suffer; our beliefs about dignity; our beliefs about dying well – or dying at all. I try to reintroduce the vocabulary of suffering and dignity and impermanence into my practice in medicine because I think those things are what unites every human being.
What are your hopes for the fellowship?
I have some exciting news about our fellowship! I just got word that ACGME has approved our application for a second fellow for the upcoming recruitment season! This is enormously exciting for our team and for UMass, and will enhance our patient care but also our educational role in the institution. I think the fact that we are a smaller fellowship is an enormous strength because we can really help mentor our fellows by tailoring the experience to what they see as their role in the field, to developing them as leaders, to supporting them emotionally, because this is not an easy fellowship to go through. My hope is to build out a leadership and humanities curriculum to supplement the rigorous medical training that is part of the fellowship. I also see collaboration opportunities between our fellowship and our other fellowship programs such as geriatrics and oncology, so that there is joint learning. I really see our fellowship and our team as agents for cultural change in helping people, whether they are patients, families, attendings, trainees, nurses, or anybody–to think about these issues in a way that is novel and empowering for them and for patients. I am honored to be in this position where I can help develop this program because I get to participate in that cultural change in a different way. I get to teach our fellows the art of this work, the challenges it presents, and the rewards. Because I think that people think that palliative care and hospice are very depressing, but really, the rewards are immense–seeing someone actually live the life they want, or garden because they aren’t in as much pain, or walk around the hall when for a week they couldn’t get out of bed because they were so nauseous. Those are the rewards that I want our fellows and our institution to see.
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Dr. Puri joined the faculty at UMass Chan/UMMH in September 2022. She earned her medical degree and a master’s degree in Health and Medical Sciences, from the UC Berkeley-UCSF Joint Medical Program in San Francisco, California. She is also a Rhodes Scholarship Awardee and holds a master’s degree in Modern History-South Asia from Oxford University in the United Kingdom. She completed her internship and residency in Internal Medicine at the University of California in San Francisco, and completed her clinical fellowship in Hospice and Palliative Medicine at Stanford University in California. Dr. Puri is the author of That Good Night: Life and Medicine in the Eleventh Hour.