Renowned pediatric palliative care physician, Glen Komatsu, MD shares about his work and why attending End Well is so impactful for his team.
We recognize that there are three cultures to be acknowledged in the care of any human being: the culture of that individual child and family, the culture of the clinician/team and the culture of healthcare.
EW: Glen, you’ve been a significant part of End Well, bringing your team and creating a whole learning journey last year. Can you share what inspired this and how it impacted your team?
GK: It was Shoshana that inspired me about the End Well program, when she presented it to the Providence Institute for Human Caring Board meeting. I thought it sounded like an innovative and fascinating approach to the topic. I was further inspired by the inclusion of pediatric topics and finally, the generosity of an End Well donor to fund admissions to your event and Shoshana’s incredible offer to give them to us at Providence! The event was very impactful for our clinicians from multiple teams to see the variety of ways end of life topics can be presented and thought of, especially through the lens of the arts and humanities. Medical teams get very stuck in looking at healthcare through only the medical lens. The response was so positive, our hospice Foundation agreed to fund 35 admissions this year. The list was full 2 hours after we sent the email, and we now have a waiting list. This was after I explained that last year’s attendees could not go again this year, unless we didn’t fill the slots.
EW: Your work at Providence Kids Care intersects with end of life in unique ways, especially given the context of pediatric care. How does your team approach discussions and support around end of life and grief, and what guiding principles do you follow?
GK: Providence Kids Care started in 2001, and I took over as medical director in 2005. Our approach is very much a work in progress as I and the team continue to grow and evolve in our thinking. I have had the benefit of wonderful mentors at Dana-Farber Cancer Institute, Boston Children’s Hospital and Harvard Medical School. I have had unbelievable support from my organization to be able to think outside normal boxes to try and help children and their families. I have had amazing philanthropic support to build programs outside of our operations budget to support caregivers and teams, like going to End Well! Our goal is to create a psychologically safe space to reflect on how we as individuals and we as a team can be of service to children and their families, to support disagreement, to encourage vulnerability, to explicitly recognize and acknowledge the love and joy that is inherent in the work, then muster the courage to do the work with kindness and compassion.
EW: Cultures around the world have different practices and beliefs surrounding death. How has your cultural background or personal experiences influence your approach to end-of-life care and grief in the pediatric setting?
GK: We recognize that there are three cultures to be acknowledged in the care of any human being: the culture of that individual child and family, the culture of the clinician/team and the culture of healthcare. We adopt a stance of cultural humility and try to learn as much as we can about the culture of that child and that family. We have done work as a team sharing our individual cultural stories. We then spend much time helping the family understand the culture of healthcare, what is possible, what is not possible, given the constraints of our system.
EW: In your experience, what are some significant society norms or beliefs about death and dying, particularly in the context of pediatric care, that you think need to challenged or redefined?Oh,
GK: Children are never supposed to die, but the fact is, children do die and will continue to die. Our society cannot accept that reality and norm. As a young neonatologist, I became very upset whenever a baby died. Then I realized that some babies will die, despite our best efforts. We can’t take all the credit when children live and we can’t take all the blame when they die. Other norms that need to be challenged are that if a child dies, it must be someone’s fault, if a child dies, the parents and doctors did not “fight” hard enough, if a child dies, the healthcare team is defeated, if a child dies, the healthcare team missed something, if a child dies, the healthcare team was not “good enough.” I am reminded on a regular basis of the humbling nature of our work: there is so much we don’t understand or know.
EW: You’ve witnessed the power of mindfulness and resilience in your work. Can you share specific strategies or practices that have helped you and your team maintain well-being and resilience while handling challenging situations?
GK: First of all, I try to embody, practice and model mindfulness in my work and interactions with children, families and colleagues. That means bringing my full presence to every encounter, visit, phone call as much as possible. For my team, we start every IDT with a thoughtful reflection, meant to allow all of us to reflect on our emotions, our feelings, how the work affects us in a safe environment. I read articles from the press, show videos, TED talks, reflect on current events, share stories, play music, journal, anything is fair game. During the IDT, we debrief difficult deaths, difficult and challenging children and families as a group. I also try to provide small educational “pearls” throughout the meeting to help the whole team, especially the non-medical members better understand what’s going on. I try to provide encouragement, support and gratitude to team members who call or text me with questions, trying to reassure them that they are not “bothering me!” Lastly, acknowledging the whole team after we have done our best for a child and family.
EW: How do you think other medical directors and team leaders can us the insights gained from End Well to enhance their own practices and improve support for their teams and patients?
GK: End Well should be used as a catalyst to stimulate creativity and imagination to think about ways to enhance our practices. Every team and program have unique needs and unique cultures. End Well does not provide answers. It is up to us, the attendees, to take back the spark that you helped light to our teams and programs and use it to make ourselves better.
EW: Is there a particular book, film, or piece of media that has had a profound impact on your views about mortality, especially in the context of pediatric care and your role as medical director?
GK: There are so many books, but on my short list are Frank Ostaseski’s, The Five Invitations, Michael Kearney’s, A Place of Healing, Tom Hutchinson’s Whole Person Care. None of them are pediatric focused but all of them apply to children and families. These are books for clinicians. I am also interested in leadership and mindfulness. That list includes Chade Meng Tan’s, Search Inside Yourself (a course I now teach based on that book), Marc Lesser’s, Know Yourself, Forget Yourself and Seven Practices of a Mindful Leader.
Dr. Glen Komatsu earned a BS in biological sciences at the University of Arizona and his MD at the Arizona College of Medicine. After completing a pediatric residence at UC Irvine Affiliated Hospitals and a neonatology fellowship at Long Beach Memorial/Miller Children’s Hospital, he entered private practice. He served as Medical Director of the Neonatal Intensive Care Unit at Providence Little Company of Mary Medical Center Torrance from 1985-2004, as well as Director of Bioethics for Providence in the South Bay. In 2004, Dr. Komatsu pursued the specialty of adult palliative care through a fellowship at Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Massachusetts General Hospital and Harvard Medical School. Returning to California in 2005, he now serves as Chief Medical Officer for Providence Hospice Los Angeles and Regional Palliative Care Southern California, Medical Director for Providence Kids Care pediatric hospice and palliative care, Director of the Edmond R. and Virginia G. Doak Center for Palliative Care at Providence Little Company of Mary Medical Center, Torrance, Co-Chair Bioethics, Providence Little Company of Mary Medical Center Torrance and Senior Advisor for Strategy and Education to Providence Institute for Human Caring. He helped launch Iyashi Care in partnership with Keiro, which provides community-based palliative care services for the Japanese American and Japanese communities in Los Angeles and Orange Counties.