On Thursday evening, at approximately 10 PM, Dr. Balfour Mount died in the Palliative Care Unit that bears his name at the Royal Victoria Hospital of the 涩里番 Health Centre. He led a remarkable life and a celebrated career as the 鈥渇ather鈥� of palliative care. He was 86 years old. In the days that come, there is much that will be said and remembered about 鈥淏al,鈥� as he was known in this community and beyond. There are countless recipients of this letter who knew Bal better and for much longer than I. However, I want to take this opportunity to write not of his accomplishments 鈥� including, perhaps, anyone who reads this letter 鈥� but of what lessons I believe he still has to teach us.听
Bal represents a generation of 鈥済iants鈥� in medicine about which one might reasonably say: 鈥淭hey 诲辞苍鈥檛 make them like that anymore.鈥� He was, for many early practitioners of our work, larger than life. Indeed, one of my own mentors, herself a senior palliative care physician in North America, recalled: 鈥淚 can remember exactly where I was when I heard that he was diagnosed with esophageal cancer.鈥� That was 25 years ago. The enormity of this diagnosis for a man who had already done so much to transform medicine was like landing on the moon, or JFK being shot.听
After alerting senior physicians in this community about this death, I received this reply from one of them: 鈥渢he word 鈥榲isionary鈥� is tossed around a lot, but he really was one.鈥� I think this is probably inarguable, and yet 滨鈥檝别 been thinking about what it means to be called a visionary. On the one hand, it is an honorific and recognition that one either 鈥渟aw鈥� a problem more clearly than others, imagined a way to address it, envisioned a better world as a result, or some combination of the three. Having read his book, I am confident that each of these is true of Bal in some way. Like Cicely Saunders and Elizabeth Kubler-Ross before him, he saw clearly our failures in caring for the dying; he imagined that the hospital was a place where we could apply the principles and practices of the modern hospice movement; and he envisioned a world in which whole person care was the norm.听
On the other hand, labeling someone a visionary separates them from the rest of us in ways that might diminish our own capacity to make change. At worst, it absolves us of the responsibility of seeing the world for what it is and doing our best to change it. In reflecting with Bal鈥檚 wife on how he survived 25 years beyond what was, for most, a terminal diagnosis, we agreed that it was in part through 鈥渟heer force of will.鈥� My own assessment of what gave him this will was some combination of factors that included cultural privilege, a strong moral compass informed by deep religious faith, a surgeon鈥檚 orientation (and clout) to fix something that is broken, and a love of humanity (and the humanities). This is a potent combination that can be hard to replicate. And yet, I think there are three important lessons that we might reflect on as we remember Bal in the days and weeks ahead.听
First, see clearly the problems that we face. While the last 50 years has seen much improvement in the care of people affected by serious illness, we have a long way to go. A system characterized by scarcity has led us towards care that feels increasingly transactional and less attuned than ever to care that attends to whole persons. The problem we face now is not a lack of evidence, but the challenge of ensuring that our colleagues and their patients see palliative care as part of the best treatment for advanced illness. That they do not has been attributed by some as a failure, at the societal level, to engage in a dialogue about death. That may hold some truth. But we are instinctually programmed to avoid death, so I wonder if a more fruitful approach is to beat louder the drum that people live better and longer with our care than without it.听
Second, imagine that you are part of the solution to addressing that problem. This asks something more of us than seeing patients. It asks more of us than expressions of frustration that people 鈥� our colleagues, their patients 鈥� 诲辞苍鈥檛 get it. It asks us to take the leap of faith that we, as individuals and as teams, can transform care for the better. Many solutions have been proposed to ensure meaningful access to the knowledge, attitudes, and skills that Balfour Mount played a significant role in articulating. Moving from imagining one鈥檚 role in solving a problem to actually solving that problems involves crossing a line so thin that 颈迟鈥檚 barely perceptible.听听
Third, envision a better world and share that vision widely. People mistakenly associate palliative care with the end of hope. Yet, we know that palliative care is ALL about hope. It is about hope for more time for what matters and more well-being whatever the outcome of disease-directed treatment. If we 诲辞苍鈥檛 share that vision we cannot expect people to see it also. Bal did so much work to help doctors and other clinicians see a world that could be different for people affected by cancer. In doing so, he changed medicine.听
I feel so inspired by all that Bal did to transform healthcare 鈥� and did in ways that heal most certainly never intended or imagined. He did so with kindness, compassion, and no small amount of force. I believe that the best way to honor the extraordinary life of a visionary like Dr. Mount is to find the visionary within us. In 50 years, I would like that Palliative Care at 涩里番 is known not known only for the contributions of its founder, but for our own contributions to this critical work.听听