life, death: doctor amy case

“‘Tell us please,what treatment in an emergency is administered by ear?’... I met his gaze and I did not blink.‘Words of comfort,’ I said...” 

–Abraham Verghese, Cutting for Stone 

Dr. Amy Case loves people. She always has. 

As a child and teenager growing up in Buffalo, New York, she was a part of every social group. She brought her creativity and her inquisitive spirit to every relationship. Her interests were broad and it showed in her high school class work and what she did with her time outside of school. 

“When I started taking science classes, I really liked biology and it was just a good fit,” she tells me. “But I was always really interested in music, and English, and the arts. Compared with my peers in science, I was always more kind of interested in the art of [science], but then with my artsy friends I was always asking more questions, was too analytical ... I didn’t really fit in any group.” 

I know going into my conversation with Dr . Case that she’ s a highly accomplished physician and a recognized expert in her field. I know that five years ago she was recruited by Roswell Park to build, essentially from scratch, the now fully-staffed Supportive and Palliative Care Program she chairs. She’s impressive. 

But as we chat about the teenager she once was–who dyed her hair in unexpected colors, decorated her tights with googly eyes, and played in punk-rock bands with her friends–I feel like I’m talking to a friend. 

That’s the way Amy Case talks to people–like she already knows them, and they her. She connects. Her naked honesty pulls you in so you can’t help but feel at ease in your back-and-forth with her. 

This is what makes her so perfect for her specialty, palliative medicine. 

Palliative care has its earliest roots in the 19th century when the development and availability of pain relieving medicines made it possible to provide physical comfort at the end of life. But palliative care in its current form is connected more directly to the hospice movement of the mid-20th century, which grew out of the realization that pain relief for the terminally ill must be much broader. The practice takes into consideration the different types of pain people experience–physical, mental, emotional, spiritual–when they know with certainty that they’re near death. 

“Palliative is even more upstream than hospice,” Dr. Case explains. “Hospice is the last six months of life where it’s really all hardcore death and dying–very, very sick people, usually in the home. But with palliative, you’re walking the journey with someone even earlier on, when they first get diagnosed or when they’re going through treatment and experiencing the utmost suffering. At the very end of life , there’s suffering, but there’s so much palliation to be done earlier on.” 

Dr. Case’s work is about improving a sick person’s quality of life when they’re faced with a long illness. It’s about relieving the body’s symptoms, but also those of the mind and soul. 

In oncology, palliative medicine has an especially significant impact. A cancer diagnosis often means a long road ahead. As a medical school graduate and young oncology resident, Case saw firsthand what it looked like: “People were dying, and they were dying really uncomfortable, terrible deaths.There was a lot of suffering that I was witnessing every day–in oncology particularly.” 

At that time, some 20 years ago, there wasn’t much of a conversation about palliative medicine, let alone many hospitals that offered it in an official capacity to their patients. The connections patients can form today with their palliative team of physicians, psychologists, faith leaders, and social workers would often be formed instead with whichever doctor, nurse, or resident could spare the time or energy to truly listen. 

That was a role Dr. Case found herself filling: “If somebody w as having a hard time coping, I’d get a call and I’d go to the bedside of someone I didn’t know, and I’d sit and talk with them. And it just kind of came naturally. I care about humans, about humanity, finding out what makes them tick, like you just did with me, we did with each other, getting to know each other as human beings.” 

She didn’t know much about palliative care as a field at the time, but looking back she knows she was essentially practicing it in those moments at a patient’s bedside, comforting them with conversation. 

When a mentor suggested she switch her focus from internal medicine and oncology to palliative care, she seized the opportunity. (“It was like I was made for that,” she says.) There wasn’t anything in the way of palliative training in Buffalo at the time, so she moved to New York City for a palliative fellowship at the Beth Israel Medical Center. 

After the fellowship, she returned home to Buffalo a freshly minted palliative physician. She began her career at Buffalo’s VA hospital, where as Director of Palliative Medicine she was not only a physician but also the architect of the organization’s entire palliative care program. 

But she was keenly aware that none of Buffalo’s universities were offering palliative training and she believed the city’s medical community was dismally short on palliative specialists because of this. 

“So I started a fellowship,” she says. One year after she’d finished her own fellowship, as she was building the VA’s program (not to mention starting a family), the University at Buffalo accepted its first Hospice and Palliative Medicine fellow. Eventually, the program grew from one fellow per year to four. “I ran it for 12 years, and we’ve now trained a lot of the palliative doctors who work all over the city. It’s probably one of the things I’m most proud of, my fellowship.” 

A decade into her career, Dr. Case’s experience in palliative medicine–her clinical work, her VA program, and her fellowship–wasn’t going unnoticed. In 2016, Roswell Park recruited her to do with them what she’d done with the VA–to build a palliative program from the ground up. 

In the five years since she joined Roswell’s staff, their Department of Palliative and Supportive Care has grown from one physician (Dr. Case herself) to a full-time staff of three physicians, two nurse practitioners, two nurses, a psychologist, a social worker, and a chaplain. Dr. Case is currently in the process of recruiting a psychiatrist. 

With Dr . Case and her diverse and passionate staff, Roswell is providing the full spectrum of what falls under palliative medicine within one central department. These are absolutely vital services for the Center’s patients, who are up against the devastating reality of cancer and all of the pain that comes with it. 

That pain is layered. It’s the side effects of chemo and radiation therapies. It’s the toll a person’s bodily suffering takes on their mental well-being. It’s the gut-wrenching conversations with friends and family. It’s the sudden uncertainty about a once strong faith. It’s the w ay a person’s plans are interrupted and their life changed so abruptly. 

All of this is what palliative medicine exists to address. At Roswell, palliative care looks like this: When a diagnosis leaves a patient with a hundred questions, a physician sits with them to offer answers. When it’s impossible to eat during chemo treatments, medical marijuana is available to trigger an appetite. When the whole family feels cancer’s effects, a social worker counsels them together. When a patient can’t go to temple or attend a mass, the chaplain is available to guide them. When a patient feels hopeless or lonely, Dr. Case and her team are there. 

A long conversation about death and dying challenges the mind, I’ve discovered over the course of my afternoon with Dr. Case. So I can’t imagine how she and her staff surround themselves with these dark realities all day and then wake up the next to do it again. It’s hard not to wonder how and why they keep going. 

Dr. Case’s simple explanation is, “I want to do this.” She wants to give Roswell P ark’s patients joy, stability, love, spiritual fulfillment, painlessness at a time when these things feel so distant. 

Abraham Verghese’s Cutting for Stone tells a story that is equal parts tragic and hopeful. It’s about an Ethiopian hospital and the surgeons, physicians, nurses, and patients who live, work, and visit it. Verghese, a physician as well as a novelist, sets vivid, bloody operating theater scenes against a backdrop of human experience, moments of love and loss and joy and suffering. The things that make us more than mere bodies. 

In the book, medicine is art–which is perhaps why it’s Amy Case’s favorite book. 

She practices medicine as an artist, connecting with her patients as whole human beings. She understands that their needs transcend what can be seen and touched. She and her palliative medicine team know their patients are fighting cancer with their bodies but also fighting a deeper kind of pain that physical intervention alone can’t soothe. 

That kind of pain is relieved, as told by Verghese and as practiced by Dr. Amy Case, only with words of comfort.