Mastering the art of end of life care


Dr. James Castillo says he is probably best known by his coworkers for always having a smile on his face. This may seem odd to those who find out he works for Odyssey Hospice Services of South Texas, a medical partner of Valley Baptist Health Systems.

“My smile is a sign of my positive attitude,” he explained. “I wear it because I like being part of a team finding solutions to make life better for our patients. I wear it because I know I am making a difference.”

However, he knows the first association many have for the word “hospice” is “death”, but he doesn’t believe it has to be that way.

“It’s a difficult perception to deal with because many times our patients reach us at a time when they truly only have a few days or even hours to live,” he said. “It’s unfortunate because it doesn’t have to be that way. We prefer for patients and their families to think of us as a part of their entire medical treatment. When an individual is diagnosed as having six months or less to live, that person automatically qualifies for hospice care. At that point, they can take advantage of our services which are really geared at improving quality of life and possibly extending life. There is always something positive that can be done in this line of work.”

And how does Castillo improve and extend life? He has several options, but they are all focused on establishing an open dialogue with his patients and understanding who they are.

“I have to talk with my patients and understand their needs and their hopes,” said Castillo. “I have to take time to think about what is going to be best for them to manage their symptoms and pain. It’s about getting them out of the hospital, back at home with their families and friends. They often have very advanced diseases and I have to look at their age and help them make the most of whatever time they have left. And I, nor any doctor, can absolutely tell a patient how much time they have or that they will never be cured. My job is to make them feel the best they can every day they are alive.”

“That means I am not going to be using the most invasive procedures or the newest, untested treatments,” he added. “I am going to look at the best evidence-based research and present informed opinions to my patients, but they make the decisions. And I work with a multi-disciplined team of medical professionals, spiritualists, counselors and family members to provide total care. It’s a true team approach that requires a positive outlook.”

So how does he deal with facing death every day of his working life?

“Honestly I really enjoy my work because I’m not chasing a cure or trying to conquer a disease,” he explained. “What I can offer are solutions to make life better for my patients. I am ensuring they their wants and their needs are met. When end of life care isn’t done well, and the focus remains simply on a cure, patients suffer greatly. We are all mortal and face death. The question is how do I, as a medical professional, make that experience as positive as possible for everyone involved. It’s truly an art.”

As a graduate of The University of Miami Medical School, Castillo had his pick of places to perform his residency, but chose the Valley because of youthful ties.

“My father had a government job and we moved to the Valley at one point,” he said. “I really liked the area so I returned to work at Valley Baptist Hospital to begin my career as an internist. I decided to become a hospitalist instead of pursuing private practice because I had more options for my schedule and my future. I found myself drawn to end of life care because there is such a need in the region.”

The husband and father of a three-month old daughter does keep a demanding schedule, but the nature of his hospice work provides him ample time to spend with his family.

“I get a fare amount of time to devote to my family, but really success at work and home is all about managing my time well,” Castillo said. “It’s the most important tool I have in my line of work. At home I relax and get the rest I need to maintain my positive outlook for my patients. If I get burned out, then my patients suffer. But when I’m at work, I try to maximize my time for talking with patients, walking them through their symptoms and the medical process. It’s all about that one-on-one communication.”

As a professional in the region since 2002, what Castillo forecast for the future of medical care in the Valley?

“What most people don’t realize is that one third of all medical spending in the U.S. goes towards end of life care,” he said. “It takes a lot of time to help people make the best decisions for them and guiding them personally through the process is crucial. This should be done by a doctor, not by an administrator or a government worker. We have to think and talk through treatment to achieve the best, high quality results.”

“I also know that we have a lot of wonderful resources in the Valley and our future is going to be about being responsible stewards of those resources,” he added. “Medical professionals need to work together to ensure we use our resources to their maximum potential so that everyone, regardless of whether or not they have the financial means, will have access to the best care possible. If we can be proactive and start working together, we can provide focused, guided care before it’s mandated.”

But Dr. Castillo has a final prescription for improving the futures of all Valleyites.

“People need to make up their advanced directives, telling their loves ones and medical professionals what their desires are for their end of life care,” he concluded. “If they do that, we can prevent things from happening that they never wanted and maintain their dignity and quality of life.”

For more information about Odyssey Hospice Services of South Texas call (888) 678-9743.