Nickolas Fouladpour’s mission to bring empathy into palliative care

Nickolas Fouladpour, MD, and fellow in the Division of Palliative Medicine at The Ohio State University College of Medicine, did more than manage patients on ventilators throughout the COVID-19 pandemic. He served as the last line of hope between families and their critically ill loved ones. His role as a pulmonary and critical care specialist incorporated empathy into every aspect of patient care, including communication between patients and their family members.  

As a first-generation college student and medical school graduate, Fouladpour’s life-long relationship with his grandfather taught him the core principles of his practice — determination, integrity and humility.  

Fouladpour recalls the precious time he spent with his grandfather.  

“We spent my childhood playing baseball, fishing in the local lakes, and taking walks along the river as the Cascade mountains framed the background,” Fouladpour says. “Those mountains were central to his lessons for determination, integrity, and humility. He challenged me to view their daunting presence not as a limitation, but as a transformative point of departure.” 

Fouladpour’s grandfather, Poppy, worked continuously in construction to support his grandson’s education. However, after years of work and a motor vehicle accident, Poppy’s degenerative arthritis eventually led to disability.  

From then on, Poppy constantly battled chronic pain, analgesia and dependency on opioid pain medications. Even then, Poppy received inadequate care, pleading with his grandson, “please do not let them hurt me anymore than they already have.” 

During Poppy’s final hours, Fouladpour realized that the hand of his grandfather, once large and powerful, was frail, the muscles hardly palpable.  

“I was struck by how many times I had watched patients die, but how little I knew about dying.”  

This experience pushed Fouladpour to change the trajectory of his medical career — he began a midcareer fellowship in hospice and palliative care.  

Both palliative and hospice care are critical for the aging, older adult. Palliative care supports the long-term health of a patient diagnosed with a serious illness. Hospice care is provided to critically ill patients with less than six months to live. Hospice care advocates for patient comfort and prepares families for end of life.  

When Fouladpour reflects on his grandfather’s deterioration, he reveals that his grandfather’s onset of symptoms was predictable but overlooked during the height of the pandemic.  

“Immersed in the throes of the winter COVID-19 surge, I missed it.”  

Fouladpour struggled to understand his grandfather’s experience of aging, disability and the dying process, thus prompting his mid-career change.   

Fouladpour acknowledges that his grandfather’s experience exposes the inability of our current medical system to compassionately care for critically ill patients.  

“The pandemic did not cause, just painfully exacerbated, this preexisting condition. These are the symptoms of a system pushing the limits of technological efficiency that has voraciously consumed its most valuable resource—the caring hand at the bedside.” 

Fouladpour was inspired by his grandfather’s life-long lessons, perseverance and patient experience to continue his medical career in hospice and palliative care. Fouladpour’s goal — transform the field of medicine to integrate empathy, resiliency and the language of hope into practice.  

Read Fouladpour’s full essay, Poppy’s Final Lesson (external link).