When Dr. David Casarett (Chief of Palliative Care, Duke Health) describes medicine as "one of the last great renaissance fields," his eyes light up. It's not just poetic language. For him, healthcare truly is where sociology meets anatomy, where psychology intersects with innovation, where the art of helping people weaves through the science of healing.
"It's a chance to go in a lot of different directions," he explains. "You get to help people, do research, innovate, and make cool stuff. You get to do a little bit of a lot."
That breadth of possibility drew him into medicine, but it was a single patient encounter during his ethics fellowship at the University of Chicago that crystallized his life's work.
The Patient Who Changed Everything
The case seemed straightforward at first: a man wanting to leave the hospital against medical advice. But as Dr. Casarett dug deeper, the real story emerged. The patient had metastatic cancer and a broken hip. His pain was poorly managed. In desperation, he was planning to return to the streets to get the drugs he needed for relief.
"The medical system failed him," Dr. Casarett says, his voice quiet but firm. "We weren't giving him what he needed."
That moment became a turning point. "I realized a lot of the ethics consults I was doing were really the result of bad palliative care," he reflects. The problems weren't philosophical. They were practical. They were preventable.
Today, as Chief of Palliative Care for Duke Health and Director of the Duke Center for Palliative Care, Dr. Casarett has built his career around a simple but powerful idea: coming up with solutions before they're actually needed.
What Palliative Care Really Means
Ask Dr. Casarett to define palliative care, and he'll give you the clinical answer: "It's a specialty that focuses on improving quality of life through management of pain and symptoms and helping with difficult decision making."
But spend time with him, and you'll understand it's so much more than that.
"Sure palliative care can be sad," he admits. "But you know that you are helping people get the closure that they need."
And it's not just about dying patients. Some of Dr. Casarett's most rewarding moments come from the turnarounds: "We make recommendations, stop by to see patients on the our way out for the night, and you can just see that they are miserable. The next morning during rounds, they have a huge smile on their face and the relief can be felt throughout the room. Those are the great wins and the moments that stay with you."
Training the Thousands
Dr. Casarett's vision extends far beyond his own patient panel. As someone who has published over 100 articles in journals like JAMA and The New England Journal of Medicine, and who received the Presidential Early Career Award for Scientists and Engineers, he thinks in systems.
His current mission? "Convincing people going into surgery and other specialties to be more well-rounded and know about palliative care. Training thousands of providers to do it better."
It's ambitious. But for someone who views healthcare as a renaissance field, it makes perfect sense. Because palliative care isn't just one specialty. It's a way of seeing patients as whole people, with goals and values and families and fears.
For Future Healthcare Professionals
When asked what advice he'd give to students and early career professionals, Dr. Casarett returns to that formative moment in Chicago, to that patient whose pain we failed to see.
The lesson isn't complicated: Listen. Look deeper. Don't accept suffering as inevitable.
"A lot of medical problems," he says, "are really just the byproduct of poor palliative care."
It's a reminder that the most important innovations in healthcare aren't always technological. Sometimes they're simply about being present, asking the right questions, and ensuring that every patient gets the dignity of good pain management and thoughtful decision making.
For Dr. Casarett, that's the work of a lifetime. And in healthcare's great renaissance, it might be the most human work of all.
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