A hospitalized man with aggressive cancer worked diligently to settle his affairs, then after he finished, paused for a few seconds and whispered in her ear, "Why am I still here?" Another daughter gently took her father's hand and said, "Dad, I'll be OK. It's OK for you to go now." The father obediently closed his eyes and passed away.

She once saw a father look into the eyes of his adult daughter and say, "I love you so much," then die seconds later. A hospitalized man with aggressive cancer worked diligently to settle his affairs, then after he finished, paused for a few seconds and whispered in her ear.

One morning Harman, petite with shoulder-length black hair and wearing a freshly pressed white coat, was called to the bedside of a 79-year-old man who had entered the hospital during the night with pneumonia. He had heart disease, diabetes, and emphysema. He was on oxygen and an IV drip.

End-Of-Life

With a compassionate smile, she asked if he was up for a conversation. She knew an end-of-life discussion needed to happen soon, but the family was too overwhelmed with emotions to broach the topic.

The patient's wife had recently had a stroke, and he didn't think she would be able to care for him at home. He wanted to be with her during his last days, not in the hospital, even if that meant he might not live as long. 

Learning Technique

Deep learning is a technique that allows a software algorithm to discover important factors from vast arrays of raw data automatically. When it's "supervised," the algorithm is allowed to analyze variables associated with known outcomes so that it can learn from the past and apply its findings to future situations in a repeatable way.

Value Of Palliative Care

As Shah waited for his deep-learning algorithm to hone its prediction skills, Harman continued to struggle with the day-to-day challenges of a palliative care physician. She became interested in the specialty during her first year of medical school when her father-in-law was diagnosed with stage-4 lung cancer.

Quality Of Life

Palliative care physicians can discuss death with kindness and clarity in a way that can make some doctors feel uneasy. Doctors are often fighting for a patient's life; a palliative care doctor is fighting for a patient's quality of life.

AI Algorithms

All of this factored into Harman's desire to work with Shah on an AI model that predicts the need for palliative care. The other risk with AI algorithms is that only clinicians with solid computer science know-how understand how they work, and this can lead to outcomes with unintentional biases or hidden agendas.

Humanity At The End-Of-Life

Harman now uses the second generation of Shah's palliative prediction tool. Each morning, it emails her a list of newly admitted hospital patients who have a 90% or higher probability of dying in three to 12 months. 

Palliative Care

The palliative care staff still acts on clinician referrals in their daily rounds, but this model provides Harman with longer-range projections on people who might have been overlooked.