Dear Colleagues,
Happy New Year!
For many years, I’ve felt and shared with those who will listen that working in a restaurant as a waiter was some of the best possible training for work as a physician. Something about working on your feet, keeping multiple balls (or plates, rather) in the air while working with multiple tables with different and differently timed needs and food, and all the while trying to ensure that everyone has a positive (and even memorable) experience. As I loved the pace and liveliness of a restaurant, I also love it in a hospital. While there are some out there who would disagree, I maintain that healthcare is ultimately a service industry.
If we’ve seen each other since the new year there is a good chance you’ve heard me speak excitedly about an inspiring book I read over the holiday. Unreasonable Hospitality, by Will Guidara, is in part a book about how one restaurant, Eleven Madison Park, became the #1 restaurant in the world. It is also an extraordinary book about leadership. The thread that links these is the concept articulated by Mr. Guidara relates to the concept of unreasonable hospitality, the idea that one might go beyond expectations to create an extraordinary experience and a relationship with the people you serve (and work with).
For me, this aligns deeply with our work in palliative care. In addition to the work we do to address the multiple dimensions of suffering that arise in the setting of serious illness, Bal and colleagues taught us that we have the potential to promote healing – a sense of integrity or wholeness – through the relationships we form with patients. The experience of serious illness can be profoundly isolating and can raise existential/spiritual questions about life’s meaning and purpose. The relationships that we build with patients and their caregivers show them very concretely that, as Dame Cicely proposed, you matter and you matter to the end – and to add, because you matter to me.
The examples of unreasonable hospitality that Guidara describes are facilitated by the 4-star prices that people pay to eat at Eleven Madison Park. One of my favorites: a family talking excitedly about a rare heavy snow fall in New York is sent out by cab to Central Park with newly purchased plastic sleds and a bottle of champagne as a post-dinner treat. Another was more surprisingly mundane: a group of tourists talking about their favorite dinners among NYC’s best restaurants were overheard expressing their regret at not having had one of New York’s famous street-vendor hotdogs. The manager, Guidara himself, ran outside, bought such a hotdog and asked the chef to plate it for 4 with ketchup and mustard. You can imagine the surprise when he introduce this “course” while apologizing for his eavesdropping. It is details that provide the foundation of a relationship – in this case, extraordinary and unforgettable memories – that long outlive the meal itself.
While the quality of these details may vary by budget, we have all the tools we need to provide our own unreasonable hospitality in our own centres. And I think we do so. This is part of the reason that people express to us so often that “this is most cared for I’ve felt since my diagnosis.” Whether it’s a trip to the hospital coffee shop to get a coffee-loving and caffeine-starved patient a decent cup, or the opportunity to bring a beloved pet to the bedside, we go out of our way to understand who it is we are caring for and what will make the experience of being with us as meaningful as possible. This is extraordinary work that we do and it builds important memories that will last forever.
A brief digression – dinner some years ago with my friend John Ellershaw from the University of Liverpool led to a discussion about palliative care and end-of-life care. I posited that our work was more about helping people live as fully as possible until they died – such that I found his intense clinician and research focus on the last hours and days of life somewhat less compelling in terms of where we place our focus as a field. He countered that the end of life is a time that family members never forget – it provides memories (good or bad) that people carry with them until their own deaths. I realized that this was not an either/or situation, but a both/and. We are the shepherds of these memories and all of us have a role in making them.
This connects to another important insight from this book. Guidara and the chef, Daniel Humm, realized that they were not going to be the best restaurant in the world without ensuring that every person on the team was bought in. To this end, they made sure that everyone on the team had a chance to share and contribute their inspirations and ideas. No idea was too big or too small – because sometimes small things have the biggest impact. One of the kitchen runners – an entry level position – was a connoisseur of beer and was asked to curate a beer program for the restaurant. Eventually, the restaurant hired a team of “dream makers” to turn snippets of ideas gathered by servers at their tables into memorable events to augment the dining experience or keepsakes for the diners to take home. This hinged on a collective culture of listening – to each other, to their guests – that is possible in every environment.
I’ve taken these ideas back to my own team at the MUHC. It is my conviction that the hospital (and university) from which palliative care emerged should be a global leader in palliative care. If we were a restaurant, I would want us to be number one in the world. In so many ways, this feels impossible (or at least very unlikely) in a province and a health system that systematically undervalues our work and fails to meet the needs of our patients. And yet, I think that if we collectively pursue our own “unreasonable” efforts, however small, we have the potential once again to be a place from which people learn to do the best palliative care. What ideas do you have about how to make this possible?
Perhaps we can carve out some time at this year’s retreat – we’re looking at Friday, June 5, 2026 - to share ideas about how we provide unreasonable hospitality to our patients – at the least, I’m sure we’d be inspired by the lengths that we go to show our patients and their loved ones that we care.
As a final note, we’ve officially entered the year of the 2026 McGill International Palliative Care Congress. This is the 50th year of the Congress, which Bal founded in 1976. If you have not already, mark your calendars for October 6-9 – there will also be a pre-conference day on October 5, with a version 2.0 of psychoeducation in palliative care and a museum education in medicine experience and facilitation course. I’m hoping it will be the biggest congress yet. Registration will open soon and be on the lookout for the heavily discounted McGill-associate early bird rate.