When Expertise Matters More Than Geography

Years ago, my father developed a melanoma behind his ear. He went to MD Anderson Cancer Center in Houston, where the cancer was surgically removed. Afterward, his physician told us that he believed he had removed most of it, but he wanted my father to return for a series of radiation treatments.

My father lived in League City, south of Houston, and anyone familiar with the area knows how exhausting the drive into the Texas Medical Center can be. Houston traffic is difficult under ordinary circumstances. For someone recovering from cancer surgery and facing repeated radiation treatments, the thought of making that trip week after week felt overwhelming.

So I asked the doctor what seemed like a perfectly reasonable question: Couldn’t my father receive the radiation treatments somewhere closer to home?

His answer stopped me.

He told me that my father had an extremely aggressive form of cancer. Of course my father could receive treatment wherever he chose, he said, but if it were him, he would want to be treated at one of the best cancer centers in the world.

I have never forgotten that conversation.

The doctor was not saying that local care was unimportant. He was saying that sometimes the nature of what we are facing should influence how far we are willing to look for expertise.

I think about that conversation often in my work with families considering Voluntarily Stopping Eating and Drinking, or VSED.

When people begin looking for an end-of-life doula, it is natural to start with geography: Who is nearby?

Proximity can matter. There are times when a family needs someone who can walk through the door, sit at the bedside, provide respite, or help with practical needs.

But VSED support often begins long before the first day without food or fluids.

Families may need help understanding what to expect, preparing caregivers, talking with physicians, choosing or coordinating with hospice, anticipating symptoms, navigating family disagreements, and creating a plan for what may unfold over many days.

Much of that work can happen virtually. An experienced VSED doula can help prepare and guide a family from a distance, collaborate with local hospice staff and other professionals, work alongside a local doula, and, in some situations, travel when in-person support is needed.

The question does not always have to be: Do we choose someone local or someone experienced?

Sometimes the better question is: What combination of support does this family need?

I have come to believe that families facing VSED deserve to understand more than where a professional lives. They should also be able to ask: How much direct VSED experience does this person have? Have they worked with physicians and hospice teams? Have they helped families through complicated situations? Can they provide virtual guidance? Will they collaborate with local support? Are they willing to travel if necessary?

These questions reveal something that a map pin cannot.

I still think about my father and that drive into Houston. At the time, I was focused on making life easier for him, and that came from love. I wanted to spare him the traffic, the exhaustion, and the inconvenience.

But his physician helped me understand something important: convenience and expertise are not always the same thing.

Sometimes local is exactly what we need.

And sometimes the situation is important enough that we should look beyond what is closest to find the experience that is right for us.