Courtesy of Diane Meier

The turning point for Diane E. Meier, M.D., a geriatrician at Mount Sinai Medical Center in New York, came one day in 1993 when she glimpsed an older patient through the open door of his hospital room. What she saw was an almost medieval picture of suffering: The man was tied to a metal bed by his arms and feet, screaming, crying and yanking at the restraints. “You could hear the clanking of the bed, and you could hear the torment in his cries,” she recalls.

Upset, Meier sought out the man’s doctor, who told her the patient had terminal lung cancer and seizures. He couldn’t swallow properly so they had inserted a feeding tube down his nose into his stomach. It was so uncomfortable he kept pulling it out with his hands, so they tied them. Then he pulled the tube out with his knees so they tied his feet. “The doctor, who was very distressed himself, told me that if they didn’t keep the tube in and the restraints on, the man would die,” Meier recalls. “It was a genuine light bulb moment. I realized that it wasn’t that the doctor or the hospital didn’t care about the patient, because they did. But they didn’t know what else they could do.”

Explaining what else could be done—relieving the pain, offering comfort and treating the patient with dignity—became Meier’s life work. And today the 56-year-old doctor, who is helping shape the relatively new field of palliative care for the seriously ill, is one of 25 men and women across the country awarded a MacArthur “genius” grant, each for $500,000. The winners for 2008—artists, writers, doctors, musicians—range in age from 30 to 76.

The annual awards from the Chicago-based John D. and Catherine T. MacArthur Foundation give recipients no-strings-attached support for five years ($100,000 per year) to pursue their interests in whatever way they choose.

The foundation cited Meier for “recognizing that modern medicine’s focus on curing disease and prolonging life failed to treat the physical and psychological distress of patients.”

Meier says that too many doctors focus on a cure and if they can’t cure a patient, they don’t know what else they can offer. But treating symptoms, and helping patients make choices about how best to cope with pain and what to do with the time they have is an important part of care, she says.

“I have always been a ‘lumper,’ ” she laughs, “someone who likes to lump everything together and see the whole picture, the entire view. That’s why I chose gerontology when the others in my medical class were choosing cardiology or endocrinology. I needed to look at a patient as a person and see him in the context of his family and his community.”

Palliative care focuses on relief from suffering and the patient’s quality of life by addressing all the problems—from pain to anxiety and depression—that can come with chronic diseases such as cancer, frailty, congestive heart failure, dementia, emphysema, and kidney and liver failure. Palliative care has long been an underpinning of hospice care, but it also addresses the problems of those who are seriously ill though not necessarily dying. Meier’s work to establish these care programs in hospitals across the country has brought relief and comfort to “millions of Americans,” the MacArthur Foundation said.

A graduate of Oberlin College and Northwestern University, Meier says that growing up, she was very close to her grandfather. “He died just as I had to choose a specialty and I think that had a great influence on me,” she says. “During my training, no matter how late it was or how tired I was, I would always try to look at the patient and ask, ‘If this were my grandfather, how would I want him treated?’ He has helped me remember that every patient is a human being.”

Working under Robert Butler, M.D., another ground-breaking gerontologist, Meier helped set up the first freestanding department of gerontology at Mount Sinai. Later, she established the Hertzberg Palliative Care Institute at Mount Sinai, a model program that helps patients and their families deal with all the complexities of illness.

The phone call from the foundation notifying Meier that she was a grant winner came when she was on a plane, about to take off. People never know they have been nominated for a MacArthur, so “the phone call came from out of the blue,” Meier says.

“I asked them to repeat themselves,” she says. “I couldn’t believe what I was hearing. I’m overwhelmed, grateful, excited.”

Meier says she is “ still trying to process this incredible honor,” and has not decided yet what to do with the money. “But I do hope this award will raise awareness about the importance of palliative care, and help make it a part of the U.S. health care system.”

The field was almost nonexistent when Meier made palliative care her mission in 1995. She has published studies on the subject and developed guidelines and national standards for this care. Meier is director of the Center to Advance Palliative Care, a national organization that offers technical assistance to hospitals that want to set up palliative care programs.

Today, 53 percent of all hospitals with more than 50 beds have palliative care teams, while 70 percent of hospitals with at least 200 beds have them. In the last six years alone, these programs have doubled in number. But Meier says more of them are needed in the hundreds of small community hospitals where so many people are treated. With more people living longer and enduring more chronic diseases, this sea change in care comes at a critical moment in health care history.

Meier and her husband, Warren Sherman, a cardiologist, have two college-age children. The family lives close to both of Meier’s parents, on the Upper West Side of New York.

As for the patient whose suffering triggered her palliative care work, Meier says, “They had to replace his feeding tube 30 times in 37 days and then he died, restrained and with that tube in his stomach. I think of my work as trying to redress some of the suffering and pain he went through.”

Three years after his death, Meier wrote about that patient’s care for the New England Journal of Medicine. The title of the piece was “When Too Much Is Too Little.”