Nick Purol


Q&A with Nick Purol, MSW, LICSW

September 4th, 2020 

Nick Purol, MSW, LICSW is a Clinical Social Worker on the Pediatric Advanced Care Team at Boston Children's Hospital and Dana-Farber Cancer Institute. Nick is Director of the Pediatric Social Work Fellowship within the Harvard Interprofessional Palliative Care Fellowship and serves as Course Faculty for Palliative Care Education and Practice.

Tell us about your background.

I was born and raised in Louisville, Kentucky as part of a large extended family all living in that area. I spent a lot of time reading speculative fiction and National Geographic, volunteering, and trying to be the next great American author as a teenager. I eventually went to the University of Kentucky (which seemed quite far away at the time) for undergraduate dual degrees in cultural anthropology and social work, and after some soul-searching and teaching abroad in Malawi for a time, I came to Boston University to complete an MSW and an advanced standing practicum in hospice care. I ended up staying in the Northeast first to complete the PACT Social Work Fellowship, then because I was starting a relationship with a nerdy health policy research and economics student who would go on to become my partner. After spending a few years working in pediatric hospice and the MA Pediatric Palliative Care Network program in the community, I was lucky enough to return to Boston Children’s and Dana-Farber as a social worker on this team.

Why did you decide to work in palliative care?

I think, like many in this field, a winding convergence of paths led me to pediatric palliative care. I grew up very comfortable in medical systems as my brother struggled with serious illness when we were very young. This led to working as a camp counselor at various camps for children with chronic/complex illnesses then as a respite care provider for similar populations. I noticed very quickly that many of these families had to make profound and difficult decisions around care for their children and that, while many faced the consequences of these decisions with such resiliency and grace, they also faced them in seeming isolation. This interest in navigating complex illness and decision-making further developed as I pursued a social work degree in parallel with work at a local HIV/AIDS education and health organization that happened to have an affiliated hospice arm. While later completing an internship as a graduate level social worker at hospice, I was never sure how I would begin to pull all my interests of family support, pediatrics, anticipatory grief, decision-making, healthcare navigation and advocacy together until I ran across a Pediatric Palliative Care Social Work Fellowship at Boston Children’s Hospital. While, if I am being honest, I don’t think I actually knew what palliative care truly was at the time, I quickly fell in love with this field and never looked back.

When thinking about the future of palliative care, what excites you the most? What do see as the biggest challenges?

I am always excited for the increasing role of social workers and other psychosocial clinicians in providing education both to primary and palliative care learners and teams with the increased recognition of the interdisciplinary nature of all our work. I think we all learn so much from each other, and it has been really rewarding watching more and more palliative care training programs incorporate diverse fields and educational backgrounds in their learning model.

Given the difficulty in prognostication and rapidly developing technology in pediatrics, I am also excited to see the development of increased subspecialty interest in fields like cardiac intensive care, solid organ transplant, hematopoietic stem cell transplant, etc as they relate to pediatric palliative care. I think some of the challenges we will all have to contend with are changing and more nuanced understandings of what quality of life means in pediatrics, and how to help our hospital, home-based, and hospice programs adapt to children living longer and with more complex conditions. There is so much more to be done in terms of advocacy and education, and I am looking forward to where this field continues to grow in that regard.

What’s your favorite part of your job?

People sometimes underestimate the joy to be found in working with children and their families. No matter what they are going through, children are kids first and it is such a privilege to help highlight and support both patient and family goals outside of medicine, better understand family stories and narratives, advocate for those goals and narratives in the real world, and see them come to fruition in meaningful ways. In this way, there is nothing quite like working with an entire medical system to get a child out of the hospital for a few hours to see a musical, or help a young adult create and get a tattoo, or support a parent in engaging with their child, who may not otherwise be able to verbally communicate, through music and art. It is humbling and edifying to see the creativity and wisdom found with children and families and to be a part in supporting these efforts through everything from goals of care and prognostic counseling to the legwork of getting them done.

What is the most helpful advice that you have received?

One of the earliest and most lasting pieces of advice I have ever received is “always be the calmest person in the room”.  I think this advice, given by a close mentor, has helped in both my personal and professional life. It has reminded me to slow down, take my time, talk only when it is helpful to do so, and to try to anticipate rather than react. It has allowed me to navigate any number of complex and potentially charged scenarios, and has reminded me that often a calm presence goes a long way—particularly when there are no easy answers. While this has and will continue to be a work in progress for me, I know that such a practice remains key to developing resiliency, professional empathy, and a groundedness for myself and hopefully for those around me.