I entered this hospice volunteer program with perhaps more exposure to medicine and serious illness than the average student. Over the past several years, I’ve done a lot of shadowing with a trauma and acute care surgery team. I’ve witnessed sickness and death. These experiences have been very informative and important to my growth as a future healthcare professional. However, the one experience I was previously lacking was developing patient relationships. The most I ever saw a patient before was a few times over several days, and since I was shadowing, I rarely spoke to them myself. Because I wanted to become more actively involved with patients, becoming a hospice volunteer was an important opportunity for me.
I worked with several patients throughout the year, but there was one in particular who impacted me the most. This patient (I’ll call her Ms. K) is a lovely woman in her late sixties. Vascular dementia has left her with some memory loss and very little speech, and she suffers from pseudobulbar affect, which primarily manifests as episodes of uncontrollable bawling, often without cause. The initial information given to me on Ms. K detailed the interests from her earlier life; she was a singer, loves music and operas, cooking, and her daughter. As I prepared myself for our first visit, I memorized these facts, hoping to use them to engage with her. However, it quickly became evident that this would not be an effective method of connecting. Ms. K can’t remember any of this about her past, including her daughter (unless she’s physically in the room, at which point Ms. K lights up with nearly tangible joy). Given her difficulty converting thoughts to words, conversation was halting and frequently one-sided, and Ms. K’s frustration with being unable to speak fluidly only exacerbates her unpredictable and volatile emotional responses.
These hurdles initially intimidated me. I had seen my mentor connect with patients seemingly without effort many times at the hospital, and yet I felt completely at a loss. The first few visits were difficult for me, I felt as if I were doing Ms. K a disservice with my ineptitude. Soon, thankfully, I had a breakthrough of sorts. I knew from her chart that Ms. K loved dogs, but given my lack of success in connecting over other interests, I hadn’t given it much thought. Then one day I pulled out a folder full of photos of dogs. She gasped at every photo with awe and adoration etched plainly across her face. I had finally found something to engage her with. From that day on, the visits changed a little bit. Of course, the old hurdles are still there: conversation is still difficult, I sometimes still feel at a loss for what to do, and Ms. K still occasionally breaks into tears and can’t be consoled. I’ve tried reading and singing to her, among other things, with varying levels of success. But now, during every visit, I pull out the dog photos, sometimes more than once. Her adoration for these puppies never fades.
Frontline documentary “Being Mortal” emphasizes the importance of finding out people’s priorities at the end of life. For many people, being comfortable, being at home surrounded by family, or other factors are more important than simply extending life as much as possible. This really resonated with me. When I met Ms. K, she was already on hospice care, so many of these decisions had already been made. But I did learn how important it is to keep listening to patients throughout this process. Just because her end-of-life care is already mapped out doesn’t mean that it isn’t important to keep engaging with her wishes in every way possible. This is one of the way, I think, in which volunteers can make such a difference. Once I realized Ms. K’s love for dogs, I began advocating for her to have pet therapy visits. It took a while, but finally I received an email confirming that the volunteer who would replace me when I leave for the summer would bring her dog in with her on visits. This was the first time that I ever felt like I tangibly contributed to helping a patient, and it’s almost an addictive feeling. Just that little moment, fairly insignificant in the grand scheme of things, reaffirmed my dedication to a career in medicine. My relationship with Ms. K turned out to be a very positive one. Though I’m unsure whether she really remembers exactly who I am, her face lights up every time I walk into the room, and she gives me a big hug. And now, I’ve made sure that when I leave, she’ll have something to make her days that much more pleasant.
My experience with Ms. K also reaffirmed a belief I’ve held strongly since I first was introduced to the medical world; I believe patient interaction to be one of the most central skills in medicine, regardless of specialty. Being able to connect with a patient and foster confidence can greatly impact the treatment or care process. Especially in hospice, during what is undoubtedly a very complicated and emotional time in someone’s life, companionship and amiability are imperative. As Dr. Dhruv Khullar points out in “We’re Bad at Death. Can We Talk?”, the conversation about end-of -life care is one that the majority of people, even seriously-ill ones, are poorly prepared to have (despite many people having opinions on what defines a “good” death). One of the most wonderful and important things that hospice has to offer is the potential to shift people’s relationship with dying by offering a good, peaceful death, rather than a horrible and traumatic one. None of this can be accomplished or addressed without seeing our patients as people, and establishing this connection, to the benefit of everyone involved. This is the lesson being a hospice volunteer has taught me, and for that I am unendingly thankful.