Whenever I walk into Mary’s room, a blue notebook sits behind the armchair on the wall heater by the window. At the end of each visit, I pick up that notebook and describe the moments that I had with Mary for the past hour. I describe how Mary was feeling that day, whether she was happy, irritated, or just calm. I write about the conversations we had about her family, especially her children. I narrate whether we did a puzzle together, or if I just sat with her while she had lunch. That notebook was added by her daughter as a way to engage with the people talking and interacting with her mother. On the inside cover, she gives suggestions for ways to improve our engagement with her mother like sitting up really close to her because she has a hard time hearing. This is the kind of intention and awareness that I’ve tried to have for all of my time with Mary.
While intention was emphasized by her daughter, the whole pre-med hospice experience has given me the tools (including intention and awareness) and knowledge to engage with Mary, end-of-life care, and death. While I absorbed many different perspectives on death and interacting with my patient, Dr. Puri describes one of the main ideas that stand out to me in the article, “The Lesson of Impermanence.” Dr. Puri expresses how “the notion that fighting death at all costs wasn’t the sole purpose of medicine.” I saw this sentiment, not just in the article, but also in the conversations that we had at the meetings. This idea that challenges the purpose of medicine further challenges us to change the questions that we ask our patients. As a volunteer, those questions that I asked my patient were ones that brought joy and a smile to her face. It was asking about her relationship with her sister. It was asking about what her favorite thing to do with her husband. And it was remembering that her daughter visited her every night and asking how those moments went. These questions didn’t reject or fight that she was coming closer to the end of her life, but gave space for her to reflect on the life she lived. In his book Being Mortal, Dr. Atul Gawande reflects in a similar way as Dr. Puri about the interactions that we need to have with our patients and the way that we talk about the end of their life. He says that physicians need to get out of the “fix it” mindset and instead focus on asking what priorities people have to have a better quality of life. This perspective and mindset shift is something I’ve been thinking about this past year (among many other things) causing me to alter the path I’ve had for myself from being a doctor to a public health lawyer.
The path I’ve shifted towards continues to encompass the intentionality of the pre-med hospice volunteer program, which is to have us connect with someone who has lived a long life and wants to connect to help improve their quality of life, and make us medical students and then healthcare workers that have a better understanding of what it takes to be a caretaker who listens to their patient. This past year, I’ve grown to ask more questions and listen more. This is something I tried to do with Mary in the times I was with her, and how I want to continue to grow. I think asking questions will improve communication and will help provide care that is more effective and personalized. This growth has shown me that I want to work in a space that helps people receive the kind of care they want by helping them navigate the systems in place. Right now, I don’t know what form that will take (as a public health lawyer), but I am excited to figure it out.