When I visited Mr. A for the first time, we found out that we were born on the same day. We both agreed that people who share a birthday should become best friends, and twenty minutes into the conversation, we did. I am awful at starting conversations but Mr. A always has something to say.
With his words, Mr. A took me on a journey vicariously, and I learned about his youth and his family. As someone who complains and moans after catching a common cold, I was struck by the amount of energy in Mr. A. However, Mr. A grimaced occasionally, and when I asked how he felt, he nonchalantly replied, “Yeah, I have this thing that the doctors can’t fix.” It reminded me of the line in Being Mortal, that “the two big unfixables are aging and dying.” I did not know how to respond; I read the patient’s profile, and saying “it will be ok” would have been so meaningless that it seemed insincere. Sensing my discomfort, Mr. A smiled kindly and continued on with stories of his military services and the things that he appreciated in life. He concluded, “I lived a good life so it is ok.” There was acceptance mixed with a hint of regret in his tone. I have never seen people during their last moments, and then for the first time, I began to doubt whether there had ever been someone who died with a serene smile. Mr. A came close to being at peace, and it undoubtedly took a lot of contemplation and courage to reach this state, but no one can be one-hundred percent prepared for something unknowable.
I realized that I was not prepared too. Trying hard in academics and caring about the patients did not help when I try to talk about sickness and death. If anything, the latter made it worse. However, intentionally avoiding the topic intensified the fear towards the subject. Before I began hospice, I always thought it would be intrusive to ask about someone’s health condition in great detail. After reading “We are bad at Death. Can we Talk?”, I learned that having these conversations can be as important as the treatments. Even though it can be uncomfortable in the beginning, it helps to alleviate some of patients’ fear and stress, as well as preparing the families.
Treating the illness of patients, needless to say, is the goal of any physician, but I learned that the approach can be much more holistic. When I began visiting Ms. Z, she seemed apprehensive and was not willing to talk. Due to her condition, she felt fatigue and was always in pain, so she asked me to leave during my first few visits. One day, when she said she wanted to take a nap, I asked if I could stay in the room. She reluctantly agreed. When she woke up, we naturally began to talk. By the end of the conversation, she seemed to be in a much better mood, and focused less on her pain.
I think the most important lesson for me during hospice was to understand the emotions of patients and see beyond their physical illness. Professionalism does not require one to be distant; the overall experience of a patient is dependent on the relationships built with caregivers.