The patient I spent the most time with was one who has been bedbound for years following his stroke and consequent paralysis. Over the months I visited him, I’d like to think I became a valuable confidante. He would not only tell me stories of his rich and fruitful life before his stroke, but also his struggles and depression since the stroke. He seemed to be rather lonely, and understandably hesitant to befriend patients at the facility who were either going to die soon and/or had psychiatric complications. On some days, it seemed like the human connection to someone who was cognitively on par with him was powerful in alleviating his depression. On other days, I learned to handle a patient when they are at their worst, and to not take it personally when they are having a bad day. Despite occasional difficulties, I am grateful he trusted me enough to confide his feelings surrounding death and chronic illness, and this trust is something I hope to experience frequently as a physician – and hopefully I will be in a better place to navigate conversations surrounding these topics.
My perspective on death has certainly developed throughout my participation in this program, especially when another patient, Candice, passed away suddenly from esophageal cancer. I say “suddenly” because she did not seem to be dying by any means. I realized this was because the mainstream conception of a dying patient on their last days encompasses hospitalization and intensive care – numerous medical staff scurrying around frantically amidst a plethora of tubes and pouches and tanks in a sterile white room. I’ve reconceptualized what it means to be dying, which in turn has heightened my appreciation of palliative care. I now firmly believe that the decision to avoid this hospitalization and intensive care at the end of life should not be frowned upon. This patient spent her last days in a beautiful room, with her makeup and nails done and a smile on her face. She died with dignity.
Candice’s death affected me more than I expected, probably because I never got closure and I never got to say goodbye. Of course, the death of a patient is something doctors will witness, and rarely with the luxury of closure. Part of me wondered if this was the first of many deaths that I would experience on a path to desensitization, but I certainly hope not. I don’t think this program is supposed to help you cope with the death of a patient through emotional detachment. Rather, I think it is okay to feel sad when a patient passes away. Perhaps the way to go about it is to appreciate life rather than fear death, which is one of the greatest lessons this program has taught me. In fact, I find solace in the fact that Candice herself did not fear death, and a large part of that was due to her stay in hospice.
Patients deserve fair access to decent palliative care consultations, and as aspiring physicians we should realize that the measure of a good doctor should not be to prolong life, but to respect patient needs, whatever they may be. There is no need to fight death at all costs. In fact, understanding death as inevitable is what makes life precious. And in order to make the most of this precious window of time, it is okay to focus on quality rather than quantity of life.