My most meaningful hospice patient relationship was with an elderly lady named “Joanne”. With COVID-19 restrictions in place, I never had the chance to meet her, but I wrote weekly letters to her from the beginning of October to the end of March. At first, I was skeptical about sending cards to Joanne. I realized that my conversation with her would largely be one way, and I didn’t know if she would find my daily college life very interesting, especially since I was staying at home more often. Either way, I slowly gained more confidence throughout my letters and wrote about topics from food to TV shows to holidays to extracurriculars. In February, I was happily surprised to receive a letter from Joanne’s daughter, “Clarissa”, thanking me for all the previous cards I had sent. I learned much more about Joanne, including that she was a surgeon’s wife, raised four children, and wrote letters to her daughter for over 30 years! With the letter, Clarissa even sent me a picture of all my past cards, which were displayed on her mother’s windowsill. I was deeply touched and glad to know that my letters were making a difference in a patient’s life. Once again, Joanne surprised me about two weeks ago when I learned that she would be discharged from our hospice center because “her health was too strong to justify hospice care.” With her birthday also in a couple of days, I sent one final card, excited that Joanne made it longer than expected but still a little sad that I would no longer be able to write to her.
Even though my patient ended up beating the odds and living over six months, this program has consistently made me face and feel more comfortable with the inevitability of death. The reality is no one lives forever and attempting to outlast the finality of death goes against the natural laws of the universe, not medicine. Although doctors are trained to fight aging and death like enemies, the two processes are intricately intertwined with our humanity and cannot be reduced into mere physiological and/or pathological conditions. At the end of life, individuals’ priorities and needs change, and doctors are expected to listen to their patients and loved ones in order to create an effective treatment plan that reflects the wishes of the patient. Consequently, dying a “good death” is defined differently by each patient and will reflect a unique balance of factors affecting quality and quantity of life.
While I may not have volunteered with a hospice patient who ultimately passed away, I feel more prepared to work with terminally ill patients and have productive conversations around end-of-life treatment options. Doctors may not be miracle workers, but they can be active listeners who work on behalf of their patient’s best interests. As a future physician, I hope to show great compassion approaching the topics of dying and death with my patients but also advocate for care that will make their remaining time most fulfilling.