Through this volunteer experience, I had less experience with hospice patients and more with palliative care patients. As I began looking into this opportunity at the VA, there was no distinction between hospice and palliative care. I fell victim of the social stigma associated with these branches of medicine, seeing them as simply a place for death and dying with no hope of a future or survival. I didn’t know the difference between palliative and hospice care, but I learned that there are major distinctions. Palliative care may include treatment and may begin at the time of diagnosis, whereas hospice care occurs after treatment options have been exhausted and when the patient has a life expectancy of less than six months.
Additionally, I learned that palliative care provides many benefits for patients that have life-altering diseases or may be near death. The many positives are exemplified in The New York Times article “We’re Bad at Death. Can We Talk?”. This article raised the question of why palliative care is not increasing in use or increasing in funding. As described in the article, “Many of the palliative care programs that do exist are underfunded and understaffed. And the availability of services remains uneven across the United States.” From previous research indicating that hospice/palliative care have several benefits and may increase survival compared to more aggressive treatments, it is still being underused. I believe this may be due to the previous stigma that I had believed in before that palliative/hospice care is simply giving up and accepting death. I believe that increased education and promotion of the benefits not only to patients, but to medical professionals may increase referrals and usage of palliative care.
Additionally, my experience disproved the stigma of palliative and hospice care as strictly about death and dying. My perspective about it changed to acceptance and relief of suffering. Similar to “The Lesson of Impermanence,” my outlook about death was that it’s a failure of medicine, and that medicine lost the war against disease. But like Dr. Sunita Puri, this experience showed me that death is natural and unstoppable. A quote from the Vietnamese summarized this view: “Impermanence does not necessarily lead to suffering. What makes us suffer is wanting things to be permanent when they are not.” Palliative and hospice care shatter the normal view of medicine as defying nature, and instead aim to relieve the suffering that comes with it. This is seen again in Dr. Puri’s view: “I’d expected, partly as a result of my medical training, to change and control what wasn’t necessarily mine to change and control.”
Although I did not work with a hospice patient specifically, I still gained valuable experience from working with palliative care patients. When I began, making conversation with many of the patients seemed impossible. However, once I learned about the patients and their interests, it became second nature. When I had first met Frank, I worried that the racial and age differences between us would prevent a strong relationship. However, as I continued to visit and learn about Frank and his life, I came to view him as my own family. I had learned about his time in the military, and one story stuck with me to this day. He told me about a child he had looked after during his deployment in Vietnam. He would look out for this child like his own son, offering him his own food to make sure he had eaten that day. After telling me about this story, he explained that him leaving was like losing a son and became visibly upset. However, his sharing this experience with me spoke to the bond we had made, where he could confide in me this emotional moment in his life. This moment changed my view of how small of an act, such as simply talking to a patient, can lead to great bonds and relief for the patient.
Another meeting with a different patient had revealed a much different experience from the one with Frank. James, on the other hand, had been a flight surgeon in the air force and had taught me a lot about his past in medical school and his career in the air force and after. However, our bond was superficial, and I had not learned why he had been put in the hospital besides the fact that he had multiple organ failure. However, I later found out that his organ failure had been due to addiction after his career in the air force. This information completely changed my view towards my meeting with James and made me feel like I had failed to create a deep bond with him. Also, it made me understand how some patients may not want to share certain experiences with others, either due to the emotional impact it may have on the patient, or to avoid stigmatization created by their past. James was a proud, high-ranked official and specialized in surgery, but had fallen victim to addiction. I regret not being able to create a deeper bond with James, but he shared his contact information with me, and I hope to contact him in the future.
This program, in my opinion, is extremely valuable for a medical school application. Not only does volunteering and patient interaction look appealing to medical schools, but the experiences you gain from this program can be used in interviews to make yourself unique and prove your interest in medicine. Additionally, this program gives you personal experience with the acceptance of death and is helpful to develop any kind of health profession. Even those not interested in medicine may benefit from this experience, as the acceptance of death may lead to spiritual or personal growth. These experiences in hospice care have opened my eyes to the importance of this practice, as well as the importance of bond-making with patients. As far as my career in medicine, I hope to learn from these experiences and apply what I have learned to myself and my patients. For example, if I lose a patient that was suffering, I hope to find my “bag of sand” like Dr. Puri and accept that death is natural and unstoppable and medicine cannot prevent nature from taking its course.