My patient, “P”, was an elderly woman with highly advanced dementia, a high level of hearing loss and limited mobility. She was well loved by her children, grandchildren and even great grandchildren, most of whom lived nearby and were able to visit on a regular basis. When I first met her, her daughter in law was there as well which was very helpful in terms of helping to facilitate communication between us. That visit was the most active “P” was the entire time I saw her. With her daughter in law present she was asking questions and even trying to respond when a question was directed at her. She talked about how she used to love going out dancing with her friends when she was young. After the initial visits, most of the other visits consisted of her drifting in and out of sleep, and sometimes we exchanged small snippets of conversations. Most of the time she would wake up when I came in, I would ask her how she was and check in on her pain level. Then she would nod off again. I always made sure to move my chair and sit near her to just keep her company during my visits. I was really thankful that the hospice training made a point to emphasize that silence was okay. If I had not learned that I would have been super anxious about what to do when keeping her company was the best thing I could have done.
After this experience I feel more prepared to go to medical school, but I also have clarity that geriatrics is probably not the field I want to go into. I feel that I have come away with a much deeper understanding of just how much work dying is. Even though my patient was sleeping most of the time, she just seemed exhausted every time I talked to her. Her body was so tired that she was barely able to stay awake for long periods anymore. From our training and personal family experience, I know that the path up to that point is so tiring as well. There are so many decisions you have to make or make for someone all while dealing with your own emotions and the feelings of those around you. I think the most important thing I learned in this experience was the importance of giving your patient a chance to make choices, even when the choices are limited. In reality, there is often only one or two possible paths but even though you know that, as part of the healthcare team, it is important to give your patients the space to come to the conclusions on their own. The best you can do is provide them all the information and let them decide.