I began looking into volunteering for hospice back at the end of my freshman year of college (almost two years ago which is crazy to think about). I decided I would wait to apply after doing some research on the emotional and mental maturity required to adequately care for those who would be ill and dying. I think looking back on this decision it was the right one to make for two reasons, firstly I have grown a lot since I first looked into it, and second, I have seen a lot of change occur in the world especially with COVID-19 which has made my understanding of the presence of death more relevant. Having gone through almost 10 months of training and reflections, discussing and diving into death and dying as a subject, I realize that for all of the difficulty that comes with this type of work, it as a learning experience and as a whole, is one of the most important journeys that I will ever embark on.
When I first began looking at the resources to write this reflection essay, I referenced the document in which I wrote all of my “prompt” entries to see what had stayed constant in my view throughout my time learning about the hospice process and what had been changed. I think one of the most consistent things that I found which spanned across my entries was that compassion and understanding are qualities of the utmost importance when giving help to those who are at the end of their life. This is a universal stage of life, aging and dying are as we know the two great unfixables. When people come to this stage, I think they are, more than any other point in their life, face to face with the fact that dying is real and that they have aged into the last stage of life. I obviously don’t know this to be 100% true but having read and listened to some very knowledgeable people speak about this stage of life I feel that it is warranted to say that almost everyone who comes to this point will be on unfamiliar ground. So, compassion and understanding can help to make this time less frightening and even one that they can perhaps feel comfortable with when the end does come.
Something that has absolutely changed since the beginning of this program is my view of death. I very much ignored death in the time before hospice. So when I began training and looking into it further, as I was of the notion that it was a far away and obscure concept, I looked at death as something I would almost never have to deal with. However, having lost people and having seen death up close, this view was most likely a coping mechanism of some form. It also could be attributed to the fact that when we are young, we feel invincible. Whatever the case, my view of death then was leaps and bounds different than what my view is today. At this point I recognize death as a fundamental part of life and one which deserves attention and planning before we arrive at it. The notion that I previously held about death was an incomplete one and it took a variety of sources to make me realize that there was so much more to the process of dying than I had ever imagined.
The next big change that has occurred in me is the idea of what it really takes to be a physician and deal with death like they do. It wouldn’t be right to say that I now know exactly what a physician’s job is now, but I think in terms of end-of-life care and the goal of preserving life I have a much greater idea of what a physician’s role is and even where medicine can lead us astray. Looking at death in a medical setting and seeing it up close is by all accounts draining. That is a fact echoed by multiple sources and many physicians. The fact that physicians are able to continue to work and have hope against the odds is a testament to how they as people are strong and resistant to the perils of pessimism. It is also a downfall in that they think that to push forward with treatments and therapies right until the end will be the best course at times. After having read “Being Mortal” by Dr. Atul Gawande my worldview was shifted and my notions of the almost omnipotence of medicine and the knowledge of physicians about all the best courses of action at the end of life was challenged. It took Dr. Gawande’s own experience with his fathers’ death to put into the correct light for me just how much medicine can actually be binding to the right course of action when death is a possibility. Medicine is in a sense built to combat death, so It makes sense that doctors often think letting nature take its course is almost akin to failing. However, it can be seen that sometimes the 50 rounds of chemo and 5 surgeries only serves to extend life by a fraction and in reality, that fraction is all the worse because of the quality of life sacrificed to get it. It is also important however that as a physician you take time to care for yourself so that you don’t suffer due to the high amount of death and illness you see. I recognize this job now as one that is not for the faint of heart and one in which I must continue onto.
Although I haven’t yet gotten to see a patient in my time at hospice I realize now that I am more invigorated than I have ever been before to become a physician. My interest in geriatric care has grown immensely and the fact that this field is one of such importance but ultimately is underrepresented has given me hope that with programs like this one, we may be able to create a future for elderly and end of life care that takes a more holistic and less medical approach when warranted. I am immensely grateful to be allowed to have had this journey and to move forward with hospice in the future to help in any way I can.