Athena Institute believes that this grant and program will help inspire students to choose geriatric medicine as their field, a specialty that is presently underserved. Concluding each year, the program graduates are asked to submit their 'reflections' in essays… we hope you find reading their feedback as rewarding as their own experiences suggest they did. Please scroll down for each student's essay (last names omitted).<
Leigh H. (Princeton University)
The first time I visited the hospice facility, I was struck most not by the patients, but by their families. The patients themselves were strangers, and without the context of their families it would have been easy for them to remain as such. It would have been simple to believe that perhaps these people had always been in their current state. That in turn would have made it easy to separate them completely from my own sphere of loved ones-– these elderly women were nothing like my energetic grandmother, my father would never be like these men. The presence of the patients’ families struggling to remain brave and steadfast in the face of all of this brought home the reality that every person in the facility had once been someone’s parent, sister, brother, child. The families served as a reminder that each of the patients had lived a life and meant something to someone. They reminded me that the patients were more than patients; first and foremost they were human beings.
After this first eye-opening visit, I began to learn more about the people I was visiting. I came to appreciate the sweet older woman with the kind eyes who could remember very little, but was nonetheless perpetually cheerful and friendly. She had such innocence about her, and despite not remembering us always seemed so happy to see us. I’ll also never forget the woman who could not speak a word of English and the way her eyes lit up when she realized we could communicate with her in her native tongue. To me this symbolized the simple joy and relief that comes from being understood. Though for most of our patients the barrier to communication was not as obvious nor as easily fixed as the one mentioned above, it was something all of them faced on some level or another. Some of them could not communicate verbally, but even with those who could, it was often difficult for us to understand what they were truly trying to tell us. It could be frustrating on both ends, but while we could walk away from it at the end of the day, they could not. My experience volunteering with hospice has driven home to me the importance of communication and truly listening to patients. Even when it is not possible to actually understand what is being said, it makes all the difference in the world for a patient to at least know that they are being listened to. This is a lesson I will carry with me forever.
I think these realizations and the memories of my time volunteering will have a significant impact on my future as a doctor. In the medical profession, the way doctors interact with their patients is often considered secondary to the treatments they prescribe. Patients are frequently viewed as cases to be solved rather than people, and this is especially true of older patients. I believe that both the suffering and strength I have witnessed as a volunteer will inspire me to be a better doctor by reminding me to always provide not just treatment, but care.
Antoine A. (Swarthmore College)
My time in the hospice program was immediately after and during a time of significant change in the health of some of my closest relatives. This closely paralleled and defined my experience with the program. I was quite familiar with hospice since three of my grandparents went through it in their final months.Some of my most difficult memories of my senior year of high school are of visiting my grandmother and her son, my uncle, in hospice. Both declined almost simultaneously during a period of about three months. But my mother was the reason I wanted to volunteer in hospice; she had been diagnosed with breast cancer the previous summer, and for a few tense weeks, we thought she would have to spend her final hours in what I viewed as a sterile and impersonal setting which had characterized my relatives' experiences with hospice.
When I first met my hospice patient, I had just finished a particularly difficult week in my studies. I thought I knew what to expect, how to act, and how to provide her with comfort and peace. The first week was the hardest for me because I had no sense of my role. My patient was dealing with late stage dementia and communication was almost nonexistent until I realized how to connect with her. The nursing staff were swamped with more patients than they could handle and I was struck by how lonely someone in that position could become.
At first I was concerned with whether I was doing enough. But eventually I came to recognize the comfort I provided just being present and the care provided through the power of human touch and a soothing voice. On my second visit, I was told my patient was a former opera singer. Gradually, her vocalizations sounded more and more like song, which had defined her life and now visibly brought her indescribable joy. With time I recognized her favorites and came to see this woman who couldn't speak produce music so powerfully it could move anyone. Her brain was degenerating, but she was clearly using music to get to something close to her heart. I recognized some of her songs as hymns and began to read Psalms to her. I doubt she could understand much of it, but it seemed to bring her some comfort.
Halfway through the program, my mother finished chemotherapy and tests over the past few months have shown complete recovery. I'm certainly incredibly thankful and in admiration of the physicians who saved my mother's life, but my hospice patient could never be that lucky. We have a tendency to avoid death as a taboo subject, which contributes to unnecessary stress and misery when it finally catches up to us. Many people have suggested to me that hospice is for the dregs or those the medical establishment can offer nothing. I've come to appreciate palliative care as the ultimate expression of love that medical caregivers can provide. By providing support to a dying patient, I could be on the same level as the best physician and have the same effect on the life of a fellow human being. In a very short period of time, I have developed a bedside manner and a sense of the emotional care physicians must provide every day. I hope that as a physician I can bring much more to improving a patient's life. The story has really come full circle: last week my mother began working as a hospice volunteer. My dream is that as a physician I will be able to be as good a caregiver.
Selena D. (Haverford College)
Prior to participating in the hospice volunteer program I was scared of death. I have never had anyone close to me die. However, when my friends’ relatives died, I often had a strong reaction even when I did not know them well. Taking part in this program has taught me a lot about death and grief and has definitely changed my attitude towards the end of life. I feel that in our culture, death is often viewed as failure. I have realized how harmful this viewpoint is and learned that death is not failure, but instead, is a natural process.
Additionally, I feel that our culture’s attitude toward grief is also unhealthy. We are told to “get over it” and “move on”. However, our training with Natalia Voz opened my eyes to the importance of the grieving process and how it is distinct for every individual. The lessons I have learned about grief will definitely impact my own life as well as my actions as a doctor.
Another lesson I have learned from this experience that will impact my interactions with patients in the future is the importance of building a relationship with your patients. This is often difficult since patients you see may be of a wide range of ages and backgrounds. In fact, prior to beginning my visits, I was unsure if I would be able to connect with Doris. She was significantly older than me and had a very different upbringing than I did. However, I easily connected with Doris and realized that although there are always differences between people, there are also some similarities. You just have to search a little harder to find them. This experience has made me more confident that I will be able to connect with patients in the future.
Despite being exciting about being able to connect with Doris, I think that forming relationships with patients can also be frightening. After spending so much time with her, I definitely grew emotionally attached to her. As she started to get sicker I felt emotionally affected by this. Nevertheless, I also knew she had led an amazing life and though she was sad to leave, she was accepting it. Knowing this was comforting. However, I am interested in pursuing pediatrics and I feel that accepting a child’s death can be much more difficult than the death of someone who is older.
My visits with Doris this past year have also shown me a version of the end of life that many would consider ideal. Although Doris suffered from an awful disease she was still able to communicate and still had a pretty good memory. Additionally, she had a large family that was incredibly supportive. She often had family members visiting her and would also often talk about her memories. She was a very outgoing, optimistic, cheerful women and I sometimes wonder what the situation would be like if she had lost her memory, if her family was not around, or she was depressed. Through this I realized how lucky Doris was, in some sense, and that not everyone at the end of their life has such “ideal” circumstances. I wonder how these patients can be supported.
Overall, participating in this program has taught me a great deal about interacting with patients, death, and grief. I truly enjoyed spending time with Doris and feel that I have gained a friend. I am grateful for the lessons I have learned that will undoubtedly influence the work I do a doctor in a positive, beneficial manner.
Frankie C. (Bryn Mawr College)
I was often told that one of the hardest challenges a medical practitioner will face is the death of their patients. A physician must accept that no matter how skilled they are or how hard they try, there will be a number of patients that they cannot save. This grim reality did not deter me from pursuing the medical career since I believed I was capable of dealing with deaths due to my experiences from growing up in an extended family.
Prior to joining the Pre-Med Hospice Volunteer Program I was very confident with my ability to interact with elderly patients and was very optimistic that I would handle any losses well. Through the many months of volunteering, I have gained invaluable experience and knowledge that have shifted my perspective and made me truly understand the strength of a medical practitioner.
Death is not easy and I only realized this the day my first patient, Mary Donkowitz, passed away. Mary was what we called a “pleasantly confused” patient; she was an 88 years old lady with dementia and no close relatives. My first visit with her consisted of me asking her five questions repeatedly, since those were the only ones she can remember the answers to, and her rejecting my hand massage. Still determined, I returned to her for a second visit, this time instead of bombarding her with questions, I asked her to pose and drew pictures of her. Mary loved it; she would smile and pose without complaining at all. While drawing her, I would ask her questions about her life; the drawing somehow stimulated her memory and she actually remembered stories from her youth. We built a bond quickly afterwards, with her sharing many of her stories. During my last visit with her before winter break, I promised that I would visit her right after I return from my trip to Thailand with photos and souvenirs. She passed away the morning of the day I planned to visit her after the break. I was shocked and grief stricken by her death, but I was even more confused by my reaction.
Mary was not my relative–I had no significant relationship towards her outside of the volunteer program, yet I was incredibly saddened and felt guilty that I was not there for her in her last moments. Even the hospice care training did not fully prepare me for the impact of her death. I wrongly presumed that a death of a patient, while tragic, would not be much different from a death of a stranger. Mary’s death allowed me to understand the difficulty of navigating through death of a patient, something all physicians must face, and highlighted the importance of training for correct grieving response. I still hold her dear to my heart but I know that I did everything I could to provide her with support, companionship and pleasant memories during this last stretch of her life; and I hope to continue doing just that with my other patients.
I am currently visiting my second patient, Thomas Denny, and I find that this experience is as fulfilling as my experience with Mary. Even though Thomas is in a much better condition than Mary was, given the subtleness of death, I need to make his end-of-life experience as meaningful as possible. As mentioned, death is not easy, but it should not prevent a physician from interacting with their patient and giving them the emotional support that the patient need.
Chloe C. (Swarthmore College)
I always knew that the patients in hospice would pass away. After all, that’s why they were admitted to the program. But it was still a shock to me when I heard that Mary died before I could visit her as I had planned to do the next day. I had realized from our last meeting that she was getting more and more sleepy, tired, and confused. I couldn’t wake her up, so I just sat there and held her hand, watching the shape of her sleeping. I thought that maybe, next time, I can bring her some textures so that she can at least feel if she can’t hear.I had put my teddy bear and a soft blanket on my bed to bring it to her, but that afternoon, I received the email from Marina telling her she had passed. The rain was drizzling around me, and I stood outside the van to my class at Bryn Mawr, wondering if I, who had only visited her three times really did give her something meaningful in the last moments of her life. Our encounter was such a small speck in the entirety of her time on earth. Was I able to help make her life worthwhile?
The first time I met Mary, she held my hands and said, “Your hands are warm. They are made out of love.” I had thought about that many times after that. Even as she was falling asleep, I would still hold her hand, hoping that small warmth would convey the love within me. I think, however, in all realness, she was probably not conscious of my touch in her deep sleep. But what I knew was that I was aware of her warmth. I knew for sure the joy within me when she smiles, the pride when I discovered that she was Roman Catholic by observing her blessing herself, and the warmth of the companionship we shared. I hope I had given her bits of myself that I brought with me into this experience. But I don’t need to hope, but know, that our encounter influenced me. My experiences with her reaffirmed my desire to be “a really weird doctor”, one who would challenge the often impersonal set-up of the current medical system, challenge the idea that doctors have no time to genuine build relationships. During my time with her, I was amazed by how much love she had to give me even when she was physically weak. She told me, “It is important to always remember to bless yourself.” And I think that doctors should also remember to do that and take care of themselves, and to allow themselves the “luxury” of sitting in with a patient, get to know them as a person, and allow themselves to be changed and taught by those they take care of. Caretaking is something that is built on a relationship. By focusing on these relationships, physicians are better able to understand patients as holistic persons and give them the care they need.
That day, as I was walking in the gentle rain, I thought about how miraculous our encounter was. I got to know her only a little bit, like sticking a finger into the water—there was so much depth that I had yet to explore. But I’m glad that I was able to meet her for that short time, because life’s beauty is most apparent when we are able to share our warmth with others, as she did with me.
Yudita L. (Princeton University)
On my first visit to a nursing home as a hospice volunteer, I saw a small woman lying silently on a bed along a wall in the hallway. She was curled in a fetal position with her eyes closed and hands slightly shaking. When she realized that I was standing beside her bed, she reached for my hand and raised it to kiss it. At first, I was shocked and slightly uncomfortable with her behavior, but I slowly began to suspect that kissing and holding my hand was comforting to her. We remained that way for quite a while, the silence occasionally broken by my effort to engage her in a conversation. Despite my best efforts, she remained silent, periodically reaching for my hand and kissing it.
When it came time for me to leave, the patient spoke to me for the first time. As I was bidding her farewell, she said in a low voice, “You are beautiful and reminds me of my mother whom I will see soon. Always remember to keep smiling and be happy”. Hearing those words, it suddenly dawned on me that during the visit, while I thought she was seeking comfort, she was in fact offering comfort to and sharing her love with me. Here lay an elderly woman struggling with a terminal illness, who, rather than becoming bitter, was generous and compassionate. Instead of solely focusing on herself, she manages to touch others with her love.Her words and actions allowed me to experience the importance of reciprocity and led me to reconsider my viewpoint on interactions with patients and with my peers. Previously, I had assumed that when interacting with patients, the medical personnel, while striving to be congenial, held the authoritative position as the person with the answers and the facts. Now I understand that there is no dominant position in patient care. On the surface, patients are seeking solutions and relief, but they are also providing their own gift as well. Patients are both pupils and teachers – as are the medical staffs. As a result of this realization, after every patient interaction I have had as an EMT and hospice volunteer, I reflect not only on the quality of care I provided to the patient, but also on what I have learned from the encounter and how I could incorporate these lessons in the future. Doing so has made me a better provider who is more attuned to the patients.
My encounter with the hospice patient also improved my interaction with my peers as well. By understanding the importance of reciprocity in a relationship, my peers and I exchanged ideas more freely and helped us to become better students. We are now able to discern more clearly what our interests are, to explore new areas that we were not previously aware of, and to become better communicators.
Having received these valuable benefits from that fateful encounter in the nursing home, I should be the one offering my gratitude to the patient, for her simple gestures and words sparked a growth that I am forever deeply thankful for.
Kaitlin S. (Bryn Mawr College)
I entered into the hospice program unsure of what to expect and had no idea that it would end up having such a great impact on my life. During my time in the hospice program, I have met three patients. Although the experiences were all very different from one another, the goal of my time with each of them was the same. I wanted to provide comfort, company, distraction, and assistance in their time of need, and hopefully help to contribute in a positive way to their journey through hospice.
My experience with hospice has given me insight into what can be seen as a “good death”. With my first patient, I saw her immediately experience a steady decline in her health. She did not seem to have any close family near her, but on my last visit with her, she was surrounded with people from the hospice program, and seemed comfortable and accepting of death. Through my experience with this patient I was able to learn how to provide comfort to someone who was minimally or not at all responsive. I learned how the dying process could be a peaceful experience, which is not normally seen. My second patient had his wife in the same room as him in the extended care center. Although I wasn’t able to talk to the patient as much, I was able to see that the wife was prepared for what was to come. His wife had time to say goodbye and they were able to provide support for one another.
However, in my most meaningful relationship during my time with hospice, I have been able to see my patient over a longer period of time and have seen her interact with family, her roommates, and other people in the hospital. I have been able to gain an understanding of her outlook on life and have heard her reflect upon some of her experiences. Whenever I ask her how she is doing, she always says “Well, you know, I’m taking it one day at a time….that’s all you can do”. This statement has really stuck with me and has made me reflect upon some of my experiences. Although this attitude is seemingly obvious, hearing someone say it to me and maintain the same feeling, even when so close to death, has really made an impact on me. I think that sometimes people, including me, try to have complete control over their lives and only take time to appreciate the larger events in life. However, I think it is important to also reflect on the smaller things in life and take time to appreciate each day as it comes. My relationship with this patient has taught me to take life a little bit slower and to have a greater appreciation for all that I have on a day to day basis. Also, this patient was recently taken off of hospice, which was a great ending to the year.
I think that this experience has definitely influenced my future career as a doctor (hopefully). I think it has taught me what a “good death” can be and has also given me much more experience interacting with patients in a one-on-one setting. I think it is impossible to know all of the other ways that this experience has impacted my career at this point, but I’m sure I will see how it has impacted me in the future.
Ranjit B. (Swarthmore College)
I have come to appreciate death as a process that is inherently social, and one that is quite active. As a hospice volunteer, my presence is not constant, but regular. And in this time, I have come to appreciate my relationship with the hospice patient—no matter how strong—as one that places me in the process of both dying and living. I say a process because, like life, death is an act in motion. My relation to the patients with whom I visited changing each time I visit.
Meet someone once, and his death is merely an absence, a pinpoint in both my and his process. During my first introductory visit to the Wayne center, I met a gentleman with advanced ALS. Hardly able to speak, he struggled to chat about motorcycles until he asked for the nurse and we left. The following week, I received an email about his passing.
Meeting someone twice, and his death is the loss of another Green Bay fan and a husband. During the same visit, I met Larry—another, less advanced ALS patient—and his wife, Sarah. Sarah informed us that she visited six days a week for the past year. Larry nodded, then returned to watching football. The next visit, Larry was again watching football. I ask him who his favorite team is. “Green Bay,” he said never looking up from the screen. My next visit, the sign on Larry’s door is gone, and his bed is empty.
Meeting someone a few times, and you begin to appreciate the sociality that seems inherent in hospice care, and in dying. By my third visit with Linda, I was lucky enough to hear all about her baby doll and the Wayne Center cat, that she likes cooking and she hasn’t seen her sister in a while. And by the fourth, she had offered to adopt my fellow volunteer and I as her niece and nephew. While Linda was still alive and active—physically, that is—on my last visit, I could see how even the last few months have changed her. She is forgetting more, and the stories started to repeat themselves.
The hospice patient, while they may be physically lying in a bed, is going through the dying process as a person in motion. Throughout this endeavor, the patient’s relationship with those around them is constantly changing as their illness and health changes and they approach death. This movement is ingrained at a socio-cultural level by the many metaphors and euphemisms we use to explain death and dying: a passing, a moving on, going to a better place, stepping through a door. Yet, I have had a chance to see these metaphors in action through my time volunteering in hospice care. In living, as in dying, it is difficult to form memorable bonds with someone after one or two visits. Relationships require building and cultivating, developing overtime. While my relationships with the gentleman in Room 202, Larry, and Linda were all different, each has taught me a little bit about the process of dying, but more importantly, each has taught me about the process of relating.
Keith Z. (Princeton University)
She lay curled up on the bed, a tiny, frail woman of 100 years. She seemed to be resting. I called out her name quietly but distinctly to announce my presence. She moved slightly, but did not speak. I crouched down and gently held her hand. We stayed like that for several minutes—I, gently stroking her hand and hair, and her, resting. I stood up to leave after she seemed to have fallen asleep, but she pulled me back and asked, “You’re leaving already?” I responded no, and we continued. Although she only spoke once, I felt a deep connection between us, and realized that she greatly appreciated my presence.
I signed up to be a hospice volunteer on a whim. I did not know much about it, but it has turned out to be one of my most fulfilling experiences.
I have tried to find ways to help the sick, but as a college student with no medical training, volunteering at the hospital usually amounted to paperwork, answering patient calls, or checking up on patients and making sure they have everything they need. While these tasks are certainly important to the hospital’s functioning, it was hard for me to see the direct impact they had on patients’ lives. I brought them water or food if they needed it, and occasionally even had hour-long conversations with them, but the patients would always be discharged by the time I came back to the hospital a week later. I doubted that I had made a difference in their lives.
With hospice, however, I visited the same faces every week. Although I still carried out other tasks similar to the ones I was doing at the hospital, my relationship with the residents was much more intimate. I rapidly morphed from a volunteer to a friend. Some of the residents were very talkative, and I found myself discussing everything from the current political situation to the characters in George Eliot’s novels. All the residents I visited, however, gave me the sense that I was truly making a difference in their lives. I was not prescribing medicines or performing procedures, but what they seemed to need most was someone to talk to—the human connection.
Although I have been going to the nursing home for quite some time now, it is still hard to imagine how dull life for the residents can be. Unlike the patients in the hospital, who are constantly visited by family or attended to by an army of doctors, nurses, and volunteers, the residents in the nursing home often went for days without seeing their families. They could talk to the nurses, but they stopped in infrequently and only to make sure that the residents were physically comfortable. It was up to me to supply the emotional connection that lay neglected. I was nervous at first, but the role has given me an enormous sense of fulfillment and many new friends.
I considered becoming purely a researcher for a long time, being drawn to the complexities of human biology and hoping to discover that cure for a terrible disease. I am still deeply interested in the scientific aspect of medicine, but experiences like being a hospice volunteer have taught me that I really enjoy medicine for its personal component. When I become a physician, I will make sure to listen to my patients and give them the compassion that they need. They might need a procedure or pill, but my work with hospice has taught me that sometimes, a simple heart-to-heart is all that’s needed.
Savannah A. (Bryn Mawr College)
Before entering this program, I experienced the death of two grandparents within six months of each other. The deaths each had their own impacts on me but when I look back at them in comparison to each other, I saw how meaningful the final steps before passing are. Having the opportunity to be part of an end-of-life-care team has reinforced my love for medicine and the support that medical professionals provide beyond the diagnosis and medication. My experience as a pre-medical student at a liberal arts institution has taught me that there is far more to medicine than the nitty-gritty science and I believe that healthcare is finally moving more towards seeing the patient as a whole; like Holisticare does.
Our country needs more healthcare providers like Holisticare and more compassionate and warm-hearted people like Cyndi and Reverend Graham. I am so fortunate to have been able to learn from them and I hope to exemplify their values in my future occupation. As a volunteer with no formal medical training or privileges, we learned how to care for the individual, which is quite a change in mindset from focusing on fixing the body.
The first few visits with my patient were hard because I felt like I should be doing more for her than just sitting there and talking, but over time, I saw how important it was to simply be there. The patient that I saw the entire year had been mentally prepared to pass away for years, and frankly, she didn’t know why she was still here. Much of what Cyndi had taught us about helping patients cope with impending death was pointless for her and I found that she rather just needed company. She enjoyed talking about her life and her hometown, we looked at history books and she would tell me about the buildings and landmarks. She had far more life left in her than I initially realized and we spent our time together crafting, talking about religion, politics, clothes or fashion, and family.
I feel that I will take away just as many life lessons from her as I have from Cyndi and Graham. But at the same time, she was still my patient and I watched her struggle through a broken ankle and a nasty cold. There were times when I wished I could do more for her and times when she’s felt too despondent to talk with me when I visited. Our relationship has had its ups and downs but I still came back every week and I could see that she appreciated it in the way that she greeted me with a smile and bright eyes and asked me how I had been or about my family to show that she remembered things I’ve told her.
Besides my patient, my favorite part of the program was the reflection meetings throughout the year. It gave us a chance to learn from each other and share our experiences with people who can connect and empathize with them. Collaboration and discourse are essential in medicine, but above all, it was important for us to acknowledge and express what we were feeling during the experience. Being a doctor may require us to be restrained and solemn but that doesn’t mean we aren’t human and we won’t experience emotions in response to our work. Rev. Graham encouraged us to embrace the emotions and provided exercises and literature to help us work through, analyze, and digest our experiences. Because of my time as a hospice volunteer, I know I will be a more capable and understanding doctor someday.
Isadora B. (Haverford College)
The relationship that I developed with Mary through the Pre-med Hospice Program is one that I will never forget. For most of this school year, I looked forward to visiting Mary at Devon Manor. Every week, I would walk into her room and see her warm smile. She was so excited to have a visitor, especially a young visitor that could connect her to the world outside of Devon Manor. I would sit on the couch next to her and ask her how she was feeling, and every week she would respond saying she was feeling well.
Next, I would ask her about the books she had been reading throughout the week—she loved reading. She loved to tell me about her books and she surprisingly seemed to remember every detail. As I got to know her, I began to bring her new books to read every week and she was so thankful and excited. She spent so much time reading that she believed that she had read every book with extra large print text available at the Devon Manor library. Mary also loved to talk about her sons. It was heart-warming to listen to her talk about her sons, as she was clearly so proud of them. I felt like I knew so much about her and family just from having an hour-long conversation with her once a week. Mary often used her life stories as an opportunity to give me life advice. It was clear that both her and I valued our time together. One of the most touching moments I had with her was when she referred to me as her friend. I felt so lucky to have established such a strong connection wish Mary in such as short period of time.
My last visit with her was very disheartening. I was shocked by how quickly she had deteriorated from the last time I saw her. She could no longer speak in coherent sentences. She was so angry and kept on kicking and hitting her nurse. She was crying and whining saying she wanted to go home and die. She told me to leave and never come back, which was very difficult for me to hear given the many meaningful conversations we had in the previous months. I try to forget this visit and focus on all of the good times we spent together.
The most important thing that my hospice work has taught me is how much I value personal relationships. In whatever career I choose to pursue in the future, I know that I would enjoy the opportunity to build relationships with others—whether that means building relationships with clients, patients etc. Surprisingly, hospice work has steered me away from wanting to pursue a career in medicine. Originally, I thought I wanted to be a surgeon. But, after experiencing this program, as well as shadowing an orthopedic surgeon and realizing that he never really had the opportunity to build relationships with patients, I came to the realization that medicine may not be a career that I want to pursue. Another thing that deterred me from a career in medicine is how quickly I became attached to Mary. I think I would have trouble successfully achieving the balance between looking at my patients from an objective point of view and expressing emotion and sympathy for my patients. Mary’s passing affected me more than I ever thought it would—I am not sure how long it will take to recover from mourning, but the relationship I built with her is one that I will value and remember forever.
Joanna L. (Princeton University)
Don’t cry because it’s over, smile because it happened– Dr. Seuss
In my past year as a volunteer for Ascend Hospice, I’ve been thinking about dying and how it fits into the context of my own experiences and the experiences of the people I’ve interacted with.
It can be hard to describe all the things I’ve learned from these interactions, but I truly feel that I’ve changed and matured in the process, not only as a pre-med student and volunteer, but also fundamentally as a person. Most of all, I’ve gradually come to think of dying as a process instead of a state of being – something dynamic, intangible, and profoundly spiritual – even though it manifests physically in the people we love. At the same time death seems to represent the ultimate end of a long journey, the process of dying doesn’t have to mean suffering until the end – perhaps instead, we should follow the words of Dr. Seuss and appreciate the life that was lived, the love that was expressed, the blessings that were counted, the moments that were experienced.
In reflecting on hospice and hospice care, I think back to Beatrice, a sweet, elderly lady who was one of the people I interacted with in my time volunteering. I met Beatrice the first time we (the other volunteers and I) visited the care center. That afternoon, Beatrice was resting on a bed and seemed to have just woken up, and she seemed pleased to see us visiting her. Although she didn’t speak very much, she reached out for us and seemed content simply with holding our hands and she looked at each of us, smiling the entire time. Before the visit, I had been worried that I wouldn’t know how to interact with the patients in the best way, that I wouldn’t know the right things to say. But with Beatrice, just our physical presence and our physical touch seemed to be a source of comfort for her, and words didn’t seem necessary. I felt connected to Beatrice on a simple human level by just holding her hand and smiling with her, and I hope that she felt the connection too. Beatrice fell asleep soon after our meeting and I left the care center that day filled with wonder and appreciation.
In some ways, being a volunteer often means opening your heart to the people you’re trying to help to form a human-to-human connection, but in doing so, you can often make yourself vulnerable as well. At the same time, you don’t want to completely erase your emotions, for you can come off as indifferent, like a wall exists between you and the person you’re trying to help, and that can be the most hurtful thing of all. In my opinion, the key lies in being emotionally cognizant in your situation – being aware of every action you make, every thing you say, every thought you have – and acknowledging that you’re sharing a part of yourself in the process of connecting with and helping someone. I think there’s a valuable lesson to be learned here, where we are constantly thinking about our impact on other people in the process of forming connections. And the kind of doctor I want to be is just this kind of person: one who recognizes patients as resilient individuals in need of help and compassion, who interacts with patients with empathy and mindfulness, who finds ways to alleviate patients’ suffering, to ultimately ease their process of dying. Dying is human – it is a part of all our stories – but suffering does not have to be; and in the end, bringing comfort and security – whether it is physical or spiritual – is perhaps a doctor’s most important duty to his or her patient. This I learned through hospice, and this I will carry with me in my present and future aspirations. Thank you for giving me this opportunity to learn and grow.
Mark S.. (Swarthmore College)
I've wanted to practice medicine since I was a child. I've always had lots of respect for doctors and the work they do; devoting one's life to the service of others in this way is both an honor and a heavy responsibility. I want to help others through my work and this is the best way I know how. I was motivated to join the hospice volunteer program because I've been thinking about oncology as a potential field of medical practice. I was interested in palliative care and I wanted to see a different side of medicine; one in which treatment has failed and we need to reevaluate the way we define patient care. I hoped to gain some insight into what hospice care is like by seeing first-hand what the patients, their families, and their caretakers go through.
My experience has been mixed. Training for the program was sobering because we learned about the reality of hospice care and it really hit me for the first time that the people we were going to be interacting with are at the end of their lives. At the actual care facility I visited two hospice patients with dementia. The facility is called Harlee Manor and it is a geriatric care center that is structured more like a hospital than a care home. One of my patients does not speak and the other reaches out to people who are not in the room. I read books to both of them and tried to have conversations but they are mostly one-sided. I began bringing a ukulele and a guitar to sing and play songs for them, and Fred (another volunteer) started coming with me to sing and play as well. In the end, both patients were eventually taken off of hospice care, even though their status had not changed.
At one of the resource and reflection meetings, we were asked what we thought a ‘good death’ was. I talked about the romanticized American idea of growing old and peacefully dying in one’s sleep, perhaps surrounded by loved ones. I do not feel that these patients are having a good death and I find this profoundly disturbing. They are locked within the care unit by a coded door and many spend their days alone in their rooms, in silence. My patients used to get visitors, but the nurses tell me that they no longer do because it is too painful for their families to come and not be recognized. I feel that these patients are suffering deeply, and when I see them wasting away in these cold, dark rooms, week after week, I feel helpless and utterly disgusted with the healthcare system and my own lack of control over the situation. I feel that the process has been dragged out and that the quality of the patient’s lives are so diminished, that dare I say, they would be better off dead. It is one of the most agonizing things I have ever experienced and their suffering fills me with sadness.
The doctor plays an important role in continuing life, but now more than ever I feel that doctor plays an even more crucial role in helping patients to die. It is certainly a wake-up call. The weight of the situation is too much; it feels as though there is nothing I can do for the patients aside from offering a little verbal support and some company, and this is difficult to accept.
I’ve learned a lot about myself. This job is so incredibly important, but I do not know if it is for me. Lots of questions have been raised: questions of faith, of happiness, and of how we deal with death. Thanks to hospice, discussions about death are no longer stigmatized for me. I am working on trying to accept death and the dying process, but I am still afraid. Because of hospice, I've taken a step back to reassess what I value in my life and I feel that this opportunity for self-reflection is, in itself, much more than I could have expected to get out of the program. It's so easy to get caught up in our schoolwork and our day-to-day problems and forget how truly blessed we are to be alive and healthy. Thank you for this opportunity to participate in the program and write on this experience. I feel that every pre-med should be exposed to hospice care to really understand the weight of their role as a future caretaker.
Karen N. (Princeton University)
Working with Ascend this year provided an opportunity to step outside the bubble that is the college experience. It was a needed reminded that there are so many ways that people experience life and perhaps more than that, that there is an end to life. I found that every time I went to volunteer at Morris Hall it was a reality check that convicted me of the pettiness I so often fall into. For me I think the most striking part of working with those in the final stages of life is reflecting on who they were in the past.
In particular I remember talking to Mr. Stefan who had been a soldier in the US armed forces posted in Korea during the Korean War and then in Alaska for a number of years after that. On the wall was a beautiful painting he had done himself while posted in Korea. Sitting by his bed I wanted to honor him somehow and I was genuinely interested in hearing his stories form his time in the army, stories that he recounted with visible pride. Unfortunately speech was difficult for him and so it was hard to understand everything he said but it was clear that having someone interested in listening to him meant a lot.
Volunteering at a hospice is not always comfortable but it is worthwhile. It’s hard to know what to say and what to do but you go in with a desire to bless people and I believe it does. It can be sad seeing people who were once strong independent individuals limited by their physical and mental conditions. It is important though to move beyond pity and come, so much as is possible, to a point of interpersonal connection rooted in respect and care.
Let us walk a while together
Whilst for a time our paths align
Tell me stories from your journey
As I am setting off on mine
You’ve been so many places
You’ve seen so many sights
It’s been a great adventure
Of happy days and mighty fights
But now your body’s weary
From so long and hard a race
So the path is turning gently
Towards a final resting place
But for this moment,
Tell me stories from your journey
As I am setting off on mine
Let us walk a while together
While for a time our paths align
Shelley B. (Haverford College)
When asked to summarize my feelings towards my hospice experience in a poem or in a few sentences, this is what came to my mind:
While hospice, in the sense of time, is the precursor to death, hospice is a moment to celebrate life, a time to reflect, remember or forget, grieve, say goodbye. It is an often opportunity to regain a sense of self after lengthy, invasive, painful treatments that can cause one to lose oneself. Hospice patients wish to be treated as the living, not as the dying.
In this statement, I hoped to convey that my experience as a hospice volunteer has, largely, not been focused on the aspect of hospice that is dying. Rather, my visits with patients have been fairly lighthearted, overall, and have focused on pleasant memories and casual conversations. I think that, at its core, this is what hospice is truly about.
I have not had much previous experience interacting with elderly people or with hospice. My mother’s mother died of ovarian cancer at the age of 48, when my mom was about to enter college, and her father, a former World War II pilot, died a few years later while in a coma resulting from a plane crash. My father’s father was diagnosed with Alzheimer’s disease when I was young and passed away when I was 9, and my father’s mother died when I was 14 from a variety of causes. Neither of the grandparents who I had known in my life experienced hospice, and, as a result, my memories of their deaths felt very chaotic and rushed. I did not feel like I had time to say goodbye to them on their own terms.
In many ways, my interactions with my two hospice patients have felt like conversations that I might have shared with my own grandparents had they been alive today. When we talk, we joke and laugh, share stories and experiences. My first patient was very proud of his minor-league baseball career in the South Pacific when he was in the service. Every week, we would talk about how he loved to go swimming in the clear water that couldn’t be found in the US and how the people there were so welcoming to him. It was clearly a highlight of his life and I really enjoyed being able to listen to his memories of his time there. I would try to talk to him about some of his other favorite sports, including football and basketball, and he would laugh at my lack of knowledge in both fields.
While I have witnessed some setbacks in my patients’ conditions, I have been amazed by their continued positivity. Just this past week, I went to visit my current patient and was asked to come back another time, not because she didn’t want me there, but because she thought it would be more worthwhile for me to visit her when she was not as tired. Later this week, when I returned to visit again, she told me about her latest fall. She simply said that sometimes things like that happen but that God looks out for her. In January, my first patient contracted shingles, and rather than fixate on the discomfort he had been feeling from the rashes on his arms, he asked me about how my winter vacation had been and whether or not I had found a job for next year (which I had!).
At least with the two patients I have interacted with, I have found that they prefer to talk about their pasts, their families or even the people they eat lunch with in the dining room above complaining or fixating on death. They have been incredibly positive, and to me, that is a sign of a life well lived.
Julian S. (Princeton University)
My fellow Friday volunteers and I developed a good relationship with a hospice patient named Irene. She is a very kind and happy woman who always smiled when she saw us and during our conversations. We learned a lot about Irene and also told her about ourselves. She would ask about our “romantic lives” and compliment us. We would end up smiling the entire visit and feel happy afterwards as well.
Irene definitely cheered us up with her great personality. I hope that we similarly made Irene happy as well. I definitely see the importance of hospice volunteering now after developing a good relationship with Irene. It is beneficial for us volunteers to visit with patients in order to learn about care and develop our interpersonal skills. It is also great for patients to have hospice volunteers visit so that they can be provided with companionship and care.
Hospice has affected me positively. It helped me improve at talking to people. Conversation and interpersonal relations are important in any field but I appreciate the importance of good bedside manner in my future work in medicine. I am also happier after conversations with patients and also with knowing the fact that I am helping in the holistic care of patients.
I have a better understanding of the importance of hospice care now that I have participated in the process. Now that I have volunteered in a hospice program the significance of palliative care is more clear. I see how important teamwork is to hospice and the value that hospice provides in medicine and the community. I realized that good collaboration between people in a patient’s care-team and between hospice and community / family members can have a very positive impact on a patient. I can more clearly see that communication and bedside manner is important in medicine. The most importance should be placed on the patient and fulfillment of their needs should be the highest priority.
A lot of questions about the dying process have been answered by my participation in this program. I have learned a lot and developed myself as a hospice volunteer, a future doctor, and a person. I do know what the importance of hospice is now. Of course, I still have much to learn and these are my questions I guess. I need to learn how to treat hospice patients the right way based on their own personal needs which is definitely something that will come with time and experience but is a question I can ask experienced care providers who can give me some advice in this regard. I’m also curious as to what the different factors that can influence families, patients, doctors, and other healthcare providers to enroll patients in hospice programs.
As stated above, volunteering in hospice has definitely influenced by future career as a doctor. I now appreciate even more the importance of good interpersonal skills and the power of companionship and developing good relationships with patients. Additionally, I realize now that all healthcare does not need to be 100% cure-focused. It should be focused on the patient and his/her needs. Sometimes palliative care is the proper choice. Even if I do not enter the specific field for hospice and palliative care, the lessons I learn here will be important for my career wherever I choose to go.
I have found volunteering to be very fulfilling and recognize that it has given me as much or more than I have given the patients, and I would like to continue doing so. As such, I have applied to AmeriCorps’ Health Corps program, and (if accepted) will be beginning my year of service in September. I would be working to expand access to high quality health care to underserved populations in the city in which I grew up. I could not imagine a better program for my gap year, and I have the hospice volunteer program to thank for inspiring me to seek it out. Additionally, in my future career as a physician’s assistant I will approach death with compassion and understanding, not fear and avoidance, and I will aim to make my patients’ end of life comfortable whenever possible.
Susan D. (Swarthmore College)
At the beginning of this program, I was unsure of exactly what to expect. I was passionate about gaining experience with a different aspect of medicine. Death is not commonly discussed, especially at the undergraduate level, but is an inherent part of life, and of life saving.
During the training and orientation prior to the volunteering, we discussed ways to interact and communicate with non-verbal hospice patients. At the time, I was not concerned about this, since I had experience interacting with non-verbal athletes through Special Olympics, and other volunteer experiences where I interacted with mentally disabled children and adults. I was also very interested to learn about aromatherapy, and other relaxation techniques recommended to interact with the hospice patients to help them find comfort and peace near the end of their lives.
However, on my first day of volunteering on my own, I found that interacting with the hospice patients was very different from the non-verbal Special Olympics athletes I was used to communicating with. Both of my patients had some degree of dementia, and were bedridden. Unlike the athletes, I could not communicate effectively through actions or movement, since these patients had to stay sitting or lying down. They also had little energy to respond or communicate back to me in any way, and were often sleeping or trying to sleep when I arrived. This was difficult for me, because I wasn’t sure if I should wake them to try and communicate, or if I should let them sleep. In the end, I decided to gently touch their hand to se if they responded, and greeted them. When they stirred, I was still unsure of how to interact since I could receive no feedback as to whether or not they were enjoying my company.
I decided to try playing music, since I played piano for 13 years and felt that it was something my hospice patients may enjoy as well. I played some of my favorite composers such as Chopin, Debussy, and Mozart. I would also read them stories that I enjoy, such as Bridge to Terabithia, and Huckleberry Finn. Although I did not receive very much feedback as to whether the patients were enjoying my presence, I liked to think I could feel their hand grow less tense as I held it, and as we were listening to music, or reading a story.
Overall, I immensely enjoyed doing my best to bring comfort to the patients I visited. Although it was definitely a challenging experience, it was very fulfilling. The reflection meetings were also an amazing resource, and I enjoyed hearing other’s stories, and being able to share some of my own. It was very interesting to be exposed to many different views on death and dying, and how people and their family members cope with it. I know this experience will make m a better physician in the future, and it has opened my eyes do many different views and thoughts about death and dying.
Emma A. (Princeton University)
As I walk into the small bedroom, I see a small, elderly woman reclining peacefully in her bed. Our eyes meet as I get closer, and hers gleam as if with recognition, though we’ve never met before. She is overjoyed that I, her presumed daughter, have come to see her in this temporary home. She tells me that she can’t wait to get home and back to work, that it will be any day now. Over and over, she repeats, “I’m so glad you’re here.”
This was how the first of my hospice visits began, and I myself am surprised by how vividly I remember it.
This one woman’s complete misconceptions about her condition and my identity, coupled with her very real gratitude, will be impossible to forget. As I have proceeded with my hospice visits, I have continued to be shocked by just how much my time and care can mean for a patient nearing the end of life. Making the effort to see someone, to show them that you care, to let them know that they matter and that they are loved – this is something that my volunteer experience has shown me is extremely powerful, and I know this knowledge will serve me both in my work as a physician and in my personal experiences in the years to come.
What’s more, though, this volunteer experience has helped me begin to develop the valuable skill of being able to talk about death. While it seemed to me at first that this would be no big deal, it quickly became evident that it can be, in fact, very, very difficult. Before joining this program, I had no substantial experience with death or the sort of grief it brings about. While I am very thankful for this, I now see that experience with death and the dying will be crucial for me if I am to become a good physician. Especially if I am to work with higher-risk patients, I must be able to talk about the end of life, even with the patients themselves. Thanks to my hospice visits and group reflection meetings, I have begun to feel myself growing accustomed to using and accepting this language, and I am grateful to have had the opportunity to begin to develop this skill. At the same time, however, I have come to realize that is rather illogical that never in the numerous years of medical training for physicians in the United States is hospice experience required. Death and grief, I now see, will be a very real part of a physician’s career, and dealing with these heavy topics is not something that should be glossed over.
At the same time, my volunteer experience has reminded me that dealing with death and grief is not something reserved for those with a medical degree. I am hardly twenty years old and am certainly nowhere near qualified to give medical care, yet when I hold a hospice patient’s hand, or listen to them tell me stories about their trip to Italy sixty years ago, or help them unwrap the sandwich that was brought up for lunch, I am providing true support. This comfort does not require a degree, and no certificate could make me more qualified to give it. As was mentioned during our very first volunteer meeting, the act of providing care for the dying has been around far longer than the word ‘hospice’ has. As a physician, a friend, a family member, a neighbor, and simply as a human being, this lesson will be one I would do well to remember. No matter what the circumstances, I now understand how powerful showing care and compassion can be. The next time I hear the remark, “I’m so glad you’re here,” I’ll know I’m doing something right.
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