Palliative. End of life. Dying. How do we care for patients at this stage of illness?
I’ve heard it said that knowledge is power, and that to be forewarned is to be forearmed. I still remember getting a text from my mother when I was on my OB/GYN rotation, during the first window of time I had gotten to use the bathroom all day. I remember her texting me a picture of a CT scan of my grandfather’s lungs with the words: “What does this mean?”
I spent the first week of my outpatient experience in internal medicine working with the nurses at Hospice of the Red River Valley in Fargo, ND. Besides being incredibly nervous to begin my third year of medical school, I was anxious about what I might encounter on my week at hospice.
In the playbook of professionalism, / Where is room for the physician who / Reads German poetry to the dying patient / For days and days until her end?
My alarm went off at 4 a.m. in the morning. I begrudgingly pulled myself out of bed, threw on some scrubs, and headed to the hospital. Not a car was on the road. It was the third week of my OB/GYN rotation, and I was on the infamous gynecologic oncology service.
I awoke to a phone ringing frantically, must have been a Whatsapp call. My father yelling from downstairs, “He passed.” And my mother, opening my bedroom door before my eyes had fully opened, stood there with her cellphone out, lips quivering, and eyes searching, “He’s gone.” My grandfather had passed away.
I found such peace in our stillness. / Your stomach rumblings almost music. / I caught myself peeking ever so often, / to find solace in your breathing.
He is not the first person to tell me that he’d rather be dead than alive. He is the first person to do so, so publicly. We sit side-by-side in orange, plastic chairs in a recessed, rectangular room awkwardly crammed in the middle of the unit. There is a nurse behind me taking the blood pressure of another man while he climbs stairs, part of the rehabilitation process for individuals receiving Ventricular Assist Devices in this hospital. Next to the nurses’ station stands a physical therapist, whom I’ve been tailing after like a cheerful retriever as part of our medical school’s homogenized introduction to hospital care.
In my third year of medical school, I was taking care of an elderly patient who had been in and out of the hospital multiple times in one month. Upon his third admission, my exasperated attending threw up his hands and said, “Who am I, Sisyphus?” I understood how he felt. Like the mythological Greek king rolling his boulder up the hill — only to have it roll back down again, ad infinitum — no matter what we did to manage this patient, he always returned to the hospital sicker than before.
The white coats and patient gowns that confer the implicit power dynamic of the physician-patient relationship are not to be found here in the operating room. This place has neither the tolerance nor the patience for this subtle symbolism. Here, on the other side of the Rubicon, the rules are stark, the stakes laid bare. The patient lies naked on the table, arms extended on boards, Christ-like, as the surgeon holds the knife handle and plays God.
A frail elderly gentleman was wheeled in on a stretcher and left alone. His paper-thin skin lay gently across his delicate frame like fine linens. His mouth lay agape. His slightly yellowed sclera framed the piercing gray eyes cast upward at the harsh fluorescent lighting. He didn’t blink. He didn’t cry for help. He awaited the inevitable on a stretcher in a hallway of a fully occupied emergency department. I was confused and scared at the apparent lack of treatment he was receiving. There was no crash cart prepared for him. He wasn’t attached to telemetry. He didn’t have a nasal cannula. He lay in bed alone — in waiting.
Everyone at the nursing station turned silent and looked at the nurse who had delivered the news. I looked at her in disbelief, my brain struggling through a fog of confusion and surprise. I squinted at my patient list trying to remember who was the patient in 1152. Recognition finally hit and I remembered the little old lady that we saw during rounds two hours ago.