The nurse cracked open the door to say, “You have a visitor here to see you.” Abraham’s mother nodded, and the nurse turned to me in the hallway with words of permission to enter. I did so, hesitantly. The room was dimly lit by sunlight fighting its way through soggy clouds to shine on the window. The walls were covered with action heroes sprinting to save lives, while foil balloons hovering over the bed gave the room an odd birthday party atmosphere. Abraham’s mother rose from her chair next to the bed.
“As-salaamu-alaikum (may peace be upon you),” she said to me in Arabic.
“Wa-alaikum-as-salaam (and may peace be upon you),” I replied. “My name is Kamran, and I was asked by the imam to visit you and Abraham.”
Abraham was silent. He seemed to be awake and moving in his bed, but his eyes were closed.
“How is Abraham?” I asked, not knowing what to say next.
“He is not feeling well. You can come stand by his bed,” she said, sensing my uneasiness.
I walked over to Abraham and his mother. The chemotherapy had thinned Abraham’s hair until now I could see the bluish-green veins of his scalp. “As-salaamu-alaikum,” I said to Abraham in my most enthusiastic voice, but there was no response, only disorganized writhing movements of his arms and head, as if he was trapped in a bad dream.
“You have an awesome room, Abraham, way better than mine,” but the awkwardness continued. Abraham’s mother smiled meekly and told him again how someone liked his room, both of us hoping he would respond to her voice. The silence returned, unyielding to any attempts to bring a moment of cheer into the room.
Not knowing what to say next, I directed the discussion toward Abraham’s mother.
“How are you doing?”
“I am fine. I just want Abraham to feel better,” revealing the unwavering commitment that mothers have for their children. “I believe in miracles, and I know there is still hope.”
Though I knew that spirituality would come up, I was still stunned and humbled by her choice to share her hope for divine intervention with me. I did not know what to do except nod.
Like a well-programmed medical student, the thoughts that kept popping up in my mind were to ask about Abraham’s inputs and outputs, his level of pain, how he was sleeping, and other questions of objective health and well-being. Instead, after a long pause, I said, “I know this is a tough situation. I will pray for you and Abraham.”
“Thank you,” she said with a voice that sounded spent of all its energy. At that moment, the nurse opened the door to check on Abraham and to let me know that my visiting time had ended. I felt relieved and simultaneously guilty of my relief. While still not being able to think of anything profound or comforting to say, I mustered my most heartfelt smile and said goodbye to Abraham and his mother. I felt like a failure, wishing I could have done more.
After much reflection, I realized that when faced with end-of-life issues it is quite painless for medical students, such as I, to talk to patients from behind the wall of medical knowledge, never venturing out of one’s white coat fortress to form a personal connection with another suffering human being. Truly deep conversations near the end of life involve uniquely human concerns such as transcendence and faith.
Standing in Abraham’s room, I was finally hit by my lack of engagement in these types of discussions. I realized that the medicine I learned to empower my patients had now unintentionally become a barrier between us as human beings searching for purpose.
Although I wish I had been of more help to Abraham and his mother, the five minutes of their life that they allowed me to fumble into and the countless hours I reflected on them afterwards motivated me to think deeper about what it means to be a compassionate healer.
Some enlightenment that I can share from my journey is that the main driver of well-being for a patient at the end of his or her life is not physical comfort, which would have been my impression, but rather existential comfort. A study using the McGill Quality of Life Questionnaire showed that physical symptoms that are not overwhelming to the patient have a much weaker relationship with quality of life than existential well-being. The importance of addressing metaphysical concerns with patients should be impressed upon students. An article in “Academic Medicine” about the experience of medical students participating in a spirituality course showed students were concerned that addressing spiritual issues as part of the healing process would take away from their time to study “real medicine.” Abraham and his mother broadened my view of “real medicine” to include more than just physical signs and symptoms.
I discovered a few weeks later that Abraham had passed away. Though I knew it was going to happen, it did not decrease how much I continued to think about him and his mother. I imperiously thought when I walked into his room that I possessed some kind of profound human insight to offer him and his mother, but the unreserved authenticity of their struggle opened my eyes to a barrier I had created for myself by becoming unilaterally focused on the science of medicine. Though we are immersed in a growing body of scientific information that perpetually requires mastery, this same information, which we so aggressively pursue to attain competency as physicians, can come between us and our patients if we do not take moments to practice the humanity of medicine. We, as the physicians of today and the future, can transform into healers if we are willing to balance the science and humanity of the medicine we offer to our patients.