I had not yet guided a ‘goals of care’ discussion. This is the discussion that entails understanding a patient’s wishes regarding end of life care, and it is often in the context of determining what advanced medical interventions the patient might want. That day, my short white coat felt shorter, like it was yelling out to everyone I encountered that I had no idea what I was doing.
His breaths are heavy when we walk in. / Abdomen distended: / a large, perfect half-sphere…
In retrospect, I regret that she was not allowed to die peacefully. I now am compassionate towards those who opt solely for palliative management in terminal illnesses.
Palliative. End of life. Dying. How do we care for patients at this stage of illness?
“What is the meaning of life?”
A perfectly reasonable question, albeit a strange one considering that I was in the third grade, it was recess time, and I was having a philosophical conversation about death with a grasshopper I had just caught.
The traditional structure of medical education begins with teaching normal anatomy and physiology followed by the various pathologies and treatments. Once students reach the clinical years, we are taught to think in the form of a SOAP note. First, perform a history and physical; then, order the necessary diagnostic tests to obtain your subjective and objective information. Next, form your assessment and plan — what is the problem, and how do you fix it?
To my dearest dying patient: / May I emulate half your strength, / and a portion of your wisdom, / just a part of your life’s length.