I never quite imagined that I would have my first one-on-one end-of-life talk with a patient’s family during my very first month on the wards. After a few weeks, I had gotten used to patients mistakenly referring to me as “doctor”; I’d even given up on correcting them. What did it matter? To them, I was just another member of their medical team, and whether I had on a short or long white coat didn’t seem to mean anything as long as they got their questions answered in friendly fashion. But when the younger sister of one very elderly Mr. K took me aside immediately after I’d left the patient’s room, I was caught entirely off guard. I will never forget the next five words:
“How bad is it, doc?”
I froze, stunned. I had never considered that anyone would ask me, a lowly medical student, a question so critical. Family meetings were the sort of thing attending physicians were supposed to handle. I quickly developed a healthy respect for the power of the white coat.
“Has he got much time left?”
Still frozen. They don’t teach these skills in classes. Rather, they try, but it’s utterly futile, and everyone knows it.
I didn’t want to mess this up. This woman’s face was clearly on the verge of tears. Her concern etched her 86-year-old face deeper than time had ever been able to.
“Just tell me, doc. I can take it. I’ve had this sort of talk before with him multiple times now, and heck, we know we’re a long-living family. We’ve outlived all our friends, and now we’ve just got each other. Honestly, neither of us cares if we go tomorrow or years from now. We’re just waiting to die, and it’s up to God when it happens.”
I finally found my tongue. I began to explain what had brought Mr. K to the hospital: he had become very weak due to anemia and had a fall. Fortunately, there were no broken bones, but he needed a few units of blood transfused so that his body could sufficiently circulate oxygen and nutrients. It was likely that he was continuously losing some blood through his GI tract, since he had a several-month-long history of some blood in his stools, but he didn’t want a colonoscopy since he knew his time was coming anyway. I reassured the sister that after receiving blood, Mr. K was doing much better, and while he may still be bleeding internally, he was, for the time being, stable–we had done everything we could do for him given his wishes.
The sister slowly nodded her understanding, and the concern began to fade from her face…but it didn’t completely disappear. I got the feeling that my job wasn’t done. I asked what was on her mind. She looked back at me, and after a bit of hesitation, admitted that she didn’t actually know the specifics of how things would happen if her brother passed away. She’d made arrangements with a funeral home and knew to call them once her brother passed away, but didn’t know how she herself would be contacted when it happened, or who would do it.
I quickly pulled out my notes and took down her contact information, assuring her several times that I would place it prominently in my hospital note to ensure that she was informed immediately by future doctors if anything happened to Mr. K in the hospital.
I cannot express in words how gratifying it was to watch the look of relief wash over the sister’s face, and how happy I was to see her crack a smile as she shook my hand and said, “Thank you, doc. I really appreciate it.”
She turned around, entered Mr. K’s room, and sat down in the available chair; I heard them begin to chat about childhood memories. As I stood in the hallway looking in, I couldn’t help but think for a moment that all of the hell I’d endured for med school was worth it. I’d just been granted the privilege of trust. I’d just been the person who delivered a bit of peace and comfort. And despite not having “M.D.” after my name, I’d somehow managed to muddle my way through this one.
The most exhilarating part was that for once, what I said had mattered to someone other than myself. As the medical student on the team, it’s rare to feel that anything I say is important. I often feel like I’m just repeating things said by my residents/attending, and honestly, it has yet to actually affect patient care, so I have little stake in anything other than for the sake of my grade/evaluations, which I don’t really care a whole lot about (my philosophy is that I’m here to constantly learn, not just work for a number that “defines” me). But just this once–what I said and how I said it made a real difference.
I think moments like this are what prevent me from becoming jaded. I was talking with my upper-level resident the other day, and she was telling me how frustrating it can be to know that patients frequently have diseases that can’t be reversed. But no matter how grave the medical scenario, there are shining moments where you know you touched someone’s life for the better, and those make up for all the rest of the drudgery. It’s times like this that remind me that medicine is perhaps the field where balancing between science and art is not only conducive to success, but rather, critical.
One of the major influencing factors in me joining medicine was the prolonged illness and death of a close family member, and I still remember all too well how painful it was. I know how horrible it feels to lose someone, no matter how “prepared” you are. I left the hospital on this particular day with my head held just a bit higher, feeling that just maybe, I’d been able to put a bit of positive energy into a family’s medical care.