2022-2023 Hospice experience

Hospice Reflection
Date: 5/1/23
I remembered opening my email that weekend three weeks ago. As usual, I was looking whether the list of patients for today’s visit, assigned by my supervisor, had arrived. When I opened the inbox that contained the list, there was only one patient to visit, but it was a patient I knew and met a few weeks ago. It was a family who had an elderly father, who was in his 80s, who is now in Hospice after his fall a couple of days ago. I picked up my badge and went to the bus stop.
The patient, to protect them and their family’s privacy, will be named ‘Henry’. I met Henry’s family during my spring break physician shadowing experience. As I was on campus during that week, I figured it would be a good idea to get some physician shadowing experience. The perfect opportunity was shadowing at the hospital where I typically volunteer, Allegheny General Hospital (AGH). The physician I shadowed that day was Dr. Tom Miller: a palliative care physician.
Prior to my shadowing experience, I had numerous previous Hospice visits. In those times, while I did understand the importance and my purpose of volunteering, I wasn’t as fully immersed as I felt I should have been. At the time I didn’t feel confident in my skills to start conversations or have good interactions, as most of my visits felt a bit awkward and out of place. Most of the family conversations I had were really brief as I felt most just wanted to be left alone and I ended up abruptly leaving. This isn’t to say I didn’t have any good interactions, but rather, overall, I felt uncertain in my role. Shadowing Dr. Miller, during that break allowed me to redefine what it means to be a volunteer, and to a greater extent, what being a good Physician meant.
I went on rounds around the hospital floor with Dr. Miller, observed his day-to-day routine, and watched his every interaction with patients. I saw how in each of his patients’ visits, he carried such an empathetic and reflective approach to every one of his patients. Palliative care providers have the advantage of being able to spend a greater amount of time with their patients, learning who they are, their value, and their fears and desires. The visit with patient Henry’s family really highlighted this, as I was personally able to watch Dr. Miller’s interaction with this family. ‘Henry’ had a traumatic head injury after suddenly collapsing on the floor, and had to be sent to the ICU. His survival did not look to be good, as his condition only got worse. The family may have known this but held onto the hope he would make it through. Watching Dr. Miller’s interactions with the family, I saw how he first opened up to get to know his patient’s history and background. We learned what ‘Henry’ was like as a person, his job occupation, and their prior experiences with Hospice (which they had briefly experienced before, but overall no familiarity). I watched as Dr. Miller asked them what they knew about Henry’s condition, their fears and worries for the future, goals, and priorities, and whether were they willing to sacrifice (the type of questions Dr. Gawande asks families/patients in Being Mortal). Overall, what his family was willing to accept was whether or not he would still be conscious enough to play cards with them, and they didn’t want him to suffer just to keep him alive. Dr. Miller informed them of the grim outcome in an honest, yet empathetic approach. He gave them several options to make their decision and the necessary space to think it over. Although the circumstances were upsetting in the end, it gave them more clarity on what they should do next.
When I asked Dr. Miller for some tips I could use on how to become a better volunteer and overall, a better future provider, he recommended approaching each patient as if they have their own narrative/story. I’ve seen this aspect throughout my shadowing experience that day, as in each patient visit, he took his time to learn about his patient’s history, who they are, their family history, and events that happened in their life. Of course, each visit varies from patient to patient, but taking the time to get to know who they are and what they value, gives more insight than seeing a patient as their condition.

Basically, through my experience as a volunteer, a student, and a student shadowing, I learned how each and every person has lived their own stories, and how their stories help paint a picture of who they are, and where they believe they’re going. As a volunteer and future physician, it is important to help engage with each and every one of our patient’s stories, so as to learn who they are and help guide them to a better and more clear position. In my experience working with Hospice, I learned that death and mortality, while difficult to handle, are inevitable. But how we choose to die, and the circumstances of it, people can control. Hospice seeks to make the process as comfortable and consoling for the patients and families as possible. I learned, as a hospice volunteer, it is my role to engage with the narrative of each of my patients (and their families) and help bring any comfort and company they may need. Of course, some may not be fully willing to come out or can’t, and that’s okay, as sometimes being physically present is enough. But for those who are willing or have some willingness to do so, I learned how to better engage.
Meeting Henry’s family again was a really meaningful experience that day, as we continued from the conversation left off from Dr. Miller’s last meeting. We talked for nearly two hours, which at that point, was one of the longest times I’ve ever spent with a hospice patient at AGH. My future volunteer visits with individual patients later on became longer such as the time when I met a family who were distantly related, reuniting with each other to take care of their aunts. Getting involved in the Athena Institute Hospice program opened the doors to another side of patient care where comfort and company for the terminally ill have allowed me to become more well-rounded and articulate when it comes to the concept of death. I hope to volunteer further with this program, as long as possible, before I begin my application as a future medical health professional.