The patient I visited for the duration of the program was an easy-going, humble, and soft-spoken 92-year old woman with protein calorie malnutrition. Our visits early on included discussions of her owl collection, our shared love of skiing, and the weather outside that day. As I kept visiting, it seemed like our conversations became less frequent, and we would spend more time sitting in silence, or watching television instead. I expected that conversation would become more organic the more I visited her, but the opposite seemed to happen. Initially, I felt uncomfortable with the silence, and would try to fill the space with words. It was hard for me to not take it personally when she would not respond, or did not engage with me. However, rather than selfishly looking at this silence as a reflection of me “not trying hard enough,” this experience has taught me that being silent leaves space for the patient to feel comfortable, giving them an opportunity to speak knowing that someone is there listening. This aligns with a key theme in the Being Mortal film, which emphasizes the importance of listening to patients instead of only talking and trying to fix the situation. Many physicians feel uncomfortable discussing death, because the primary goal of medicine is to cure illness, not navigate end-of-life care. While it may be hard to grapple with as a physician, the film questions whether living longer should be considered the primary goal of care, as this may not account for the patient experience. Rather, emotional support and comfort for a patient may be more beneficial for a patient than treatments, and this should be seen as honoring the patient, rather than “giving up” as a physician. This idea coupled with my experience seeing how end-of-life care can improve the patient experience will serve me well as a future physician, by teaching me that the best patient care may not come from a pill or treatment, but from human interaction.
As someone who appreciates acknowledgement for things I have done, hospice work was a new experience for me because the effects are not always tangible. I have been challenged by the fact that my patient may not remember my visits. At first I felt as though this discredited my time with her, as if I had never even been there. I have wrestled with feeling selfish for wanting this gratification, but I have grown to realize that simply showing up for someone is one of the biggest gifts you can give a patient. Realizing that I am comfortable with this lack of acknowledgement has solidified my interest in healthcare, as I want to be a steady presence for patients with or without recognition. Additionally, knowing that I am improving my patient’s day for the present moment, even if my presence is not remembered long-term, has helped me appreciate my daily life more, and given me self-gratification.
Through the experience of volunteering with a hospice patient, in addition to the supplemental materials to facilitate end-of-life care discussions, I have gained the emotional maturity and compassion necessary to have difficult conversations. My participation in hospice care has also given me the opportunity to have direct patient contact, which has helped me get comfortable speaking to patients and healthcare professionals alike with a sense of confidence and respect that only comes from direct experience. Lastly, the experience has also helped me develop active-listening skills such that my first instinct is now to listen, rather than to try to fix the problem, which will be crucial to my success as a physician and patient advocate.