I arrived at my first visit with four of my classmates. Our shared nervousness provided a source of comfort as we walked toward the residence of our patients. This unspoken support was short lived, however, as our paths diverged to separate floors. I was excited; I had the opportunity to make a difference in someone’s day and witness palliative care, an approach to medicine foreign to me. I was also anxious; uncertainties surrounding the first visit filled my mind. Does my patient know I’m visiting? Is my patient going to be alone or in a group? Will my patient want to talk?
Thankfully, my unease was removed the moment I met Sarah. Without worrying who I was or why I was visiting, Sarah dove into conversation about her family and how proud she was of her grandsons. A continuous dialogue filled the entire visit as she asked about my interests and shared all of hers. My subsequent visits consisted of similar discussions, and Sarah and I began to learn about each other’s lives. Each encounter concluded with a shared disappointment in the brevity of our time and anticipation for the next week’s visit. Eventually, near my final visits, Sarah not only stated her pride for her grandchildren, but also her pride for me.
Sarah’s decline in health was painful. When I first met Sarah, she was receiving treatment for sores that had arisen due to immobility. These sores would persist, as well as eventual pains in her chest that made it difficult for her to communicate. I spent my last visits reading to her, as she had the lost the ability to read herself and her pain had become too prohibitive to speak.
However, the concerns Sarah shared with me were unrelated to her pain. Instead, Sarah resented her current location. She discussed wanting to be home, cooking for herself and her family as she had for the past 60 years. Additionally, Sarah was dismayed by the limitations her condition caused. She yearned to drive to see her sons, to get out of bed, to read scripture.
The nature of the worries Sarah vocalized is representative of a true struggle faced with death; the ability to accept that life is irreparably changed and the unavoidable process of death has begun. Sarah’s condition prohibited her from returning home, and there was little hope for the restoration of functionality once it had been removed. Nevertheless, Sarah fought against these realities and remained fixed in her belief that normal life would return. As a result, her decline in health coincided with a constant state of emotional distress.
The experience of visiting with Sarah and being with her as her health deteriorated has altered my perception of death. Before beginning the hospice program, I had never pondered the implications of death’s inevitability. I was aware of mortality, and believed that the promise of death required every effort to delay its arrival. I now see that death is simply a natural process. Furthermore, instead of fear, I believe death warrants preparation to combat the struggle that may arise from its finality.
Finally, this experience has shaped my approach to medicine. In accordance with my stance against death’s arrival, I previously imagined the ultimate purpose of medicine was to combat death. Through the pre-med hospice program, I have gained an appreciation for the importance of palliative care. There are still many circumstances were medicine can help prevent death. Nevertheless, when the process is meant to occur, the use of palliative care is not an admission of defeat, but rather an important implementation of medicine to allow a person to pass comfortably and with dignity.